Detection and management of hospital malnutrition: General guidelines versus “on the ward” sensitization.

Article Sidebar

Requires Subscription or Fee PDF (USD 25)
Published: Jun 25, 2012
DOI: https://doi.org/10.5750/ijpcm.v2i2.164
Keywords:
Malnutrition Nutritional care Nutritional education Continuous quality management Quality indicators

Main Article Content

Celine Michel
Mont-Godinne University Hospital Clinical Pharmacy Dr G. Therasse 1 5530 MONT-GODINNE BELGIUM
Anne Spinewine
Mont-Godinne University Hospital Clinical Pharmacy Dr G. Therasse 1 5530 MONT-GODINNE BELGIUM
Ariane Mouzon
Mont-Godinne University Hospital Clinical Pharmacy Dr G. Therasse 1 5530 MONT-GODINNE BELGIUM
Jean-Daniel hecq
Mont-Godinne University Hospital Pharmacy Department Dr G. Therasse 1 5530 MONT-GODINNE BELGIUM
Jacques Jamart
Mont-Godinne University Hospital Scientific Support Unit Dr G. Therasse 1 5530 MONT-GODINNE BELGIUM
Alain Dive
Mont-Godinne University Hospital Critical Care Unit Dr G. Therasse 1 5530 MONT-GODINNE BELGIUM
bruno krug
Mont-Godinne University Hospital Quality-Safety Officer Dr G. Therasse 1 5530 MONT-GODINNE BELGIUM

Abstract

Background 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. 

Article Details

Issue
Vol. 2 No. 2 (2012): June
Section
Regular Articles

References

Kubrak C and Jensen L.(2007) Malnutrition in acute care patients: a narrative review. Int J Nurs Stud, 44 (6), 1036-1054.

Lassen KO, Olsen J, Grinderslev E, Kruse F and Bjerrum M.(2006) Nutritional care of medical inpatients: a health technology assessment. BMC Health Serv Res, 6 7.

Vanderwee K, Clays E, Bocquaert I, Gobert M, Folens B and Defloor T Malnutrition and associated factors in elderly hospital patients: A Belgian cross-sectional, multi-centre study. Clin Nutr,

Naylor CJ, Griffiths RD and Fernandez RS.(2004) Does a multidisciplinary total parenteral nutrition team improve patient outcomes? A systematic review. JPEN J Parenter Enteral Nutr, 28 (4), 251-258.

Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ and Van Bokhorst-de van der Schueren MA.(2005) Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr, 82 (5), 1082-1089.

Bavelaar JW, Otter CD, van Bodegraven AA, Thijs A and van Bokhorst-de van der Schueren MA.(2008) Diagnosis and treatment of (disease-related) in-hospital malnutrition: the performance of medical and nursing staff. Clin Nutr, 27 (3), 431-438.

Rasmussen HH, Kondrup J, Staun M, Ladefoged K, Lindorff K, Jorgensen LM, Jakobsen J, Kristensen H and Wengler A.(2006) A method for implementation of nutritional therapy in hospitals. Clin Nutr, 25 (3), 515-523.

Shang E, Hasenberg T, Schlegel B, Sterchi AB, Schindler K, Druml W, Koletzko B and Meier R.(2005) An European survey of structure and organisation of nutrition support teams in Germany, Austria and Switzerland. Clin Nutr, 24 (6), 1005-1013.

Seres D, Sacks GS, Pedersen CA, Canada TW, Johnson D, Kumpf V, Guenter P, Petersen C and Mirtallo J.(2006) Parenteral nutrition safe practices: results of the 2003American Society for Parenteral and Enteral Nutrition survey. JPEN J Parenter Enteral Nutr, 30 (3), 259-265.

DiMaria-Ghalili RA, Bankhead R, Fisher AA, Kovacevich D, Resler R and Guenter PA.(2007) Standards of practice for nutrition support nurses. Nutr Clin Pract, 22 (4), 458-465.

Hearnshaw SA and Thompson NP.(2007) Use of parenteral nutrition in hospitals in the North of England. J Hum Nutr Diet, 20 (1), 14-23; quiz 24-16.

Meijers JM, Halfens RJ, van Bokhorst-de van der Schueren MA, Dassen T and Schols JM.(2009) Malnutrition in Dutch health care: prevalence, prevention, treatment, and quality indicators. Nutrition, 25 (5), 512-519.

Singh H, Watt K, Veitch R, Cantor M and Duerksen DR.(2006) Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the malnourished patient? Nutrition, 22 (4), 350-354.

Sriram K, Cyriac T and Fogg LF.(2009) Effect of nutritional support team restructuring on the use of parenteral nutrition. Nutrition,

Schneider PJ.(2006) Nutrition support teams: an evidence-based practice. Nutr Clin Pract, 21 (1), 62-67.

Kruizenga HM, Wierdsma NJ, van Bokhorst MA, de van der S, Haollander HJ, Jonkers-Schuitema CF, van der Heijden E, Melis GC and van Staveren WA.(2003) Screening of nutritional status in The Netherlands. Clin Nutr, 22 (2), 147-152.

Meijers JM, Schols JM, van Bokhorst-de van der Schueren MA, Dassen T, Janssen MA and Halfens RJ.(2009) Malnutrition prevalence in The Netherlands: results of the annual dutch national prevalence measurement of care problems. Br J Nutr, 101 (3), 417-423.