Nutrition Screening Practices Research Articles

Survey of nutrition screening practices in pediatric hospitals across the United States.

Nutrition screening on admission is critically important to systematically identify patients with undernutrition given the known relationship with deleterious clinical outcomes. Limited data exist regarding optimal processes and criteria for pediatric nutrition screening. Therefore, we sought to characterize nutrition screening practices in pediatric hospitals. A total of 365 inpatient pediatric hospitals in the United States were identified, eligible, and contacted. Eligible hospitals included general pediatric hospitals, adult hospitals with pediatric units, and specialty pediatric hospitals. One respondent at each eligible hospital was asked to complete a 33-question survey of admission nutrition screening practices. Of 268 survey respondents, 37% represented pediatric units in adult hospitals, 35% general pediatric hospitals, and 28% pediatric specialty or psychiatric hospitals. A total of 98.5% endorsed the existence of a screening process on admission. Anthropometrics (eg, body mass index z score, 84%) and nutrition status (eg, change in intake, 67%) were the most common screening criteria applied. A nutrition screening instrument was used in 37% of institutions, and only 31% of institutions reported using pediatric-specific screening instruments. Pediatric units within adult hospitals were 1.38 times more likely to use a screening instrument validated in any population. Barriers to nutrition screening included the lack of a standard screening procedure and insufficient staff to conduct screening. Fifty-four percent of respondents reported a desire to change their hospital's nutrition screening process. Most pediatric hospitals screen for nutrition risk on admission. However, methods and criteria varied widely across pediatric hospitals, highlighting the importance of standardized best practices.

Prevalence and related assessment practices of adult hospital malnutrition in Africa: A scoping review

Background and aimsGlobally, hospital malnutrition prevalence is estimated at 20–50%, with little known about the situation in African hospitals. The aim of this scoping review was to appraise the current evidence base regarding the prevalence of adult hospital malnutrition and related assessment practices in an African context. MethodsA comprehensive and exhaustive search strategy was undertaken to search seven electronic bibliographic databases (including Africa-specific databases) from inception until August 2022 for articles/resources reporting on the prevalence of adult hospital malnutrition in an African setting. Two reviewers independently reviewed abstracts and full-text articles and data extraction was undertaken in duplicate. ResultsWe screened the titles and abstracts of 7537 records and included 28 studies. Most of the included studies were conducted in the East African region (n=12), with ten studies from South Africa. Most studies were single-centre studies (n=22; 79%), including 23 to 2126 participants across all studies. A variety of study populations were investigated with most described as medical and surgical populations (n=14; 50%). Malnutrition risk prevalence was reported to be between 23% and 74%, using a variety of nutritional screening tools (including MNA-SF/LF, NRS-2002, MUST, NRI, GNRI). Malnutrition prevalence was reported to be between 8% and 85%, using a variety of tools and parameters, including ASPEN and ESPEN guidelines, SGA, MNA-SF/LF, anthropometric and biochemical indices, with one study using the GLIM criteria to diagnose malnutrition. ConclusionsBoth malnutrition risk and malnutrition prevalence are alarmingly high in African adult hospitalised patients. The prevalence of malnutrition differs significantly among studies, owing in part to the variety of tools used and variability in cut-offs for measurements, underscoring the importance of adopting a standardised approach. Realities in the African context include limited nutritional screening and assessment, poor referral practices, and a unique disease burden. General awareness is needed, and routine nutritional screening practices with appropriate nutrition support action should be implemented as a matter of urgency in African hospitals.

Families' perception of proposed nutrition screening on admission to pediatric hospitals: a qualitative analysis.

