Multi-site implementation of nutrition screening and diagnosis in medical care units: Success of the More-2-Eat project

被引：24

作者：

Keller, Heather H. ^{[1
,2
]}

Valaitis, Renata ^{[1
]}

Laur, Celia V. ^{[1
,4
]}

McNicholl, Tara ^{[1
]}

Xu, Yingying ^{[1
]}

Dubin, Joel A. ^{[1
]}

Curtis, Lori ^{[1
]}

Obiorah, Suzanne ^{[3
]}

Ray, Sumantra ^{[4
]}

Bernier, Paule ^{[5
]}

Gramlich, Leah ^{[6
]}

Stickles-White, Marilee ^{[7
]}

Laporte, Manon ^{[8
]}

Bell, Jack ^{[9
,10
]}

机构：

[1] Univ Waterloo, 200 Univ Ave W, Waterloo, ON N2L 3G1, Canada

[2] Univ Waterloo, Schlegel Univ Waterloo Res Inst Aging, Waterloo, ON, Canada

[3] Ottawa Hosp, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada

[4] St Johns Innovat Ctr, NNEdPro Global Ctr Nutr & Hlth, Cowley Rd, Cambridge CB4 0WS, England

[5] Ordre Profess Dietetistes Quebec, Montreal, PQ, Canada

[6] Univ Alberta, Royal Alexandra Hosp, Dept Med & Dent, Edmonton, AB, Canada

[7] Niagara Hlth, Clin Nutr Serv, St Catharines, ON L2S 0A9, Canada

[8] Campbellton Reg Hosp, Reseau Sante Vital Hlth Network, New Brunswick, NJ USA

[9] Univ Queensland, Sch Human Movement & Nutr Sci, Rode Rd, Chermside, Qld 4032, Australia

[10] Prince Charles Hosp, Rode Rd, Chermside, Qld 4032, Australia

来源：

CLINICAL NUTRITION | 2019年 / 38卷 / 02期

关键词：

Malnutrition; Screening; Assessment; Hospital; Implementation; HOSPITAL MALNUTRITION; FOOD; TOOL; UNDERNUTRITION; INTERVENTION; GUIDELINES; STAY;

D O I：

10.1016/j.clnu.2018.02.009

中图分类号：

R15 [营养卫生、食品卫生]; TS201 [基础科学];

学科分类号：

100403 ;

摘要：

Background: Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. Aim: To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition. Methods: Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2-5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify nutrition care practices implemented with a variety of strategies and behaviour change techniques. Results: All sites increased nutrition screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive nutritional assessment. In Period 1, the nutrition diagnosis and documentation by the dietitian of 'malnutrition' was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6. Conclusion: The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing the risk of missing malnourished patients. Trial registration: Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

引用

页码：897 / 905

页数：9