Implementing the Global Leadership Initiative on Malnutrition framework for diagnosing malnutrition by registered dietitians: A quality improvement project

Malnutrition presents a significant burden to healthcare organizations, and worsens clinical outcomes. Despite this, the frequency of malnutrition diagnosis remains far below known prevalence. Multiple validated frameworks for diagnosing malnutrition exist, the most recent being the Global Leadership Initiative on Malnutrition (GLIM). The purpose of this article is to describe the implementation of the GLIM framework using a multi-disciplinary co-documentation process at one institution. Preimplementation analyses were conducted demonstrating wide discrepancy in frequency and severity of malnutrition diagnoses made by registered dietitian nutritionists (RDNs) and licensed independent practitioners in a one month period with minimal overlap. This was associated with coding capture in the lowest quartile compared with like organizations. Institutional support was obtained for a co-documentation process to include all required elements identified by the coding team. Nutrition leadership reviewed malnutrition frameworks and identified that transition to GLIM would streamline diagnosis in many cases. Education of RDNs focused on interprofessional collaboration and transition to the new framework. Post-implementation, monthly monitoring of co-signature rates on malnutrition notes improved from 72% initially to 90% one year after implementation. Coding capture of malnutrition diagnoses doubled from 4.8% of admissions in January of 2020 to 10% of admissions in mid 2021, increasing institutional performance to the median compared with like organizations. This has been sustained for over 5 years, as demonstrated by 2025 data, and denials remain low. Implementation of GLIM was well accepted by practicing RDNs and supported a collaborative process that improved multi-professional malnutrition documentation.