Frank Madeleine, Sivagnanaratnam Aravinth, Bernstein Jo
West Hertfordshire Hospitals NHS Trust.
BMJ Qual Improv Rep. 2015 Jan 22;4(1). doi: 10.1136/bmjquality.u204810.w2031. eCollection 2015.
Malnutrition affects over three million people in the UK with associated health costs exceeding £13 billion annually.[1] In hospital, malnutrition has been shown to increase complication rates, morbidity, mortality, hospital readmissions, and length of hospital stay.[2] To screen for malnutrition, a reliable and validated screening tool such as the malnutrition universal screening tool (MUST) should be used.[3] We believe that improved patient outcomes and significant savings to the trust can be achieved, not only by ensuring that every patient has a MUST score documented, but that it is calculated correctly and the appropriate interventions are implemented. We have carried out the audit three times (May, July, and November 2013). The study included the patients on the elderly care ward of Watford General Hospital (n=64, 62, and 63 respectively). MUST scores documented in nursing notes for each patient were noted. We re-calculated each MUST score ourselves for comparison. We went through patient notes and nursing information and noted which recommended nutritional interventions were being implemented. Our results highlighted several issues: 1) Patients did not consistently have a MUST score documented 2) MUST scores were calculated incorrectly. This was generally due to BMIs calculated incorrectly, and patients' weights from six months ago not being known 3) High MUST scores not being acted on appropriately. Our interventions have involved liaising with various teams within the hospital to maximise the efficacy of the MUST score. This has included encouraging the trust to provide regular training to nurses because of high nursing staff turnover. Following our audit, the dietitian department agreed to undertake weekly ward rounds to screen for patients at risk of malnutrition. Our interventions so far have resulted in increased proportion of MUST scores being calculated (73 to 97%), and increased rates of patients being referred to dietitians (62 to 86% in the second audit cycle).
在英国，营养不良影响着超过300万人，每年相关的健康成本超过130亿英镑。[1] 在医院中，营养不良已被证明会增加并发症发生率、发病率、死亡率、再次入院率以及住院时间。[2] 为了筛查营养不良，应使用可靠且经过验证的筛查工具，如营养不良通用筛查工具（MUST）。[3] 我们认为，不仅要确保每位患者都有记录在案的MUST评分，而且要正确计算该评分并实施适当的干预措施，这样才能改善患者的治疗效果，并为医疗信托机构节省大量资金。我们进行了三次审计（2013年5月、7月和11月）。该研究纳入了沃特福德总医院老年护理病房的患者（分别为64例、62例和63例）。记录了每位患者护理记录中的MUST评分。我们自己重新计算了每个MUST评分以作比较。我们查阅了患者病历和护理信息，并记录了正在实施哪些推荐的营养干预措施。我们的结果突出了几个问题：1）并非所有患者都始终有记录在案的MUST评分；2）MUST评分计算错误。这通常是由于体重指数（BMI）计算错误，以及不知道患者六个月前的体重；3）高MUST评分未得到适当处理。我们的干预措施包括与医院内的各个团队联络，以最大限度地提高MUST评分的效用。这包括由于护理人员流动率高，鼓励医疗信托机构为护士提供定期培训。在我们的审计之后，营养师部门同意每周进行病房巡查，以筛查有营养不良风险的患者。我们目前的干预措施已使计算出的MUST评分比例有所增加（从73%提高到97%），并使转介给营养师的患者比例有所增加（在第二个审计周期中从62%提高到86%）。
