Original Article

Evaluation of Nutritional Assessment Quality and Rate of Referral to a Dietitian in Shariati Hospital, Tehran, Iran: A Clinical Audit

Abstract

Background: Malnutrition is an acute or a chronic condition resulting from an imbalance in the intake, both in the form of undernutrition and over nutrition, leading to changes in the composition or reduced function of the body. Bio-social conditions and acute or chronic diseases are the most important factors affecting nutrition. It has been suggested that awareness of the prevalence and severity of malnutrition in hospitalized patients can be used by managers to understand the causes, health care system requirements, and health plans.
Methods: Medical records of 483 patients from 11 different wards of Shariati general hospital were assessed to evaluate the quality of nutritional assessment and the rate of referral to nutrition experts by physicians. This study consisted of two phases: evaluation of initial nutritional assessment and assessing the accuracy of malnutrition screening forms completion.
Results: Our study showed no initial nutritional assessment for 34% of the patients. Assessment of the accuracy of malnutrition screening showed that there was a considerable error in the reporting of BMI (66%), weight loss (51%), appetite loss (50%), and severity of the patient’s situation (39%). Also, the rate of referral to a nutritionist was 0% and 1% in the first and second phases of the study, respectively.
Conclusion: The present study showed that the quality of nutritional screening and subsequent referral to nutrition experts for professional nutritional assessment is negligible in Shariati hospital, Tehran, Iran.

1. Soeters PB, Reijven PL, Schols JM, Halfens RJ, Meijers JM, van Gemert WG. A rational approach to nutritional assessment. Clin Nutr. 2008;27(5):706-16.
2. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415-21.
3. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’(‘MUST’) for adults. Br J Nutr. 2004;92(5):799-808.
4. Pirlich M, Schütz T, Kemps M, Luhman N, Minko N, Lübke HJ, et al. Social risk factors for hospital malnutrition. Nutrition. 2005;21(3):295-300.
5. McKee J. Protein-calorie malnutrition: The skeleton in the litigation closet. J Legal Nurse Consult. 2006; 17:12-6.
6. Ferguson M. Uncovering the skeleton in the hospital closet. What next? (Leading article). Australian Journal of Nutrition and Dietetics. 2001;58(2):83-5.
7. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff SC, et al. The German hospital malnutrition study. Clin Nutr. 2006;25(4):563-72.
8. Banks M, Ash S, Bauer J, Gaskill D. Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutrition & Dietetics. 2007; 64(3):172-8.
9. Jebb SA. Incidence and recognition of malnutrition in hospital J. P. McWhirter and C. R. Pennington BMJ 1994; 308: 945-948. Clin Nutr. 1994;13(4):267-8.
10. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514-27.
11. Christensen KS, Gstundtner KM. Hospital-wide screening improves basis for nutrition intervention. J Am Diet Assoc. 1985;85(6):704-6.
12. Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. JPEN J Parenter Enteral Nutr. 2011;35(2):209-16.
13. Dinmohammadi M, Purmemary M. Nutrition markers in under-hemodialysis patients in Zanjan Shahid Beheshti Hospital. 2002.
14. Hosseini S, Amirkalali B, Nayebi N, Heshmat R, Larijani B. Nutrition status of patients during hospitalization, Tehran, Iran. Nutr Clin Pract. 2006;21(5):518-21.
15. Nozari B, Tabibi H, Mahdavi-Mazdeh M, Hedayati M, Houshiar Rad A. Prevalence of protein-energy malnutrition and its various types in hemodialysis patients in Tehran, 2008. Iranian Journal of Nutrition Sciences & Food Technology. 2010;5(1):17-28.
16. Ferguson M, Capra S. Nutrition screening practices in Australian hospitals. Australian journal of nutrition and dietetics. 1998.
17. Elia M, Zellipour L, Stratton RJ. To screen or not to screen for adult malnutrition? Clin Nutr. 2005;24(6):867-84.
18. Lazarus C, Hamlyn J. Prevalence and documentation of malnutrition in hospitals: a case study in a large private hospital setting. Nutrition & Dietetics. 2005;62(1):41-7.
19. Adams NE, Bowie AJ, Simmance N, Murray M, Crowe TC. Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients. Nutrition & Dietetics. 2008;65(2):144-50.
20. Kirkland LL, Kashiwagi DT, Brantley S, Scheurer D, Varkey P. Nutrition in the hospitalized patient. Journal of hospital medicine. 2013;8(1):52-8.
21. Singh H, Watt K, Veitch R, Cantor M, Duerksen DR. Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the malnourished patient? Nutrition. 2006;22(4):350-4.
22. Elia M. The'MUST'report. Nutritional screening for adults: a multidisciplinary responsibility. Development and use of the Malnutrition Universal Screening Tool'(MUST) for adults. British Association for Parenteral and Enteral Nutrition (BAPEN); 2003.
23. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994;308(6934):945-8.
24. Kelly I, Tessier S, Cahill A, Morris S, Crumley A, McLaughlin D, et al. Still hungry in hospital: identifying malnutrition in acute hospital admissions. Qjm. 2000;93(2):93-8.
25. Edington J, Boorman J, Durrant E, Perkins A, Giffin C, James R, et al. Prevalence of malnutrition on admission to four hospitals in England. Clin Nutr. 2000;19(3):191-5.
26. Mowé M, Bøhmer T, Kindt E. Reduced nutritional status in an elderly population (> 70 y) is probable before disease and possibly contributes to the development of disease. Am J Clin Nutr. 1994;59(2):317-24.
27. Raja R, Lim AV, Lim YP, Lim G, Chan SP, Vu CK. Malnutrition screening in hospitalised patients and its implication on reimbursement. Intern Med J. 2004;34(4):176-81.
28. Ferguson M, Capra S, Bauer J, Banks M. Coding for malnutrition enhances reimbursement under casemix-based funding. Australian journal of nutrition and dietetics. 1997.
29. Bruun LI, Bosaeus I, Bergstad I, Nygaard K. Prevalence of malnutrition in surgical patients: evaluation of nutritional support and documentation. Clin Nutr. 1999;18(3):141-7.
30. Gallagher-Allred CR, Voss AC, Finn SC, McCamish MA. Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc. 1996;96(4):361-6, 369; quiz 367-8.
Files
IssueVol 5, No 1/2 (Winter/Spring 2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jnsd.v5i1.5215
Keywords
Clinical Audit Nutrition assessment Quality of health care Hospital practice
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Emami M, Zarezadeh M, Sharifzadeh M, Fazelifarsani Z, Khorshidi M. Evaluation of Nutritional Assessment Quality and Rate of Referral to a Dietitian in Shariati Hospital, Tehran, Iran: A Clinical Audit. J Nutr Sci & Diet. 2019;5(1-2):8-13.