I have previously discussed the fact that my electronic health record (EHR) incorporated the Nestle Mini Nutritional Assessment (MNA) so that it only takes me a few seconds to do a proper nutritional screen and it can be done while I’m in the room with the patient.
The MNA gives me a score from 0-14, which represents either a normal nutritional status (12-14 points), a patient who is at risk for malnutrition (8-11 points), or a patient who is likely malnourished (0-7 points). You would be amazed at how often patients with chronic wounds get a score between 0 and 7!
It’s all very well and good to get a score, but what am I supposed to DO with that number? Clinical guidelines say that I need to consult a registered dietician, and I agree! The problem is that I’m in a busy outpatient department and most of these patients do not have diabetes, so insurance doesn’t cover the cost of seeing a dietician. In an imperfect world, how can I use the MNA score to make some reasonable recommendation for these patients?
I asked for help from Nestle and they gave it to me! They said that I could share the algorithm we came up with, which is evidence-based. So, I’ve provided it. Above is the Oral Supplement Selection Guide for Partial and Full Thickness Wounds. This is part of my “secret sauce” in caring for patients with chronic non-healing wounds and ulcers.
I actually recommend Arginaid for all patients with non-healing wounds, regardless of their MNA score. I use the MNA score to decide whether they are also recommended to take IMPACT Advanced Recovery or Novasource Renal (if they are on dialysis).
Yes, I know this algorithm is simple. In fact, I call it my “simple girl” guide to oral nutritional supplementation (ONS). I also counsel patients on how to improve their diet (yes, I take time to ask them what they typically eat at breakfast, lunch and dinner) and I check their Vitamin D-OH level.
This approach may not be fancy, but it’s helping to get wounds healed. It’s also easy for me to do, it’s fast, and it’s evidence-based. This is how I use the MNA score to create reasonable recommendations for oral nutritional supplementation.
Additional Resources:
- More information on the CMS-approved quality measure on nutritional assessment of patients with wounds
- Here are my previous articles on this project
- A discussion of Vitamin D in wound healing
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
