Improving the nutritional intake of hospital patients: how far have we come? A re‐audit

Abstract

Background Malnutrition affects up to 33.6% of hospitalised patients, with consequences that are detrimental for both patients and healthcare providers. In 2015, an audit demonstrated inadequate nutritional provision and consumption by hospitalised patients, comprising a major risk factor for malnutrition. This re‐audit evaluates whether patients are meeting recommended energy and protein standards and estimated individual requirements, subsequent to food service improvements since 2015. Methods Patients (n = 111) were included from a South West hospital, and Malnutrition Universal Screening Tool scores (MUST) categorised patients as ‘nutritionally well’ (MUST 0) or ‘nutritionally vulnerable’ (MUST ≥ 1). Individual energy and protein requirements were estimated using weight‐based equations. Nutritional intakes were assessed via 24‐h dietary recall and compared against the British Dietetic Association's Nutrition and Hydration Digest standards, as well as estimated individual requirements. Results In total, the Digest standards for energy and protein were met by 35% and 63% of patients respectively, which is an increase of 19% and 36% since 2015. ‘Nutritionally well’ patients were more likely to meet nutrient standards for protein (62%) than estimated individual requirements (30%) (P ≤ 0.001). ‘Nutritionally vulnerable’ patients were more likely to meet estimated individual requirements for energy (60%) than the Digest standards (30%) (P = 0.047). Conclusions The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein‐dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice.

Are Energy and Protein Intakes Lower Than Requirements in Older Adults? An Urgent Issue in Hospitals and Nursing Homes

“…Computed results based on the five studies that had previously estimated dietary provision of nutritional requirements found that 49% to 82.7% of patients had an energy gap and 37% to 74% of patients had a protein gap [13][14][15]17,19]. Our study revealed that intake-to-requirement gaps were higher in the older-adult population.…”

“…Studies have measured food intakes in patients hospitalized in acute care wards, but rarely in rehabilitation units or NH and specifically in older adults [11,[13][14][15][16][17][18][19][20][21]. Most of these studies estimated food intake based on percentage intake of meal served (0%, 25%, 50%, 75%, or 100%) or on the larger threshold of meal served (<100%, <75% or ≤50%).…”

“…Sanson et al used photography to assess intakes and estimated requirements in older acute-care patients (81.5 ± 11.5 years old) over the first 5 days of a hospital stay [17]. Two further studies estimated intakes based on patient interviews and calculated the proportion of patients that failed to meet their energy and/or protein requirements: Beavan et al [15] studied patients with a median age of 72 years (range 22-98) in 25 medical and surgical wards, and Vasse et al [19] measured protein intakes in acute medicine or surgical wards in patients aged at least 65 years old (mean age was 77.4 ± 5.6 in the low-malnutrition-risk group and 78.7 ± 6.4 in the medium/high-risk group).…”

Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review

“…Application of the dietary assessment method was completed by a range of individuals with researchers and dietitians being the most common professional groups (Figure 3) (12,21,23,25,26,37,39,40,43,46,50,52,56,62,63,68,69,73,74,76, 151,154,[156][157][158][159][160][161][163][164][165][166][167][168]170,171,175) . The majority of studies (n = 94, 60%) did not specify the type of oral diet that was quantified; where this was specified, regular texture (n = 31, 19%) was the most commonly quantified diet type (27,28,36,46,50,51,54,64,77,81,87,102,103,105,(107)(108)(109)116,128,130,132,139,142,150,159,160,165,172,174)<...…”

Managing food waste in the inpatient population

“…Reasons for inadequate dietary intake vary greatly. Poor appetite, nil-by-mouth status, inadequate nutritional screening, missed meals for medical procedures, polypharmacy, limited dietary selection or nutritional inadequacy of hospital meals and food waste are all contributing factors 7. This project focuses on food waste.…”