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Norman G, Mason T, Dumville JC, Bower P, Wilson P, Cullum N. Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries. BMJ Open 2022; 12:e064345. [PMID: 36600433 PMCID: PMC10580278 DOI: 10.1136/bmjopen-2022-064345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment of rapid methodologies is lacking although challenges in ensuring rigour and effective use of resources are known. We mapped reports of rapid evaluations of health and social care innovations, categorised different approaches to rapid evaluation, explored comparative benefits of rapid evaluation, and identified knowledge gaps. DESIGN Scoping review. DATA SOURCES MEDLINE, EMBASE and Health Management Information Consortium (HMIC) databases were searched through 13 September 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included publications reporting primary research or methods for rapid evaluation of interventions or services in health and social care in high-income countries. DATA EXTRACTION AND SYNTHESIS Two reviewers developed and piloted a data extraction form. One reviewer extracted data, a second reviewer checked 10% of the studies; disagreements and uncertainty were resolved through consensus. We used narrative synthesis to map different approaches to conducting rapid evaluation. RESULTS We identified 16 759 records and included 162 which met inclusion criteria.We identified four main approaches for rapid evaluation: (1) Using methodology designed specifically for rapid evaluation; (2) Increasing rapidity by doing less or using less time-intensive methodology; (3) Using alternative technologies and/or data to increase speed of existing evaluation method; (4) Adapting part of non-rapid evaluation.The COVID-19 pandemic resulted in an increase in publications and some limited changes in identified methods. We found little research comparing rapid and non-rapid evaluation. CONCLUSIONS We found a lack of clarity about what 'rapid evaluation' means but identified some useful preliminary categories. There is a need for clarity and consistency about what constitutes rapid evaluation; consistent terminology in reporting evaluations as rapid; development of specific methodologies for making evaluation more rapid; and assessment of advantages and disadvantages of rapid methodology in terms of rigour, cost and impact.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Thomas Mason
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Peter Bower
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Paul Wilson
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
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Yinusa G, Scammell J, Murphy J, Ford G, Baron S. Multidisciplinary Provision of Food and Nutritional Care to Hospitalized Adult In-Patients: A Scoping Review. J Multidiscip Healthc 2021; 14:459-491. [PMID: 33654405 PMCID: PMC7910096 DOI: 10.2147/jmdh.s255256] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Multidisciplinary approaches to nutritional care are increasingly emphasized and recommended. However, there is little evidence of how different disciplines work together collaboratively to deliver optimum quality care to adult in-patients. This scoping review aimed to describe the existing literature on multidisciplinary collaboration to identify the various disciplines involved and the features that influence collaborative working in implementing multidisciplinary food and nutritional care with adult in-patients. METHODS Multiple databases were searched, including MEDLINE Complete, Embase, CINAHL Complete, HMIC, and Scopus, from their inception to December 2019. Data were retrieved from eligible studies. A narrative description of findings is reported with respect to the disciplines involved, the aspects of nutritional care explored, and the collaborative processes categorized using the input, process, and outcome framework. RESULTS Thirty-one studies with heterogeneous study designs met the eligibility criteria. Studies were undertaken in six countries. Findings show a wide diversity of multidisciplinary collaborations in various aspects of nutritional care in all studies. Multidisciplinary nutritional care provision was facilitated by several processes, including training and development, communication and information sharing, and clinical leadership and management support. Outcomes were reported at the patient, team, and organizational levels. CONCLUSION This review reveals the significance of the interrelationship between different disciplines and their complementary contributions towards the delivery of optimal food and nutritional care. Key aspects include the involvement of different disciplines, the clarification of roles and multidisciplinary interrelationships, communication, information sharing, clinical leadership, and management support, all of which facilitated collaborative working. Our review uncovered that these features can significantly influence multidisciplinary working. This review is the first to present literature concerning the attributes that affect collaborative working. Further research is recommended specifically around multidisciplinary nutritional care processes and conditions that allow for better collaborative working.
