Evaluation of the flowchart of nutritional management of adult patients hospitalized in medicine, surgery and rehabilitation at the CHR de la Citadelle (Liège, Belgium)

• Published in: Nutrition clinique et métabolisme 2016-03, Vol.30 (1), p.66-66
• Main Authors: Al-Halabi, S.A., Luca, C., Delbrassine, N., Beque, L., Gazzotti, C.
• Format: Article
• Language: English
• ISSN: 0985-0562; 1768-3092
• DOI: 10.1016/j.nupar.2016.01.082

As part of a nutritional support systematic review of adult patients hospitalized in medicine, surgery and rehabilitation at The Citadel regional hospital (Liège, Belgium), starting on 01/12/2014 and using the liaison committee on feeding and nutrition (CLAN: Comité de liaison alimentation et nutrition), the nursing department implemented a flowchart. The first part of the NRS-2002 was integrated into the nurse anamnesis. The goal was to evaluate the application of this multidisciplinary flowchart after five months of operation. A retrospective study was conducted from April to August 2015. The work of dieticians (12 respondents) and nurses (47 nurses interviewed) was analyzed with specific questionnaires. Then, audits of nurse records (334 record audited) and also of doctors’ corresponding letters were carried out. Five months after the introduction of the nutritional support systematic review, two nurses out of 12 did not note down the NRS-2002 score and/or undernutrition grade. The flowchart allows targeted nutritional support systematic reviews. The results showed that 75% of polled nurses know the NRS-2002 and 25% do know it but not its name. 94% of the nurses contacted the dietician in case of NRS-2002 Part 1 score>0. The audit of nurse records revealed that 21% had completed the first part of NRS-2002, i.e. 63% were incomplete, with at least one of the requested items not completed and 16% were not completed. For the 63% of incomplete records, the main item missing was body mass index (BMI). The provision of BMI scales could be a solution. The patient weight was found for 78% of nurse records via the NRS-2002 Part 1 and for 48% the weight was found elsewhere in the files. The NRS-2002 Part 1 is problematic for care units with significant turnover. Nurses ask for training. Little or no nutritional information were found in doctors’ output letters when a nutritional support systematic review was performed. This constitutes a lack of justification for the length of stay and quality of nutritional support systematic review. Five months after the introduction of the flowchart, it is properly applied by nurses and dieticians. Nurses are aware of undernutrition but wish to better understand the NRS-2002 to avoid automatic application. The results of the nurse questionnaires and the audit of nurse records were given to each care unit for analysis. The flowchart will be explained during nurse continued training and to new staff. It is essential to involve do