Essential Steps in the Nutrition Care Process Ø Nutrition Screening Ø Nutrition Assessment and Diagnosis of malnutrition Ø Nutrition Care Process
Nutrition Screening Ø Tests must be sensitive to identify those at risk Ø Tests must be specific to rule out those not at risk Ø Training for effective implementation
Improvements in identification of malnutrition and management Ø Sensitisation of the multi-disciplinary team by clinical dietitians (physicians and nurses) Ø Feedback on progress of the project Ø Daily ward huddles Ø Weekly nurse update meetings
Nutritional Diagnosis Ø Identification of nutritional problems Ø Existing Ø Potential (where a medical intervention is likely to cause a nutritional problem) Ø Preventative or anticipatory
Nutrition assessment and diagnosis of malnutrition Ø A nthropometry Ø B iochemistry Ø C linical / physical Ø D ietary Ø E nvironmental / behavioural / social Ø S ervice user focussed
Targeted nutrition interventions Ø Assessment drives the personalised nutrition plan Ø Underlying causes of malnutrition Ø Individual preferences, resources and expectations, severity of nutritional deficit Ø Anticipation of future disease / treatment
Individualised nutrition support Ø Medical patients at nutritional risk Ø Nutrition risk score > 3 Ø Expected hospital stay > 4 days Ø Multi-centre study in Swiss hospitals Ø 5015 patients screened with 2088 randomised to Ø Individualised nutrition support Ø Standard hospital food
Proportion of patients reaching caloric (A) and protein (B) requirements during the first 10 days after randomisation Kaplan-Meier estimates of the cumulative incidence of the primary endpoints and all-cause mortality (A) Time to the first event of the composite primary endpoint (log-rank p value = 0.035). (B) Time to death (log-rank p value = 0.031)
Summary Ø Management of malnutrition Ø Identify those at risk Ø Assessment Ø Individualised nutrition careplan Ø Nutritional care from the multi-professional team Clare Shaw Email: clare.shaw@rmh.nhs.uk
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