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Affiliation(s)
- Gladys Yinusa
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Janet Scammell
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Jane Murphy
- Ageing and Dementia Research Centre, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Gráinne Ford
- Dietetic Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Dorset, UK
| | - Sue Baron
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
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Roediger MDA, Marucci MDFN, Santos BZBD, Dourado DAQS, Silva MDLND, Queiroz ECS. [Systematic review of nutritional screening methods for elderly Brazilians living at home]. CIENCIA & SAUDE COLETIVA 2019; 24:2307-2316. [PMID: 31269187 DOI: 10.1590/1413-81232018246.18072017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 09/13/2017] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to identify a specific method of nutritional screening for use on elderly Brazilians living at home. It is a systematic review article using the PubMed, LILACS and Web of Science databases. The eligibility criterion was articles about nutritional screening methods for the elderly. The articles were read by evaluators who selected the methods and classified them according to evidence of validity, reproducibility and acceptability. EndNote software was used for scrutiny of the articles. Twelve methods of nutritional screening were identified, 3 being developed for use in the US population (n = 4), though none for the Brazilian population. In seven methods, the forms were filled out by the elderly themselves, and 4 of these presented anthropometric measures. Only one method produced information on acceptability. Reproducibility and validity was identified in 1 and 8, respectively, however only the Determine Your Nutritional Health® - DNH method presented acceptability data, which is a fundamental aspect in the choice for adaptation and use of the method in another country. Among the methods studied, the DNH was the most appropriate for cross-cultural adaptation and use on elderly Brazilians living at home.
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Affiliation(s)
- Manuela de Almeida Roediger
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | - Maria de Fátima Nunes Marucci
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | - Bruna Zillesg Borges Dos Santos
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | | | - Maria de Lourdes Nascimento da Silva
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | - Elza Cristina Silva Queiroz
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
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Frequency of and Reasons for False-Positive Consults Generated by the Malnutrition Screening Tool. J Nurs Care Qual 2018; 34:E1-E6. [PMID: 29677026 DOI: 10.1097/ncq.0000000000000338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nutrition screening on admission is one way to identify patients with malnutrition. The Malnutrition Screening Tool (MST) is a commonly used screening tool but has been found to generate false-positive consults. PURPOSE The purpose of this research was two-fold: (1) to determine the percentage of nursing screens, using the MST, that generated a false-positive consult for a registered dietitian, and (2) to identify the reasons for these false-positive consults. METHODS During a 3-month period, registered dietitians documented the number of false-positive consults received from the MST and reasons they were received. RESULTS Of the registered dietitian consults generated, 5.5% were deemed false-positive. The most common reason for a false-positive consult was patient-reported weight loss that had resolved. CONCLUSIONS As nurses are integral to completion of the MST, data generated can be used in ongoing education of nursing staff.
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Keller HH, Valaitis R, Laur CV, McNicholl T, Xu Y, Dubin JA, Curtis L, Obiorah S, Ray S, Bernier P, Gramlich L, Stickles-White M, Laporte M, Bell J. Multi-site implementation of nutrition screening and diagnosis in medical care units: Success of the More-2-Eat project. Clin Nutr 2018; 38:897-905. [PMID: 29605573 DOI: 10.1016/j.clnu.2018.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/04/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. AIM To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition. METHODS Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2-5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify nutrition care practices implemented with a variety of strategies and behaviour change techniques. RESULTS All sites increased nutrition screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive nutritional assessment. In Period 1, the nutrition diagnosis and documentation by the dietitian of 'malnutrition' was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6. CONCLUSION The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing the risk of missing malnourished patients. TRIAL REGISTRATION Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.
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Affiliation(s)
- Heather H Keller
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada; Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Canada.
| | - Renata Valaitis
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Celia V Laur
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada; NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge CB4 0WS, UK
| | - Tara McNicholl
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Yingying Xu
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Joel A Dubin
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Lori Curtis
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Suzanne Obiorah
- The Ottawa Hospital, L'Hôpital d'Ottawa, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge CB4 0WS, UK
| | - Paule Bernier
- Ordre professionnel des diététistes du Québec, Montréal, Québec, Canada
| | - Leah Gramlich
- Department of Medicine & Dentistry, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Manon Laporte
- Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland & The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
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Cascio BL, Logomarsino JV. Evaluating the effectiveness of five screening tools used to identify malnutrition risk in hospitalized elderly: A systematic review. Geriatr Nurs 2017; 39:95-102. [PMID: 28943049 DOI: 10.1016/j.gerinurse.2017.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/09/2017] [Accepted: 07/17/2017] [Indexed: 01/29/2023]
Abstract
This systematic review investigated 5 frequently used nutrition screening tools (NSTs) used in hospitals and their effectiveness at identifying malnutrition risk in the elderly. A literature review was conducted to obtain research articles focused on malnutrition screening in hospitalized elderly and effectiveness of the NST used. Twenty six articles were reviewed and evaluated, resulting in 8 that met inclusion criteria. The Mini Nutritional Assessment-Short Form, designed for use in the elderly, resulted in overestimation of malnutrition. Four screening tools did demonstrate more effectiveness in identifying malnutrition risk; however, several different biochemical and anthropometric parameters were used, which prevented meaningful comparisons. There is a need for a universal NST "gold standard" for use in the elderly, and further research is indicated.
