遵守医院营养状况监测和报告指南。
Adherence to hospital nutritional status monitoring and reporting guidelines.
机构信息
Institute of Social and Preventive Medicine (IUMSP), Lausanne, Switzerland.
Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
出版信息
PLoS One. 2018 Sep 21;13(9):e0204000. doi: 10.1371/journal.pone.0204000. eCollection 2018.
AIMS OF THE STUDY
Despite the widespread existence of guidelines regarding undernutrition monitoring and reporting, there is scarce information whether they are followed. We aimed to evaluate the adherence to guidelines regarding undernutrition monitoring and reporting as well as their determinants in a university hospital.
METHODS
Retrospective analysis of discharged patients with data on Nutritional Risk Screening score (NRS-2002) from the department of internal medicine of the Lausanne University Hospital for years 2013-14. Adherence to the hospital monitoring guidelines, i.e.: 1) discharged patients with NRS-2002 score≥3 should have prealbumin levels measured, and 2) discharged patients with prealbumin levels<0.20 g/l should be rechecked 7 days afterwards, was assessed. Reporting of nutritionally 'at-risk' status in the discharge letter was also assessed. Multivariable logistic regression was used to examine potential determinants of adherence to guidelines.
RESULTS
Of the 2,539 discharged patients with NRS-2002 data, 1,605 (63.0%) were nutritionally 'at-risk'. Complete adherence to the monitoring guideline was observed in 238 (14.8%) of 'at-risk' patients. After multivariable analysis, adherence to the first step of monitoring guideline was associated with older age (≥ 80 years) [OR (95% CI): 2.03 (1.29-3.18)], high comorbidity index [1.36 (1.05-1.77)], and nutritional management [5.57 (4.38-7.07)]. Nutritional management was also associated with adherence to the second step of monitoring [3.98 (2.33-6.78)]. Adherence to the reporting guideline was observed in 343 (21.4%) of 'at-risk' patients. Multivariable analysis showed that adherence to the reporting guideline was associated with NRS-2002 score>4 [1.97 (1.47-2.64)], nutritional management [3.80 (2.85-5.07)], and adherence to the monitoring guideline [3.33 (2.35-4.71)].
CONCLUSIONS
Our results show a poor adherence to guidelines regarding undernutrition monitoring and reporting, possibly due to lack of training, staff, and time.
研究目的
尽管存在广泛的关于营养不良监测和报告的指南，但关于这些指南是否得到遵循的信息却很少。我们旨在评估在一所大学医院中，对营养不良监测和报告指南的遵循情况及其决定因素。
方法
回顾性分析 2013-2014 年洛桑大学医院内科出院患者的营养风险筛查评分（NRS-2002）数据。评估对医院监测指南的遵循情况，即：1）NRS-2002 评分≥3 的出院患者应测量前白蛋白水平，以及 2）前白蛋白水平<0.20g/l 的出院患者应在 7 天后复查。还评估了出院信中营养“风险”状态的报告情况。使用多变量逻辑回归检查了遵循指南的潜在决定因素。
结果
在 2539 名具有 NRS-2002 数据的出院患者中，有 1605 名（63.0%）处于营养“风险”状态。在 238 名（14.8%）“风险”患者中，完全遵循了监测指南。经过多变量分析，对监测指南第一步的遵循与年龄较大（≥80 岁）[比值比（95%置信区间）：2.03（1.29-3.18）]、高合并症指数[1.36（1.05-1.77）]和营养管理[5.57（4.38-7.07）]相关。营养管理也与监测指南第二步的遵循相关[3.98（2.33-6.78）]。在 343 名（21.4%）“风险”患者中观察到对报告指南的遵循。多变量分析表明，对报告指南的遵循与 NRS-2002 评分>4[1.97（1.47-2.64）]、营养管理[3.80（2.85-5.07）]和监测指南的遵循[3.33（2.35-4.71）]相关。
结论
我们的结果表明，对营养不良监测和报告指南的遵循情况不佳，这可能是由于缺乏培训、人员和时间所致。
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