Nutrition screening is the first step in most acute care pediatric nutrition care pathways. However, there is a lack of understanding of patient and families' perception of nutrition screening in pediatric populations. The objective of this study was to explore the potential perceptions, feelings, and opinions of families if pediatric nutrition screening were to be completed during hospital admission. Nine members of the Family Advisory Council at the Alberta Children's Hospital participated in a focus group to discuss questions around nutrition screening practices, malnutrition, and the pediatric nutrition screening tool. Transcripts were analyzed using MAXQDA and thematic analysis using the Braun and Clarke methodology. Two major themes emerged: screening may raise sensitive emotions and understanding the purpose of nutrition screening and the questions. Participants agreed discussions around growth and nutrition are vital to comprehensive medical care; however, the timing and approach of nutrition screening can lead to anxiety and feelings of judgement. A lack of understanding of the purpose of screening, next steps, and benefit to the individual patient could limit acceptance of nutrition screening. The findings of this study can inform training and education of healthcare professionals involved in nutrition screening.

Exploring nutrition screening practices in patients with traumatic brain injury and spinal cord injury in specialist rehabilitation: A qualitative study

Exploring nutrition screening practices in patients with traumatic brain injury and spinal cord injury in specialist rehabilitation: A qualitative study

BMI-based figure rating scale (FRS) as an adjunctive aid in nutritional screening and assessment in a resource-limited setting

Objectives: Many existing malnutrition screening and diagnostic tools require body mass index (BMI) and quantification of weight change to detect malnutrition or risk thereof. This is often a challenge in South African public hospitals due to missing data, including patient records. This study investigated the extent to which hospitalised patients can gauge their current and usual body size from a validated BMI-based figure rating scale (FRS). It also ascertained whether a relationship exists between a change in clothing size and a change in perceived BMI, derived from the FRS. Methods: A total of 196 adult patients participated in a cross-sectional study, in three Eastern Cape public hospitals. Data were collected by consulting medical files, patients and taking anthropometric measurements. Validated FRSs were used to determine patients’ accuracy of actual and usual BMI. Data were analysed with Statistica® and Microsoft Excel 2016. Results: Some 66% (n = 131) of participants were accurate in selecting an image representative of their BMI, which was statistically significant (r 2 = 0.80; p < 0.001). Female participants were more likely to select the correct corresponding BMI image (p < 0.05; r 2 = 0.77 for males; r 2 = 0.82 for females). Altogether, 61% (n = 79) of participants with a known previous weight were accurate in selecting an accurate image representative of their usual BMI, also statistically significantly (r 2 = 0.71; p < 0.001). Conclusion: An existing FRS may be a useful adjunctive aid in clinical practice to estimate certain anthropometric indices when not otherwise available. This may be especially relevant to nutritional screening practices conducted by frontline healthcare professionals, e.g. nurses and doctors not specifically trained in anthropometry. This in turn may improve malnutrition detection rates and facilitation of appropriate nutrition care pathways.

Nutrition screening practices and barriers in patients with chronic kidney disease. Results from a worldwide survey

Rationale: Screening for malnutrition is the first step of the nutrition care process. As protein energy wasting (PEW) is a common problem of patients with chronic kidney disease (CKD) , a survey was conducted in order to explore the malnutrition screening practices and the barriers that prevent health professionals to apply nutritional screening in CKD patients.

Nutrition Screening Practices Across Care Settings: Results of a Canadian Survey

Nutrition Screening Practices Across Care Settings: Results of a Canadian Survey

Nutrition Screening Practices amongst Australian Residential Aged Care Facilities.

To determine the proportion of Residential Aged Care Facilities (RACFs) in Australia who use a nutrition screening tool on residents to identify those at risk of malnutrition, and to review practice following identification of residents as being at high risk of malnutrition. Multi-center, cross sectional observational study. Residential Aged Care Facilities. The Director of Nursing at each site was contacted by telephone and asked questions relating to current nutrition screening practices at their residential aged care facility. Data was collected from a stratified sample of 229 residential aged care facilities in each state and territory in Australia. 82% of RACFs (n = 188) use a nutrition screening tool on residents to identify those at risk of malnutrition, however only 52% of RACFs (n = 119) used a screening tool which is validated in the residential aged care setting. There was a significant association between facilities using a nutrition screening tool and the staff members being trained to conduct nutrition screening (p < 0.001). Facilities that employed a dietitian were more likely to use a validated nutrition screening tool (p < 0.005). The most frequently used nutrition screening tool was the 'Mini Nutritional Assessment - Short Form (MNA-SF)', which was used by 32% (n = 60) of the RACFs, followed by the 'Malnutrition Universal Screening Tool (MUST)' (15%, n = 29). We found that the majority of RACFs in Australia use a nutrition screening tool, however many of these RACFs use a tool which has not been validated in the RACF setting. This study highlights the need for greater dietetic advocacy in using validated nutrition screening tools to ensure malnutrition is identified.

