Kavli Research Centre for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway.
Eur J Clin Nutr. 2012 Mar;66(3):388-93. doi: 10.1038/ejcn.2011.149. Epub 2011 Aug 24.
BACKGROUND/OBJECTIVES: Malnutrition is present in 20-50% of hospitalized patients, and nutritional care is a challenge. The aim was to evaluate whether the implementation of a nutritional strategy would influence nutritional care performance in a university hospital.
SUBJECTS/METHODS: This was a prospective quality improvement program implementing guidelines for nutritional care, with the aim of improving nutritional practice. The Nutrition Risk Screening (NRS) 2002 was used. Point prevalence surveys over 2 years to determine whether nutritional practice had improved.
In total, 3604 (70%) of 5183 eligible patients were screened and 1230 (34%) were at nutritional risk. Only 53% of the at-risk patients got nutritional treatment and 5% were seen by a dietician. The proportion of patients screened increased from the first to the eighth point prevalence survey (P=0.012), but not the proportion of patients treated (P=0.66). The four initial screening questions in NRS 2002 identified 92% of the patients not at nutritional risk.
Implementation of nutritional guidelines improved the screening performance, but did not increase the proportion of patients who received nutritional treatment. Point prevalence surveys were useful to evaluate nutritional practice in this university hospital. In order to improve practice, we suggest using only the four initial screening questions in NRS 2002 to identify patients not at risk, better education in nutritional care for physicians and nurses, and more dieticians employed. Audit of implementation of guidelines, performed by health authorities, and specific reimbursement for managing nutrition may also improve practice.
背景/目的：营养不良存在于 20-50%的住院患者中，营养护理是一项挑战。目的是评估在一所大学医院实施营养策略是否会影响营养护理的效果。
对象/方法：这是一项前瞻性质量改进计划，实施营养护理指南，旨在改善营养实践。使用营养风险筛查（NRS）2002。在两年内进行点患病率调查，以确定营养实践是否有所改善。
共有 5183 名符合条件的患者中，有 3604 名（70%）接受了筛查，有 1230 名（34%）存在营养风险。仅有 53%的有风险患者接受了营养治疗，仅有 5%的患者接受了营养师的诊治。从第一次到第八次点患病率调查，筛查患者的比例有所增加（P=0.012），但接受治疗的患者比例没有增加（P=0.66）。NRS 2002 的前四个初始筛查问题识别出了 92%没有营养风险的患者。
实施营养指南提高了筛查的效果，但并没有增加接受营养治疗的患者比例。点患病率调查有助于评估这所大学医院的营养实践。为了改善实践，我们建议仅使用 NRS 2002 的前四个初始筛查问题来识别没有风险的患者，加强医生和护士的营养护理教育，并增加营养师的数量。卫生当局对指南实施情况的审核以及对营养管理的专项报销也可能改善实践。
