Annetta M G, Pittiruti M, De Rosa S, Franchi P, Pintaudi G, Caricato A, Antonelli M
Department of Emergency and Intensive Care, Catholic University Hospital "A.Gemelli", Rome, Italy -
Minerva Anestesiol. 2015 Nov;81(11):1210-8. Epub 2014 Nov 6.
A proper strategy for fighting hospital malnutrition should include nutritional screening of all hospitalized patients, adequate utilization of the Hospital facilities - such as Clinical Nutrition Services or Nutrition Teams - and an adequate algorithm for the adoption of proper nutrition support (oral, enteral or parenteral) with proper timing. The main aim of the present study was to investigate the current policies of different non-intensive wards of our institution (a 1100 beds University Hospital) in terms of prevention of hospital malnutrition.
We conducted a one-day survey to verify the current policies of nutritional screening and the indication to nutritional support in adult patients, interviewing nurses and physicians of our non-intensive hospital wards.
A total of 29 wards were considered, which sum up to 755 hospitalized patients. We found that nutritional screening at admission is routinely assessed only in 41% of wards and that oral nutrient intake is controlled regularly only in 72%. Indication to clinical nutrition support and specifically to artificial nutrition is not consistent with the current international guidelines. Only 14% of patients were receiving artificial nutrition at the moment of the survey and the majority of them were given parenteral nutrition rather than enteral feeding.
Our survey confirmed that in large hospitals the main barriers to the fight against hospital malnutrition are the lack of knowledge and/or commitment by nurses and physicians as well as the lack of well-defined hospital policies on early nutritional screening, surveillance of nutritional status and indication to nutrition support.
应对医院营养不良的恰当策略应包括对所有住院患者进行营养筛查,充分利用医院设施,如临床营养服务或营养团队,以及采用适当的算法在合适的时间给予恰当的营养支持(口服、肠内或肠外)。本研究的主要目的是调查我们机构(一家拥有1100张床位的大学医院)不同非重症病房在预防医院营养不良方面的现行政策。
我们进行了为期一天的调查,以核实成人患者营养筛查的现行政策和营养支持的指征,采访了我们医院非重症病房的护士和医生。
共纳入29个病房,总计755名住院患者。我们发现,仅41%的病房常规评估入院时的营养筛查,仅72%的病房定期控制口服营养摄入。临床营养支持尤其是人工营养的指征与当前国际指南不一致。在调查时,只有14%的患者接受人工营养,其中大多数接受的是肠外营养而非肠内营养。
我们的调查证实,在大型医院中,应对医院营养不良的主要障碍是护士和医生缺乏知识和/或积极性,以及缺乏关于早期营养筛查、营养状况监测和营养支持指征的明确医院政策。