Background: The impact of malnutrition on pediatric patients in the acute care setting is significant. Hospitalized patients with malnutrition have been shown to have poor clinical outcomes. Nutrition screening is the first critical step in identifying and treating malnutrition. Although several pediatric nutrition screening tools exist, none incorporate both electronic health record (EHR) compatibility and the recommended indicators of pediatric malnutrition, a gap recently identified in a systematic review by the Academy of Nutrition and Dietetics. The aim of this study was to prove the validity of a new version of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), EHR-STAMP, modified for incorporation into the EHR and inclusion of updated pediatric malnutrition indicators. Methods: An interprofessional team modified the existing STAMP for integration into the EHR. Audits were performed by the research dietitian to assess accuracy and provide feedback for continuous improvement of the tool design. Results: A total of 3553 pediatric inpatients were studied from August 2017 to May 2019. Accuracy, sensitivity, and specificity improved with each modification to the EHR-STAMP. The final version of the EHR-STAMP found 85% accuracy, 89% sensitivity, and 97% specificity, with a positive predictive value of 60% and a negative predictive value of 94%. Conclusion: The EHR-STAMP is a highly reliable tool in the screening of nutrition risk for pediatric hospitalized patients. The tool is easy to use, EHR compatible, and incorporates the current indicators recommended for assessing pediatric malnutrition.

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Background: Diabetes is a known risk factor for stroke. We sought to assess the reduction of secondary complications of diabetes in stroke patients through an education initiative. We identified prediabetic pts as a group not receiving any instruction in glucose control to prevent diabetes. Methods: At our private, community health center, we introduced a pilot education program for all ischemic stroke and transient ischemic attack patients from March to July 2011. Patients were included if they tolerated oral diet and were placed on the stroke protocol at our center. Patients were identified by a certified dietician and divided into two groups: HbA1c ≤ 6.4% and HbA1c > 6.4%. Patients with an HbA1c of 5.8 -6.4% (prediabetics) were placed on a calorie controlled diet and received diet and activity education from the dietician. Meters were available for them to take home if they desired. Patients with an HbA1c greater than 6.4% received diet and activity education, and also met with the diabetes nurse educator for more in depth education on controlling their diabetes. Our endpoint was to increase the number of patients receiving diabetic education. Results: The program saw 214 patients, and education was provided to 81 prediabetics and 51 diabetics. In the first 4 months of the pilot program, 76% of prediabetics and 71% of diabetics received education. Limitations to education included pts not on stroke protocol so HbA1c was not ordered, difficulty getting orders for calorie controlled diet, and difficulty placing order for Diabetes Educator. By month 5 only 1 pt did not receive education and 5 had not had HbA1c drawn to assess need for education. Conclusion: Education of glucose control strategies for prediabetic and diabetic stroke pts has been effectively initiated. The large population of prediabetic pts has received education to begin to reduce their risk of developing diabetes in the next 3-5 years. Patient feedback has been entirely positive at this time. Future evaluation to determine if pts with prediabetes were able to delay onset of diabetes and reduce development of future stroke would be beneficial.