PWE-420 An international multi-centre survey to assess resources allocation and nutritional practices in spinal cord injury centres

<h3>Introduction</h3> There is still uncertainty about the resource distribution between spinal cord injury centre (SCICs) and this may have implications to the quality of patient care.¹The present study aimed to review the service provision in SCICs; to establish and compare how much time dietitians spend in direct and indirect contact with patients, and to document current nutritional screening practices. <h3>Method</h3> All 12 SCICs in the United Kingdom and the Republic of Ireland were surveyed by questionnaire in April 2014. Data collected included the number of whole-time-equivalent staff available, whether they use of nutrition screening tools. A work sampling tool was used to capture dietetic activity for a period of one week. <h3>Results</h3> Eight (66.7%) SCICs responded (390/531 of total beds) and the average numbers (median) of patients per whole-time-equivalent staff, including consultants (18), nurses (1.3), dietitians (93.4), physiotherapists (5.9), occupational therapists (10) were recorded and comapred with previous published figures (Table 1). Six out of eight SCICs used a validated nutritional screening tool. Thirty-two work sampling tool were analysed, dietitians spend 39.1% of the working day in direct patient-related activities. Dietetic staffing levels are varied and below clinical recommendations in 6 out of 8 SCICs. <h3>Conclusion</h3> The resources allocated to nutritional care in SCICs appear to be limited. This suggests malnutrition may continue to be under-recongnised and under-treated. To address the complex nutritional needs of this special population group, there is a clear need to establish staffing level for dietitians. Information collected from the present study could contribute to the supply analysis of future workforce planning exercise. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Wong S, <i>et al</i>. Spinal Cord. 2012;50:132–135 NHS England. NHS standard contract for spinal cord injuries (all ages). NHS England, Redditch. 2013. http://www.england.nhs.uk/wp-366content/uploads/2013/06/d13-spinal-cord.pdf[accessed 07.02.2015]

Dépistage nutritionnel chez les aînés en établissements de soins de santé: comparaison entre les établissements francophones et anglophones

ObjectivesMalnutrition among the elderly is a widespread problem in hospitals and nursing homes. However, data on the practice of nutritional screening in these facilities are limited, particularly in Francophone establishments. This study aimed to compare nutritional screening practices among the elderly in Anglophone and Francophone health care facilities in New Brunswick (NB), as well as perceptions and practices of health care professionals.MethodsInformation on screening parameters was taken directly from elderly patients’/residents’ medical records. Health care professionals’ (doctors, nurses, dietitians) perceptions and practices of nutritional screening were collected through questionnaires.ResultsA total of five hospitals and 31 nursing homes in NB took part in the study. Of these, 421 patients/residents and 457 health professionals participated. Significant differences in the availability of screening parameters were observed between Francophone and Anglophone patients/residents. Certain screening parameters, such as weight at admission, loss of appetite and meal fractions consumed were less available in Francophone patients’/residents’ records. In addition, health care professionals’ perceptions regarding nutritional screening varied by occupation and language of the establishment. Several barriers to screening were also identified.ConclusionReduced availability of screening parameters in Francophone establishments and the underestimation of malnutrition in elderly patients/residents by doctors and nurses are barriers that can influence nutritional screening in Francophone health care facilities.

The utilisation of the MUST nutritional screening tool on vascular surgical wards.

