Purpose
Subjective global assessment (SGA) is the gold standard for diagnosing malnutrition. In October 2017, SGA was implemented as a routine part of dietitian assessments in acute care at Providence Health Care (PHC).  Implementation and use of SGA ensures consistent identification and diagnosis of malnutrition by PHC dietitians.  

Systematic Approach
A knowledge translation approach was used.  Knowledge, skill and environmental barriers were assessed and addressed through pre-training readings, a group workshop, hands-on training with a dietitian experienced in SGA and modification of nutrition assessment forms.  Peer champions were used to train dietetics students and additional staff.  Regular group experience sharing and discussions were used to further facilitate uptake and address unforeseen challenges.  Evaluation of use was completed pre and post training, nine and twelve months after implementation using surveys and chart audits.

Summary
Forty-one dietitians participated in an SGA workshop with 21 receiving additional hands on-on training.  Prior to the workshop, 75% of dietitians surveyed indicated they were “somewhat knowledgeable” or “knowledgeable” about SGA but only 8% were routinely using SGA in their practice.  After hands-on training, 100% of dietitians surveyed indicated they were “somewhat knowledgeable” or “knowledgeable” about SGA and were “somewhat likely” or “likely” to incorporate SGA into their practice.  One year after implementation, chart audits showed that dietitians in acute care were using SGA in 63% of the time.

Conclusions
One year after implementation, use of SGA is a more routine part of dietitian practice at PHC. 
Recommendations
Knowledge, skill and environmental barriers must be identified and addressed for SGA to be successfully incorporated into practice.  Peer champions can help with ongoing training needs. It is important to ensure a consistent approach is used through regular group experience sharing and discussion.  

Significance to the field of dietetics
Our learnings will be of benefit to those organizations that are in the earlier stages of SGA implementation.

Implementing Subjective Global Assessment as a Routine Part of Dietitian Nutrition Assessments in a Multi-Site Health Care Organization