Ellick Jennifer, McCoy Simone, Olufson Hannah, Adams Amanda, Banks Merrilyn, Young Adrienne
Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Health, Herston, Queensland, Australia.
School of Human Movement & Nutrition Science, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia.
Nutr Diet. 2025 Apr;82(2):218-230. doi: 10.1111/1747-0080.12913. Epub 2024 Nov 17.
Delegation of nutrition care activities to Dietetic Assistants in hospitals has been identified as one innovative malnutrition model of care, but there has been limited evaluation of their roles. This study aimed to develop, implement and evaluate a new Malnutrition Model of Care embracing automated delegation and digital systems.
The Malnutrition Model of Care was created to detect patients at risk of malnutrition (using the Malnutrition Screening Tool) and nutritional decline (via routine intake tracking at all meals and snacks). Digital systems generated automated referrals to dietetics, with protocols to support Dietetic Assistants to action these to direct care escalation to the ward dietitian. Dietetic Assistant training included simulations and clinical task instructions. Implementation evaluation was guided by the Donabedian model of quality and included a review of inpatient dietetics occasions of service, survey of Dietetic Assistant role satisfaction and task confidence, and hospital-wide cross-sectional malnutrition audit. Data was descriptively analysed.
During the first year of implementation, 60% of Dietetics inpatient occasions of service were completed by Dietetic Assistants, with 26% of Dietetic Assistant inpatient tasks initiated from nursing malnutrition risk screening. Most Dietetic Assistants reported adequate training and confidence in completing delegated tasks. Malnutrition prevalence was 14% with no hospital-acquired malnutrition identified. No clinical incidents were reported.
The Dietetic Assistant workforce and technology were harnessed to implement an innovative delegated Malnutrition Model of Care that appears to be safe and effective at managing malnutrition from preliminary evaluation. Work continues to formally assess service efficiencies, cost and patient experience.
将医院营养护理活动委托给营养助理已被确定为一种创新的营养不良护理模式，但对其作用的评估有限。本研究旨在开发、实施和评估一种包含自动委托和数字系统的新型营养不良护理模式。
创建营养不良护理模式以检测有营养不良风险的患者（使用营养不良筛查工具）和营养状况下降情况（通过对所有餐食和零食的常规摄入量跟踪）。数字系统生成自动转介至营养科的信息，并制定协议以支持营养助理采取行动，将护理升级引导至病房营养师。营养助理培训包括模拟和临床任务指导。实施评估以唐纳贝迪安质量模型为指导，包括对住院营养科服务情况的审查、对营养助理角色满意度和任务信心的调查以及全院横断面营养不良审计。对数据进行描述性分析。
在实施的第一年，60%的住院营养科服务由营养助理完成，26%的营养助理住院任务由护理人员的营养不良风险筛查发起。大多数营养助理报告称接受了充分的培训，并对完成委托任务有信心。营养不良患病率为14%，未发现医院获得性营养不良。未报告临床事件。
利用营养助理团队和技术实施了一种创新的委托营养不良护理模式，初步评估显示该模式在管理营养不良方面似乎是安全有效的。工作仍在继续，以正式评估服务效率、成本和患者体验。
