Patel Vihas, Romano Michelle, Corkins Mark R, DiMaria-Ghalili Rose Ann, Earthman Carrie, Malone Ainsley, Miller Sarah, Sabino Kim, Wooley Jennifer, Guenter Peggi
Metabolic Support Service, Brigham and Women's Hospital, Boston, Massachusetts.
Mayo Clinic, Jacksonville, Florida.
Nutr Clin Pract. 2014 Aug;29(4):483-490. doi: 10.1177/0884533614535446. Epub 2014 Jul 2.
Background: The Joint Commission has mandated universal screening and assessment of hospitalized patients for malnutrition since 1995. Although various validated and nonvalidated tools are available, implementation of this mandate has not been well characterized. We report results of a survey of hospital-based professionals in the United States describing their perspective on the current range of nutrition screening and assessment practices as well as associated gaps in knowledge. Methods and Materials: Data from a 2012-2013 cross-sectional, web-based survey targeting members of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), the Academy of Medical-Surgical Nurses, and the Society of Hospital Medicine were collected with non-hospital-based members excluded. Descriptive statistical analysis was performed. Results: Survey data from 1777 unique email addresses are included in this report. A majority of respondents were dietitians, nearly half were A.S.P.E.N. members, and 69.4% reported caring for a mix of adult and pediatric patients. Most respondents answered affirmatively about nutrition screening being performed in alignment with The Joint Commission mandate, but only 50% were familiar with the 2012 Consensus Statement from the Academy of Nutrition and Dietetics/A.S.P.E.N. on adult malnutrition. In most cases, nurses were primarily responsible for nutrition screening, while dietitians had primary responsibility for assessment. No one specific assessment tool or International Classification of Diseases, Ninth Revision code was identified as being used a majority of the time in assessing or coding a patient for malnutrition. Conclusions: The survey findings affirmed compliance with accreditation standards in completing a nutrition screen within 24 hours of admission, and most hospitals appear to have a process to perform a nutrition assessment once a screen is completed. However, there is considerable heterogeneity in both use of tools and mechanisms for coding capture. Opportunities exist to improve education around nutrition screening and assessment and to identify ideal practices for these processes in hospitalized patients.
自1995年以来，联合委员会已强制要求对住院患者进行营养不良的普遍筛查和评估。尽管有各种经过验证和未经验证的工具可用，但这项规定的实施情况尚未得到很好的描述。我们报告了一项针对美国医院专业人员的调查结果，描述了他们对当前营养筛查和评估实践范围以及相关知识差距的看法。
收集了2012 - 2013年基于网络的横断面调查数据，该调查针对肠外肠内营养学会（A.S.P.E.N.）、内科外科护士学会和医院医学学会的成员，排除了非医院成员。进行了描述性统计分析。
本报告纳入了来自1777个唯一电子邮件地址的调查数据。大多数受访者是营养师，近一半是A.S.P.E.N.成员，69.4%的人报告照顾成人和儿科患者。大多数受访者对按照联合委员会的规定进行营养筛查给予肯定回答，但只有50%的人熟悉营养与饮食学会/A.S.P.E.N. 2012年关于成人营养不良的共识声明。在大多数情况下，护士主要负责营养筛查，而营养师主要负责评估。在评估或编码患者营养不良时，没有一种特定的评估工具或国际疾病分类第九版代码被确定为大多数时候使用。
调查结果证实了在入院24小时内完成营养筛查符合认证标准，并且大多数医院似乎有一个在完成筛查后进行营养评估的流程。然而，在工具使用和编码捕获机制方面存在相当大的异质性。存在改善营养筛查和评估教育以及确定住院患者这些流程理想做法的机会。
