改善住院患者的营养摄入：我们已经走了多远？再审核。

Improving the nutritional intake of hospital patients: how far have we come? A re-audit.

机构信息

Department of Nutrition and Dietetics, Cambridge University Hospital, Cambridge, UK.

Department of Nutrition and Dietetics, East Sussex Healthcare NHS Trust, Conquest Hospital, St Leonards-on-Sea, UK.

出版信息

J Hum Nutr Diet. 2019 Jun;32(3):372-384. doi: 10.1111/jhn.12607. Epub 2018 Oct 17.

DOI:10.1111/jhn.12607

PMID:30334301

Abstract

BACKGROUND

Malnutrition affects up to 33.6% of hospitalised patients, with consequences that are detrimental for both patients and healthcare providers. In 2015, an audit demonstrated inadequate nutritional provision and consumption by hospitalised patients, comprising a major risk factor for malnutrition. This re-audit evaluates whether patients are meeting recommended energy and protein standards and estimated individual requirements, subsequent to food service improvements since 2015.

METHODS

Patients (n = 111) were included from a South West hospital, and Malnutrition Universal Screening Tool scores (MUST) categorised patients as 'nutritionally well' (MUST 0) or 'nutritionally vulnerable' (MUST ≥ 1). Individual energy and protein requirements were estimated using weight-based equations. Nutritional intakes were assessed via 24-h dietary recall and compared against the British Dietetic Association's Nutrition and Hydration Digest standards, as well as estimated individual requirements.

RESULTS

In total, the Digest standards for energy and protein were met by 35% and 63% of patients respectively, which is an increase of 19% and 36% since 2015. 'Nutritionally well' patients were more likely to meet nutrient standards for protein (62%) than estimated individual requirements (30%) (P ≤ 0.001). 'Nutritionally vulnerable' patients were more likely to meet estimated individual requirements for energy (60%) than the Digest standards (30%) (P = 0.047).

CONCLUSIONS

The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein-dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice.

摘要

背景

营养不良影响了多达 33.6%的住院患者，对患者和医疗保健提供者都有不利影响。2015 年的一项审计显示，住院患者的营养供给和摄入不足，这是营养不良的一个主要危险因素。本次再审计评估了自 2015 年以来改善餐饮服务后，患者是否达到了推荐的能量和蛋白质标准以及估计的个体需求。

方法

从西南地区一家医院中纳入了 111 名患者，并使用营养不良通用筛查工具评分（MUST）将患者分为“营养良好”（MUST 0）或“营养脆弱”（MUST≥1）。使用基于体重的公式估计个体的能量和蛋白质需求。通过 24 小时膳食回顾评估营养摄入量，并与英国营养师协会的营养和水合 Digest 标准以及估计的个体需求进行比较。

结果

总体而言，满足 Digest 标准的能量和蛋白质摄入量分别占患者的 35%和 63%，与 2015 年相比，这一比例分别增加了 19%和 36%。“营养良好”的患者更有可能满足蛋白质（62%）而不是估计的个体需求（30%）的营养素标准（P≤0.001）。“营养脆弱”的患者更有可能满足能量（60%）而不是 Digest 标准（30%）的个体估计需求（P=0.047）。