Nutrition & Dietetics
 Maree Ferguson
Management of Patients with Malnutrition
Introduction
Malnutrition, often referred to as the skeleton in the hospital closet, has been reported in studies, both overseas and in Australia, as affecting between 4% and 58% of hospital patients (Ferguson et al 1997). Previous studies at the Princess Alexandra Hospital (PAH) have documented a malnutrition prevalence rate of ~28% over the past five years. Despite a high prevalence of malnutrition among hospitalised patients, recognition and documentation of malnutrition is often poor (McWhirter & Pennington, 1994). Malnutrition is a significant problem because it results in an increased risk of morbidity and mortality, and hence an increased length of stay and increased hospital costs (Green, 1999).
A comprehensive nutrition screening program will ensure that patients who are malnourished or at risk of becoming malnourished are identified (Ferguson et al 1997). A nutrition screening protocol has been implemented at the PAH for the past few years. Nutrition assistants in NOSS (Nutrition and Operating Support Services) are responsible for implementing nutrition screening. An audit of screening practices is required and barriers/supportive mechanisms for the implementation of nutrition screening need to be explored.
Objectives
- To conduct a job analysis of the role of nutrition assistants including an evaluation of efficiency and effectiveness (e.g. reducing paperwork and increasing time spent with the patient)
To determine nutrition assistants conformity with conducting nutrition screening practices to identify patients at risk of malnutrition
To identify barriers and supportive mechanisms for implementing nutrition screening, and make practice improvements where necessary
- To determine the prevalence of malnutrition at the PAH, and its association with other conditions such as falls and pressure ulcers; and outcomes such as length of stay and readmission
- To examine whether coding for malnutrition as a comorbidity would have an impact on changing the DRG assigned for the patient’s admission to one with a higher weight and hence, potentially increase the financial reimbursement to the PAH under casemix funding
- To recommend, implement and evaluate a midmeal off trolley select service (nutrition intervention) for patients with malnutrition
To determine if the midmeal trolley system has an impact on clinical outcomes such as length of stay, pressure ulcers and falls
To conduct a cost benefit analysis of the midmeal trolley system including reviewing staff labour time, food consumption and wastage
To assess patient satisfaction with midmeal trolley system
- To identify other methods of increasing dietary intake of patients with malnutrition
|