Whilst malnutrition is prevalent in approximately 40% of general surgical patients, the prevalence of malnutrition and nutritional screening practices amongst vascular patients remain unknown. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides 3 scores for risk classification: 0=low risk, 1=intermediate risk, 2=high risk. The aim of this preliminary study was to evaluate the use of MUST on vascular wards.This prospective study was undertaken in a tertiary referral vascular unit in the UK. Patient demographics, utilisation of MUST by nursing staff (N-MUST) and referral to nutritional support teams (NST) were studied. When MUST was not completed by nursing staff, the study team (S-MUST) performed it.Fifty-three patients, median (interquartile range, IQR) age 67 (59-75) years were initially studied. For N-MUST: Overall MUST score was recorded in 18/25 (72%) patients, of whom 1 (4%) scored 2, whilst the remainder scored 0. For S-MUST: Overall MUST scores were recorded in 28 patients, MUST=0 in 75% and ≥2 in 21%.An educational session on use of MUST was delivered to nursing staff, as well as a Trust-wide educational initiative to improve assessment of nutritional status and, after a 2-month period, the study was repeated. The second cohort comprised forty-two patients, median (IQR) age 72 (64–79) years. For N-MUST: Overall MUST score was recorded in 37/40 (93%) patients, of whom 3 (8%) scored ≥2. For S-MUST: Overall MUST scores were recorded in 2 patients, MUST = 0 in 67% and ≥2 in 33%.Despite the ease of use of MUST, it was under-utilised on vascular wards. However, following provision of a dedicated educational programme to ward nursing staff, utilisation of MUST for risk scoring patients on admission increased to over 90%.

Nutrition screening practices in Australian healthcare facilities: A decade later

AbstractAim: Nutrition screening can identify patients at risk for malnutrition so that early nutrition intervention can be initiated. The aim of this descriptive study was to compare nutrition screening practices in Australian hospitals in 2008 with those in 1995.Methods: A survey on nutrition screening practices in Australian healthcare institutions was sent to members of the Dietitians Association of Australia in 1995 and a similar survey in 2008.Results: Sixty‐eight hospitals responded to the 2008 survey and 124 hospitals to the 1995 survey. The number of hospitals reporting the conduct of nutrition screening has increased since 1995 (78% vs 23%). The number of patients being screened has also increased (all admissions 54% vs 35%) and the time taken to screen a patient has decreased (0–5 minutes 64% vs 13%). The Malnutrition Screening Tool was the most frequently reported screening tool used in 2008 (67%). The use of albumin as a nutrition screening parameter (which was the second most commonly used screening indicator after weight loss in 1995) has appropriately decreased (9% vs 65%). There is still some confusion among dietitians as to the definition of screening, with nutrition assessment tools such as Subjective Global Assessment and Mini‐Nutritional Assessment being used during the nutrition screening process (16% in 2008). Insufficient time and staff are still the top two barriers to nutrition screening implementation. Staff training was the most frequently cited strategy to assist with successful implementation of nutrition screening.Conclusion: There has been a significant increase in malnutrition screening over the past decade despite ongoing barriers to implementation.

Nutrition screening practices in adult day care centers: a national survey.

Older adults have been identified as one of the largest groups at risk of malnutrition in America and represent the target population of the Nutrition Screening Initiative. At the University of Delaware Adult Day Care Center, nutrition screening is an integral component of basic services provided to clients and their caregivers. To determine the extent of current nutrition screening practices in other adult day care centers, centers across the United States were surveyed. A total of 160 centers (53%) responded; 101 indicated nutrition screening was an on-going service. A number of differences and similarities in nutrition screening parameters was evident. Most centers responding assessed the following parameters: food intolerance, medical history, weight, height, swallowing difficulties, and bowel habits. Hematological parameters and other anthropometric measurements were evaluated with least frequency. Interest in nutrition screening appeared great. Further research should examine relationships between nutrition screening and other factors such as staffing patterns, center settings, and funding sources.