Malnutrition in an acute regional hospital setting: Implications for practice based on hospital screening, prevalence and identification.

Abstract

Background/aim: Malnutrition describes a state of inadequate intake of nutrients commonly associated with higher rates of sarcopenia, impaired wound healing and increased length of admission. The prevalence remains poorly understood with some literature suggesting hospital rates as high as 40%. The goal at Grampians Health Ballarat (GHB) is for 100% of admissions to undergo malnutrition screening via weigh-ins and the use of validated tools. The aims of this study were to measure the prevalence of malnutrition and identify hospital acquired malnutrition (HAM) verse community acquired malnutrition (CAM) along with the severity. Additionally, to measure dietetic referral rates when an MST score was ≥2, as per best practice guidelines. Population/setting: This project involved a point of prevalence review in the acute setting, consisting of a prospective audit of medical histories at GHB. Records were examined to determine the proportion of people being screened, receiving dietetic referrals and HAM verses CAM. Methods: A validated Subjective Global Assessment (SGA) tool was used to classify degree of malnutrition when a patient scored ≥2 on the Malnutrition Screening Tool (MST). For patients who did not have an MST completed upon admission, the Dietitian conducted one. This enabled all patient in the hospital to be screened and assessed for malnutrition. Results: Only 58% of patients had their weight taken and 55% of patients had an MST completed on admission. When all patients in the hospital had MSTs completed by dietitians (83 patients), 44.5% scored and MST of ≥2 prompting completion of an SGA. 38% of patients were identified as having malnutrition with 58% either mild/moderate and 18.5% severe. From this, CAM was identified in 65.5% of patients and HAM in 24.2% patients with 10.3% unable to be determined. Conclusion: High prevalence of malnutrition reveals the importance of screening and assessment. Low adherence to screening in the acute setting requires further exploration to ascertain barriers towards implementation. If detected early and dietetic involvement employed, appropriate treatment may better support clinical outcomes. Translational impact/implications for future practice: We recommend that dietitians continue to support best-practice guidelines in ensuring MSTs and SGAs are completed on all patients in the acute setting to facilitate identification, assessment and treatment of malnutrition.