Malnutrition Assessment

• Seeking national stakeholder and expert opinion on recommended malnutrition assessment tools so that assessment findings support diagnosis
• Working with other MCANZ workstreams to ensure recommendations align across the wider programme and support a nationally consistent malnutrition care pathway.
• Participating in a Delphi consensus process to refine and finalise nationally agreed assessment and diagnostic recommendations.
• Considering implementation requirements, including workforce training, time and resource implications, cultural responsiveness and integration into clinical practice
• Working with the Diagnosis and Coding Workstream to ensure assessment findings provide the evidence needed to support consistent diagnosis, documentation and coding.

If implemented, the workstream's recommendations are intended to:

• Enable consistent, evidence-based assessment and diagnosis of malnutrition across healthcare settings.
• Improve early and consistent identification of people experiencing malnutrition.
• Enable timely nutrition intervention through a standardised assessment pathway.
• Reduce variation in clinical practice and support more equitable access to nutrition care.
• Strengthen national data, research and quality improvement through consistent assessment approaches.
• Support the development of culturally responsive assessment approaches for Māori, Pacific peoples and other diverse populations.

• Reviewing how malnutrition assessment is undertaken and how assessment findings are used to determine if malnutrition is present in healthcare settings across Aotearoa New Zealand.
• Reviewing validated malnutrition assessment tools for use across adult healthcare settings in Aotearoa New Zealand.
• Considering cultural responsiveness, equity and applicability across diverse populations, including Māori and Pacific peoples and identifying areas that require further validation and research.
• Defining the minimum components of a malnutrition assessment, including the clinical information and indicators needed to determine nutrition status and support diagnosis.
• Considering how validated assessment tools, clinical judgement and specialist approaches are used to determine if malnutrition is present.
• Working with the Diagnosis and Coding Workstream to support consistent documentation and coding of a resulting malnutrition diagnosis.

• Developing a new malnutrition assessment tool.
• Developing detailed treatment or intervention guidelines for malnutrition.
• Determining workforce staffing levels or funding allocations.
• Selecting electronic health record systems or digital solutions.
• Managing local service delivery models or operational processes.
• Replacing professional clinical judgement or discipline-specific scopes of practice.
• Developing standards for nutrition screening tools unless directly linked to diagnostic pathways.

Recent progress includes:

• Completed an updated literature review of validated malnutrition assessment tools and approaches.
• Developed preliminary recommendations for nationally consistent malnutrition assessment and how assessment findings support diagnosis in Aotearoa New Zealand.
• Translated proposed recommendations into Delphi consensus statements to support stakeholder consultation
• Identified areas requiring further consideration, including cultural responsiveness, clinical judgement in specialist settings, and future validation of assessment approaches for Māori and Pacific peoples.

Based on an evidence review, the workstream has developed preliminary recommendations for nationally consistent malnutrition assessment and how assessment findings support the diagnosis of malnutrition in Aotearoa New Zealand. These recommendations are currently progressing through stakeholder consultation and a Delphi consensus process.

Current recommendations include:

• Recognition of the Subjective Global Assessment (SGA) and/or Patient-Generated Subjective Global Assessment (PG-SGA) as established malnutrition assessment tools that may be appropriate for many adult populations and healthcare settings
• Recognition of the full Mini Nutrition Assessment (MNA) as an established validated assessment option for older adults.
• Recognition of the role of clinical judgement where assessment findings may be affected by complex clinical conditions.
• Flexibility for specialist clinical areas to use alternative validated assessment approaches where clinically appropriate.
• Prioritisation of further research into the cultural validity and equity implications of malnutrition assessment and diagnostic approaches for Māori and Pacific peoples.

The MCANZ workstreams are guided by a Steering Group, which provides strategic oversight and helps ensure the work reflects clinical, community and health system needs across Aotearoa New Zealand.

Workstream Leads

• Bex Baskett, Professional Lead Dietitian, Bay of Plenty
• Erica Smart, Senior Clinical Dietitian, Waitematā

Members

• Richard Swift, Advanced Clinician, Waitematā
• Shayal Chand, Doctoral Candidate, Waipapa Taumata Rau
• Krystal Hika, Renal Dietitian, Ngāpuhi, Ngāti Porou, Te Tai Tokerau
• Sarah Duncan, Renal Dietitian, Te Toka Tumai