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Affiliation(s)
- Brooke L Cascio
- Orlando Health and Rehabilitation Center, 830 W 29th Street, Orlando, FL 32805, USA.
| | - John V Logomarsino
- Central Michigan University, Department of Human Environmental Studies, 842 Maybank Loop, The Villages, FL 32162, USA.
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Keller H, Laur C, Valaitis R, Bell J, McNicholl T, Ray S, Murphy J, Barnes S. More-2-Eat: evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care. BMC Nutr 2017. [DOI: 10.1186/s40795-017-0127-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dupuis M, Kuczewski E, Villeneuve L, Bin-Dorel S, Haine M, Falandry C, Gilbert T, Passot G, Glehen O, Bonnefoy M. Age Nutrition Chirugie (ANC) study: impact of a geriatric intervention on the screening and management of undernutrition in elderly patients operated on for colon cancer, a stepped wedge controlled trial. BMC Geriatr 2017; 17:10. [PMID: 28061830 PMCID: PMC5219771 DOI: 10.1186/s12877-016-0402-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/21/2016] [Indexed: 01/16/2023] Open
Abstract
Background Undernutrition prior to major abdominal surgery is frequent and increases morbidity and mortality, especially in older patients. The management of undernutrition reduces postoperative complications. Nutritional management should be a priority in patient care during the preoperative period. However undernutrition is rarely detected and the guidelines are infrequently followed. Preoperative undernutrition screening should allow a better implementation of the guidelines. Methods/design The ANC (“Age Nutrition Chirurgie”) study is an interventional, comparative, prospective, multicenter, randomized protocol based on the stepped wedge trial design. For the intervention, the surgeon will inform the patient of the establishment of a systematic preoperative geriatric assessment that will allow the preoperative diagnosis of the nutritional status and the implementation of an adjusted nutritional support in accordance with the nutritional guidelines. The primary outcome measure is to determine the impact of the geriatric intervention on the level of perioperative nutritional management, in accordance with the current European guidelines. The implementation of the intervention in the five participating centers will be rolled-out sequentially over six time periods (every six months). Investigators must recommend that all patients aged 70 years or over and who are consulting for a surgery for a colorectal cancer should consider participating in this study. Discussion The ANC study is based on an original methodology, the stepped wedge trial design, which is appropriate for evaluating the implementation of a geriatric and nutritional assessment during the perioperative period. We describe the purpose of this geriatric intervention, which is expected to apply the ESPEN and SFNEP recommendations through the establishment of an undernutrition screening and a management program for patients with cancer. This intervention should allow a decrease in patient morbidity and mortality due to undernutrition. Trial registration This study is registered in ClinicalTrials.gov NCT02084524 on March 11, 2014 (retrospectively registered).
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Affiliation(s)
- Marine Dupuis
- Unité de Recherche Clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
| | - Elisabetta Kuczewski
- Service d'Hygiène Épidémiologie Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France
| | - Laurent Villeneuve
- Unité de Recherche Clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, EAM Parcours Santé Systémique, 4128, Lyon, France.,Université Lyon 1, Lyon, France
| | - Sylvie Bin-Dorel
- Unité de Recherche Clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, EAM Parcours Santé Systémique, 4128, Lyon, France.,Université Lyon 1, Lyon, France
| | - Max Haine
- Service de Médecine Gériatrique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Claire Falandry
- Université Lyon 1, EMR 3738, Oullins, France.,Oncologie Médicale, Centre d'Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Centre Hospitalier Lyon-Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Lyon, France
| | - Thomas Gilbert
- Service de Médecine Gériatrique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Guillaume Passot
- Université Lyon 1, EMR 3738, Oullins, France.,Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Glehen
- Université Lyon 1, EMR 3738, Oullins, France.,Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marc Bonnefoy
- Université Lyon 1, Lyon, France.,Service de Médecine Gériatrique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,INSERM U1060, Laboratoire CarMeN (cardiovasculaire, métabolisme, diabétologie et nutrition), Université Claude Bernard Lyon 1, Pierre-Bénite, France
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Halvorsen K, Eide HK, Sortland K, Almendingen K. Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes. BMC Nurs 2016; 15:70. [PMID: 27980452 PMCID: PMC5134106 DOI: 10.1186/s12912-016-0193-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/28/2016] [Indexed: 01/04/2023] Open
Abstract
