Abstract
Background: A decade ago, the Australasian Nutrition Care Day Survey 2010 (ANCDS) reported a high prevalence of malnutrition (32%) and sub-optimal food intake in more than half of patients in acute care hospitals across New Zealand. Since then, Canterbury and Southern District Health Boards hospitals have implemented nurse-completed malnutrition screening at admission as routine practice. Nevertheless, the accuracy in hospital malnutrition screening at admission is unknown and dietary intake of at-risk of malnutrition patients is poorly documented.
Objective: This thesis aims to provide a snapshot of the current hospital malnutrition status, investigate the accuracy of nursing-completed malnutrition screening, and dietary treatments for at-risk of malnutrition patients in two New Zealand South Island hospitals.
Methods: Phase 1 was an audit of nurse-completed malnutrition screening records. Malnutrition screening tool (MST) was completed by a student dietitian on patients admitted within 48 hours to six acute wards at Dunedin and Christchurch hospitals. This MST score was compared against that documented by nurses in patient clinical notes. All patients, whose student dietitian completed MST score ≥ 2 (at-risk of malnutrition), were invited to participate in phase 2 of this study. Phase 2 involved a malnutrition-focused nutritional assessment (anthropometrics, nutritional status using Subjective Global Assessment, SGA) and 24-hour estimated food intake (plate waste assessment and food recall) were carried out once consent was given. Data was statistically analysed using descriptive analysis.
Results: Of 366 patients (55% female, 67 ± 20 years), 23% were at-risk of malnutrition (MST ≥ 2) at admission and were more likely to be malnourished. There was a minimal agreement between MST score of nurses and student dietitians and nurses were more likely to score lower than student dietitians. Most of phase 2 participants were moderately malnourished (76%) and 37% received a high protein energy (HPE) hospital diet code. On average, patients consumed two thirds of the food offered with highest consumption at breakfast, lowest at dinner. In-between meals snacks were not served most of the time. When snacks were served, morning tea (79%) was mostly consumed while afternoon tea (62%) was less likely to be consumed. The highest intake was from the Soup (67%), Main (66%), and Starch (65%) food groups. Nevertheless, 90% of the time soup was not served at dinner. There was no difference in food group consumption between patients on a standard and an HPE diet code.
Conclusion: It appears that malnutrition and poor food intake are on-going issues in acute care patients in the two South Island hospitals. MST scores by nurses often differed and were lower than that of student dietitians. Many of at-risk of malnutrition patients were not receiving a HPE diet code to address malnutrition risk during hospitalisation. A review of the hospital menu is warranted to improve intakes including menu changes for food fortification, frequent snacks in-between meals and ongoing intake monitoring.