Valaitis Renata, Laur Celia, Keller Heather, Butterworth Donna, Hotson Brenda
1University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1 Canada.
2Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Canada.
BMC Nutr. 2017 Jul 14;3:60. doi: 10.1186/s40795-017-0177-8. eCollection 2017.
Malnutrition is common in hospitalized patients and is associated with increased mortality, length of stay, and risk of re-admission. The consensus based Integrated Nutrition Pathway for Acute Care (INPAC) was developed and validated to enhance patients' nutrition care and improve clinical outcomes. As part of the More-2-Eat project (M2E), five hospitals implemented INPAC activities (e.g. screening) in a single medical unit. The purpose of this paper is to demonstrate the care gaps with respect to INPAC activities on these five units prior to implementation. Results were used as part of a needs assessment on each unit, demonstrating where nutrition care could be improved and tailoring of implementation was required.
Cross-sectional data was collected by site research associates (RAs) using a standardized audit form once per week for 4 weeks. The audit contents were based on the INPAC algorithm. All medical charts of patients on the study unit on the day of the audit were reviewed to track routine nutrition care activities (e.g. screening). Data was descriptively displayed with REDCap™ and analyzed using R Studio software.
Less than half of patients (249/700, 36%) were screened for malnutrition at admission. Of those screened, 36% (89/246) were at risk for malnutrition yet 36% (32/89) of these patients did not receive a dietitian assessment. Also, 21% (33/157) of patients who were not screened at risk were assessed. At least one barrier to food intake was noted in 85% of patient medical charts, with pain, constipation, nausea or vomiting being the most common. Many of these barriers were addressed through INPAC standard nutrition care strategies that removed the barrier (e.g. 41% were provided medication for nausea). Advanced nutrition care strategies to improve intake were less frequently recorded (39% of patients).
These results highlight the current state of nutrition care and areas for improvement regarding INPAC activities, including nutrition screening, assessment, and standard and advanced nutrition care strategies to promote food intake. The results also provided baseline data to support buy-in for INPAC implementation in each M2E study unit.
Retrospectively registered ClinTrials.gov Identifier: NCT02800304, June 7, 2016.
营养不良在住院患者中很常见，与死亡率增加、住院时间延长及再次入院风险相关。基于共识制定的急性护理综合营养路径（INPAC）已得到开发和验证，以加强患者的营养护理并改善临床结局。作为“多吃一点”项目（M2E）的一部分，五家医院在单个医疗单元实施了INPAC活动（如筛查）。本文的目的是展示在实施前这五个单元在INPAC活动方面的护理差距。结果被用作每个单元需求评估的一部分，以表明营养护理可在哪些方面得到改善以及需要如何调整实施方式。
现场研究助理（RA）每周使用标准化审核表收集一次横断面数据，共收集4周。审核内容基于INPAC算法。审核当天对研究单元所有患者的病历进行审查，以追踪常规营养护理活动（如筛查）。数据用REDCap™进行描述性展示，并使用R Studio软件进行分析。
入院时接受营养不良筛查的患者不到一半（249/700，36%）。在接受筛查的患者中，36%（89/246）存在营养不良风险，但其中36%（32/89）的患者未接受营养师评估。此外，21%（33/157）未被筛查出有风险的患者也接受了评估。85%的患者病历中记录了至少一个食物摄入障碍，疼痛、便秘、恶心或呕吐最为常见。通过INPAC标准营养护理策略消除障碍的情况很多（如41%的患者因恶心接受了药物治疗）。改善摄入量的高级营养护理策略记录较少（39%的患者）。
这些结果突出了营养护理的现状以及INPAC活动方面有待改进的领域，包括营养筛查、评估以及促进食物摄入的标准和高级营养护理策略。这些结果还提供了基线数据，以支持每个M2E研究单元实施INPAC。
回顾性注册，ClinicalTrials.gov标识符：NCT02800304，2016年6月7日。
