Abstract
BackgroundMany patients are undernourished during hospitalisation. The clinical consequences of this include lassitude, an increased risk of complications and prolonged convalescence. The aim of the study is 1) to implement a new organisation with a focus on improving the quality of the nutritional care of medical inpatients at risk of undernutrition, and 2) to investigate the effect of the intervention.MethodsSocial and healthcare assistants are educated to the higher level of nutritional and healthcare assistants to provide nutritional care in daily practice to undernourished medical inpatients. The effect of the intervention is investigated before and five months after the employment of the nutritional and healthcare assistants. Data are obtained from structured interviews with patients and staff, and the amount of ordered and wasted food is recorded.ResultsPatients regard the work of the nutritional and healthcare assistant as very important for their recovery and weight gain: the assistant takes care of the individual patient's nutritional requirements and wishes, and she imparts knowledge to the patient about optimum nutrition. Staff members benefit from the knowledge and dedication of the nutritional and healthcare assistant and from her work; the staff is often too busy with other nursing tasks to make it a priority to ensure that patients who are nibblers get sufficient nutrition. The choices of food from the production kitchen are utilised to a higher degree, and more of the food is eaten by the patients. Before the intervention, a 20% increase in ordered food in relation to the food budget is found. During the intervention a 20% decrease in ordered food in relation to the food budget is found, and food wastage decreases from 55% to 18% owing to the intervention.ConclusionThe job function of the nutritional and healthcare assistants on the medical wards is of great value to patients, nursing staff members and the production kitchen. The quality of the nutritional care of undernourished patients increases significantly, and a considerable optimisation of resources in the production and ordering of food takes place. Hospitals can benefit from implementation of the present organisational model if they focus on improving the quality of the nutritional care of weak and elderly inpatients and on optimisating the use of resources.
Highlights
The patient-reported average daily weight loss is 160 grams. This figure has to be judged with caution, it does give an indication of the level of weight loss in this group of patients
Data from interviews with patients not being nursed by the nutritional and healthcare assistants show that the nursing staff often does not talk to the patients about their reduced food and fluid intake and weight loss
Retrained social and healthcare assistants working on wards as nutritional and healthcare assistants strengthen the focus on and raise significantly the quality of the nutritional care of under-resourced patients who are at nutritional risk
Summary
The clinical consequences of this include lassitude, an increased risk of complications and prolonged convalescence. Insufficient nutritional intake and consequent weight loss during disease remains a serious problem for many elderly inpatients. The clinical consequences include lassitude, difficulty in mobilising, prolonged convalescence [3,10,11,12,13,14] and an increased risk of pressure wounds [15], phlebitis and infections [16,17]. Intervention studies have shown that patients' protein and energy intake can be increased significantly through optimisation of the nutritional care using the available hospital food [18,19,20,21,22]. Patients are hospitalised for eight days on average and are usually admitted acutely (data printout from the Office of Economic Affairs, Bispebjerg Hospital)
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