Background Nutritional care is a basic human right for all people. Nevertheless, undernourishment is known to be a frequent and serious health care problem among elderly hospitalized patients in Western Europe. Nutritional documentation contributes to ensuring proper nutritional treatment and care. Only a few studies have explored how nurses document nutritional care in hospitals, and between hospitals and nursing homes. Available research suggests that documentation practices are unsatisfactory. The aim of this study was to explore how nurses document nutritional treatment and care for elderly patients in hospitals and how nurses and undergraduate nurses communicate information about patients’ nutritional status when elderly patients are transferred between hospital and nursing homes. Methods A qualitative study was conducted using a phenomenological-hermeneutic approach. Data was collected in focus group interviews with 16 nurses in one large university hospital, and 11 nurses and 16 undergraduate nurses in five nursing homes associated with the university hospital. Participants from the university hospital represented a total of seven surgical and medical wards, all of which transferred patients to the associated nursing homes. The catchment area of the hospital and the nursing homes represented approximately 10% of the Norwegian population in heterogenic urban and rural municipalities. Data were coded and analysed thematically within the three contexts: self-understanding, critical common sense, and theoretical understanding. Results The results were summarized under three main themes 1) inadequate documentation of nutritional status on hospital admission, 2) inadequate and unsystematic documentation of nutritional information during hospital stay, 3) limited communication of nutritional information between hospital and nursing homes. The three main themes included seven sub-themes, which reflected the lack of nutritional screening and unsystematic documentation on admission and during hospital stay. Further the sub-themes elucidated poor exchange of information between hospital and nursing homes regarding the nutritional status of patients. Conclusion Overall, the documentation of nutritional treatment and care for elderly patients was inadequate in the hospital and between health care settings. Inappropriate documentation can create a negative nutritional spiral that leads to increased risk of severe health related complications for elderly patients. Moreover, it hinders nutritional follow-up across health care settings. Electronic supplementary material The online version of this article (doi:10.1186/s12912-016-0193-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristin Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Helene Kjøllesdal Eide
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway ; Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Sortland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Abstract
The Malnutrition Universal Screening Tool (MUST) is frequently cited as a simple screening tool for malnutrition. However, anecdotally, it seems that not all staff find it simple to use. If staff do not find MUST simple to complete, then screening is less likely to be completed accurately. Accurate completion of MUST is essential for malnutrition to be identified and treated, otherwise the nutritional needs of patients with unrecognised malnutrition may be neglected. The use of simplified versions of body mass index score, weight loss score and ulna-length charts together with ongoing training and support may help to improve accurate MUST completion. Audit of MUST completion must consider the accuracy of completion rather than completion alone. Therefore, those auditing MUST completion require a good understanding of the tool. This article draws on the author's own significant experience with applying the MUST tool and synthesises this with evidence from the literature to demonstrate the potential barriers to effective MUST implementation.
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Affiliation(s)
- Alison Smith
- Prescribing Support Dietitian, Medicines Management Team, Aylesbury Vale CCG and Chiltern CCG; Nutrition Advisory Group for Older People (NAGE), British Dietetic Association
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11
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Evaluation of adherence to a nutrition-screening programme over a 5-year period. Eur J Clin Nutr 2014; 68:847-52. [PMID: 24865482 DOI: 10.1038/ejcn.2014.95] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 04/03/2014] [Accepted: 04/10/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Nutrition screening using the Malnutrition Universal Screening Tool (MUST) was implemented for adult patients in 2006. The aim of this study was to assess adherence to the screening programme over a 5-year period after a targeted approach to training ward staff. SUBJECTS/METHODS Following the implementation of MUST on 32 wards, regular audits were carried out. Data on completion rates at ward level were collected by nutrition link nurses and submitted electronically for collation. RESULTS Data on MUST were collected on a total of 17 876 patients during this period. Mean percentage of patients screened with a moderate or high risk of malnutrition was 19% in those screened within 24 h after admission and 28% in those screened at 7 days. Twenty percent of patients had an uncompleted MUST score at 24 h after admission and 15% were uncompleted after 7 inpatient days. After implementation, half the hospital population were being screened on admission. However, a number of wards were neither reporting the data nor completing the screening process. Following targeted training on wards, screening rates improved in 2009 and the number of patients screened improved as ward engagement increased. CONCLUSION Audit has been fundamental in the implementation of MUST and has allowed training, additional time and educational resources to be allocated to specific wards to facilitate improvements in screening. Lead nurse support and monitoring has improved adherence rates and facilitated an increase in the identification of patients at moderate and high risk of malnutrition.
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Guerra RS, Fonseca I, Pichel F, Restivo MT, Amaral TF. Hand length as an alternative measurement of height. Eur J Clin Nutr 2013; 68:229-33. [DOI: 10.1038/ejcn.2013.220] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 11/09/2022]
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