Dr. Tappenden
Health-care reform is on everyone’s mind these days, and SHM, along with numerous other groups, believes some reform goals can be achieved through the stomach.
Data show an effective program of nutritional intervention during a patient’s hospital stay can go a long way toward improving patient outcomes and reducing costs.1 Hospitalists, however, often have little formal nutrition training. A multidisciplinary approach to patient nutrition that brings together multiple stakeholders—hospitalists, nurses, and dietitians—might effectively address this need with a team tactic, according to Melissa Parkhurst, MD, medical director of the hospital medicine section at the University of Kansas Medical Center in Kansas City.1
Between 20% and 50% of inpatients suffer from malnutrition.2 Many patients, especially the elderly, are malnourished on admission. Many more become malnourished within a few days of their hospital stay due to NPO orders and the effects of disease on metabolism.2 Malnutrition has been associated with worsened discharge status, longer length of stay, higher costs, and greater mortality, as well as increased risk of:2
- Nosocomial infections;
- Falls;
- Pressure ulcers; and
- 30-day readmissions.
To address malnutrition prevalence and its detrimental effects, SHM and the Academy of Medical-Surgical Nurses (AMSN), the Academy of Nutrition and Dietetics (AND), the American Society of Parenteral and Enteral Nutrition (ASPEN), and Abbott Nutrition have formed the Alliance for Patient Nutrition. Kelly Tappenden, MD, PhD, professor of food science and human nutrition at the University of Illinois at Urbana, says the alliance aims to raise awareness of the impact nutrition can have on patient outcomes (see “Three Steps to Better Nutrition,” below).
The campaign is being initiated with the publication of a consensus paper in several peer-reviewed journals. A baseline survey will be conducted among professionals represented in the alliance to assess their familiarity with the prevalence of malnutrition in a hospital setting. The next step is to foster this change in patient care by providing resources on the alliance’s website (www.malnutrition.com), including malnutrition screening tools, a toolkit to facilitate multidisciplinary collaboration, and continuing medical education (CME) information.
As a founding member of the alliance, SHM is communicating this message to its members, encouraging hospitalists to lead the way in transforming hospital culture to recognize the critical role nutrition plays in patient care.
“Nutrition matters,” Dr. Parkhurst says. “You can be winning the battle and losing the war if you are not paying attention to patient nutrition.”
Team Approach
Beth Quatrara, DNP, RN, director of the nursing research program at the University of Virginia Health System in Charlottesville and nursing spokesperson for the alliance, says several shortcomings can be identified in the nutritional care U.S. hospitals provide from admission through discharge and beyond. For example, the Joint Commission requires that all patients be screened for malnutrition risk within 48 hours of admission. But screening is often as cursory as looking at the patient and deciding that he or she “looks fine.” Diets often are set for patients with no thought to taste, texture, or cultural preferences, or even to such practical matters as ascertaining whether the patient has dentures, Quatrara says. Meal trays are left when patients are out of their rooms for procedures and retrieved by dietary staff before patients return. And except for calorie count orders, accurate records often are not kept of actual food consumption.