Nutrition Therapy Support Center, Aichi Medical University, Aichi, Japan. Email:
Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.
Asia Pac J Clin Nutr. 2024 Dec;33(4):515-528. doi: 10.6133/apjcn.202412_33(4).0006.
Study aim was to determine the levels and barriers of the Nutrition Care Process (NCP), a practical method of individualized nutrition support.
Delegate of registered dietitians (RDs) from acute-care hospitals answered our nationwide web-based questionnaire (April-June, 2023) to determine the implementation status of screening, assessment, intervention (including planning), and monitoring (components of the NCP).
Of 5,378 institutions contacted, 905 (16.8%) responded. For Screening, 80.0% screened all inpatients: primary personnel in charge were RDs (57.6%); the most used screening tool was Subjective Global Assessment (SGA) (49.2%). For Assessment, 66.1% assessed all inpatients: food intake (93.3%) was most evaluated whereas muscle mass and strength (13.0%, 8.8%) were least evaluated. For Intervention, 43.9% did so within 48h of hospital admission: oral nutritional supplement (92.9%) was the most common RDs intervention and parenteral nutrition (29.9%) was used less. For Monitoring, 18.5% of institutions had monitoring frequency of ≥ 3 times/week whilst 23.0% had monitoring less than once a week for severely malnourished patients. Energy and protein intake (93.7%, 84.3%) were most monitored and lipid intake (30.1%) was less monitored.
Barriers of NCP included inefficient staffing systems and unsuitable tools in Screening, inaccurate patient targeting and lack of important evaluation items in Assessment, delayed timing and incomplete contents in Intervention, and inadequate fre-quency and lack of important evaluation items in Monitoring. An increase in RDs staffing in acute-care general wards, widespread NCP instruction manuals, and education about the tools and evaluation items utilized in nutritional management are possible solutions.
本研究旨在确定营养护理过程（NCP）的水平和障碍，这是一种个体化营养支持的实用方法。
来自急症医院的注册营养师代表（RDs）回答了我们的全国性网络问卷（2023 年 4 月至 6 月），以确定筛选、评估、干预（包括计划）和监测（NCP 的组成部分）的实施情况。
在联系的 5378 家机构中，有 905 家（16.8%）做出了回应。在筛选方面，80.0%的机构对所有住院患者进行了筛选：主要负责人员是 RDs（57.6%）；最常用的筛选工具是主观整体评估（SGA）（49.2%）。在评估方面，66.1%的机构对所有住院患者进行了评估：最常评估的是饮食摄入（93.3%），而肌肉质量和力量（13.0%，8.8%）评估最少。在干预方面，43.9%的机构在住院后 48 小时内进行干预：最常见的 RDs 干预措施是口服营养补充（92.9%），而较少使用的是肠外营养（29.9%）。在监测方面，18.5%的机构每周监测频率≥3 次，而 23.0%的机构每周对严重营养不良患者的监测次数少于一次。能量和蛋白质摄入（93.7%，84.3%）监测最频繁，而脂质摄入（30.1%）监测较少。
NCP 的障碍包括筛选中效率低下的人员配备系统和不合适的工具、评估中不准确的患者定位和缺乏重要的评估项目、干预中延迟的时间和不完整的内容以及监测中不充分的频率和缺乏重要的评估项目。增加急症普通病房的 RDs 人员配备、广泛的 NCP 操作手册以及营养管理中使用的工具和评估项目的教育可能是解决方案。
