Detection and management of hospital malnutrition: General guidelines versus “on the ward” sensitization.
Keywords:Malnutrition, Nutritional care, Nutritional education, Continuous quality management, Quality indicators
AbstractBackground and aims This study aims to evaluate impact of a clinical pharmacist on detection and management of malnutrition in hospitalised patients Methods A cluster-randomized controlled study. Six care units were randomised into two groups, each including one medical, one surgical and one mixed unit. In the intervention group a clinical pharmacist worked with other health care professionals to improve the screening and management of malnutrition. Predefined quality indicators were collected during a baseline period (two months) and an experimental period (6 months). The pharmacist was unaware of them. Results The percentage of patients with a complete malnutrition screening was significantly higher in the intervention group (48.2% versus 27.0%). The percentage of patient with enteral nutrition prescribed did not differ, but there were significantly more prescriptions for parenteral nutrition in the intervention group (17.4 vs 6.6%). During parenteral nutrition, triglycerides, glycemia and extended serum electrolytes were significantly more frequently measured in intervention group. Conclusions Moving from a passive to a more active approach contributed to better sensitization of the hospital front professionals resulting in a better screening at admission within the 72 hours and the higher number of admitting weight and heights. Parenteral nutrition was more frequently prescribed, which may question the appropriateness of the route of artificial nutrition. The biochemical monitoring remained suboptimal.
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