Evaluation of the provision of food and management of nutritional risk across medical wards at the University Hospital of Wales
Authors: Constantinou C. , Jenkins J. 
Published: July 2008

Background:  A validated nutritional screening tool had been developed and launched within the Trust in 1997. A programme of education and training had been operating since in clinical areas where it was deemed particularly necessary. Despite this, there were concerns about accuracy of screening and referral practices in the Medical Directorate. Patient safety is high on the agenda and with nutrition risk screening recommended by NICE clinical guideline 32 (2006) and in the Welsh Assembly Government ‘Fundamentals of Care’ (2003), it was necessary to obtain reference data on current nutritional practices. The aim was to establish a database of evidence to identify areas of superior practice and to use as a baseline to illustrate the effect of future dietetic/catering/medical and nursing led developments aimed at improving nutritional practices and patient care.

Methods:  Medical notes of 189 patients were surveyed between October and December 2006. A Data was collected including Nutritional history such as weight loss, appetite, special dietary needs, weight, food record chart completion, dietetic referrals and nutritional screening practices.

Results:  Sixty‐four patients(38%) were weighed during admission with 23 (12%) unable to be weighed. One hundred and fifty‐eight patients (84%) had at least one nutritional risk score during their admission but only 48 (25%) had an accurate score within 24 h of admission and with the correct action being taken. Only 28 (33%) high risk patients were referred to the dietitian. Fifty‐three (39%) patients who should have had their food intake recorded had no documentation on appropriate charts. Seventy‐seven patients required a special diet but 37 (48%) of these were not catered for as the catering staffs were unaware of their needs.

Discussion:  This survey showed that although nutritional screening is undertaken, it tends to be inaccurate and incomplete. Patients with poor nutritional status are being missed and deterioration is not always being monitored or acted upon, despite regular education and training updates. Dietary needs are not being catered for. Documentation and monitoring of nutritional intake is poor. From the nutrition perspective patient safety is about identifying those at risk and acting to reduce physical deterioration. The correct diet, whether this relates to allergy, consistency, therapeutic benefit or nutrition support, should be provided to avoid risk to patient.

Conclusions:  There is no benefit to patients if nutrition risk screening is undertaken but not to a high quality or if the results are not upon and monitored. The quantity of patients screened should not be the only marker of meeting national guidelines and standards. This study demonstrates the need for explicit management of nutrition as a central element of the patient care pathway. This needs to be supported by an ongoing and structured programme of education and training for the multidisciplinary team.

References  National Institute for Clinical Excellence (NICE). (2006) Clinical Guideline 32; Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Available at http://www.nice.org (Accessed on 21 March 2008)

Welsh Assembly Government. (2003) Fundamentals of Care; Guidance for Health and Social care Staff. Improving the Quality of Fundamental Aspects of Health and Social Care for Adults. Welsh Assembly Government.