Clinical guidelines and enteral nutrition support: a survey of dietetic practice in the United Kingdom

Abstract

• Malnutrition in adults on admission to hospitals and care homes affects almost 1 in 3 subjects, who were mostly in the high risk category. Malnutrition is common in all types of care homes and hospitals, all types of wards and diagnostic categories, and all ages. It is also common in mental health units.• Nutritional screening policies and practice vary between and within health care settings, whilst malnutrition continues to be under-recognised and under-treated.• Much of the malnutrition present on admission to institutions originates in the community. Consistent and integrated strategies to detect, prevent and treat malnutrition should exist within and between all care settings. 1 2 Summary 1. The Nutrition Screening Survey 1.1 This report provides a summary of the largest nutrition screening survey undertaken in the UK. Reporters from 175 hospitals, 173 care homes and 22 mental health units in the UK completed a general questionnaire and an anonymous patient questionnaire as part of a national audit on nutritional screening. Unlike previous studies that used different criteria to identify malnutrition in various care settings, this survey used the same criteria based on the 'Malnutrition Universal Screening Tool' ('MUST') in all care settings. Data were collected on patients during the first three days of admission to hospitals and acute mental health units, and on residents admitted to care homes and long stay / rehabilitation mental health units in the previous six months. Hospitals 2.1Of 9336 patients who were screened on admission to hospital, 28% were found to be at risk of malnutrition, (high risk, 22%; medium risk, 6%).The combination of these two risk categories is henceforth referred to as 'malnutrition' for simplicity. 2.2Since the presence of 'malnutrition' at or shortly after admission to hospitals suggests that it largely originated in the community, strategies to prevent and treat malnutrition in the community setting should be considered. 2.3'Malnutrition'varied significantly according to source of admission (25% from home, 31% from another hospital, 32% from another ward, and 43% from a care home), type of admission (32% for emergency admission, 20% for elective admission), and type of ward (e.g. 43% in oncology wards and 15% in orthopaedic/trauma wards). It was also greater in hospitals that had a screening policy than those that did not (28% v 24%), and considerably greater in large hospitals with ≥1000 beds than in those with <1000 beds (38% v 26%).2.4'Malnutrition'was common in all age groups and diagnostic categories, but it was significantly more common in women, who were older than men (29% v 26%), in subjects aged over 65 years than under 65 years (30% v 24%), and in certain diagnostic categories than others (e.g. gastrointestinal disease (43%) and neurological disease (33%) versus cardiovascular (21%) and musculoskeletal conditions (18%)). A low body mass index (BMI <20 kg/m 2 ) contributed to a 'MUST' score in 4 out of 10 'malnourished' patients. 2.5Most hospitals reported that th...

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