program, one challenge is integrating the screening into the workflow.
Start by identifying who will be part of the nutrition screening
process. In most outpatient facilities, this will require a strong rela-
tionship with your surgeons and their offices. Share the checklist with
your surgeons and tell them how you want patients screened for
nutrition, but make sure you're being fair with what you're asking. If
your surgeons are seeing 30 patients a day, and you're asking them to
come up with an intervention that adds 5 minutes per patient, right
there you've already failed because it will take away too much time.
Maybe a nurse educator can do the screening instead of the physician?
Can the patient be screened during a pre-op phone call?
2. Find a nutritional expert to partner with. If your facility has
worked with one in the past, it may be a matter of reestablishing that
relationship. Or, you may have no idea who your healthcare network's
dietitian is, or you might not have one at all. If you don't have a dieti-
tian on hand, look to the local community to identify the resources
and establish a partnership before implementing the nutrition screen-
ing. As a facility leader, you should know the local healthcare commu-
nity and can identify potential partners.
3. Focus on one initiative at a time. To be successful, you don't
want another initiative happening at the same time — if your focus is
nutrition, you don't want staff to also be worrying about a recent
acquisition or EMR rollout.
4. Have experience with QI efforts. If your facility regularly holds qual-
ity improvement efforts, such as hand hygiene or infection prevention
campaigns, your staff are likely already open to change and you have the
infrastructure in place to form a multidisciplinary team to look at nutri-
tion screening and treatment.
5. Activate the power of one. For those resistant to change, look to
the power of one. Who will be the champion — the one surgeon, the
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