Eglseer Doris, Halfens Ruud J G, Lohrmann Christa
Medical University of Graz, Institute of Nursing Science, Graz, Austria.
Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands.
Nutrition. 2017 May;37:104-111. doi: 10.1016/j.nut.2016.12.016. Epub 2016 Dec 28.
The aims of this study were to evaluate the association between the use of clinical guidelines and the use of validated screening tools, evaluate the nutritional screening policy in hospitals, and examine the association between the use of validated screening tools and the prevalence of malnutrition and nutritional interventions in hospitalized patients.
This was a cross-sectional, multicenter study. Data were collected using a standardized questionnaire on three levels: institution (presence of a guideline for malnutrition), department (use of a validated screening tool), and patient (e.g., malnutrition prevalence).
In all, 53 hospitals with 5255 patients participated. About 45% of the hospitals indicated that they have guidelines for malnutrition. Of the departments surveyed, 38.6% used validated screening tools as part of a standard procedure. The nutritional status of 74.5% of the patients was screened during admission, mostly on the basis of clinical observation and patient weight. A validated screening tool was used for 21.2% of the patients. Significant differences between wards with and without validated screening tools were found with regard to malnutrition prevalence (P = 0.002) and the following interventions: referral to a dietitian (P < 0.001), provision of energy-enriched snacks (P = 0.038), adjustment of consistency (food/drinks; P = 0.004), monitoring of the nutritional intake (P = 0.001), and adjustment of the meal ambiance (P < 0.001).
Nutritional screening with validated tools in hospitalized patients remains poor. Generally, the nutritional status of patients is screened with unreliable parameters such as clinical observation and body mass index. The results of the present study suggest that the use of validated malnutrition screening tools is associated with better nutritional care and lower malnutrition prevalence rates in hospitalized patients.
本研究旨在评估临床指南的使用与经过验证的筛查工具的使用之间的关联，评估医院的营养筛查政策，并研究经过验证的筛查工具的使用与住院患者营养不良患病率及营养干预措施之间的关联。
这是一项横断面多中心研究。使用标准化问卷在三个层面收集数据：机构（是否存在营养不良指南）、科室（是否使用经过验证的筛查工具）和患者（如营养不良患病率）。
共有53家医院的5255名患者参与。约45%的医院表示他们有营养不良指南。在接受调查的科室中，38.6%将经过验证的筛查工具作为标准程序的一部分使用。74.5%的患者在入院时接受了营养状况筛查，主要基于临床观察和患者体重。21.2%的患者使用了经过验证的筛查工具。在使用和未使用经过验证的筛查工具的病房之间，在营养不良患病率（P = 0.002）以及以下干预措施方面存在显著差异：转诊至营养师（P < 0.001）、提供能量丰富的零食（P = 0.038）、调整食物/饮料的稠度（P = 0.004）、监测营养摄入（P = 0.001）以及调整用餐环境（P < 0.001）。
住院患者使用经过验证的工具进行营养筛查的情况仍然较差。一般来说，患者的营养状况是通过临床观察和体重指数等不可靠参数进行筛查的。本研究结果表明，使用经过验证的营养不良筛查工具与住院患者更好的营养护理和更低的营养不良患病率相关。
