"nutritionDay worldwide" is a large scale, worldwide action project designed to reduce disease-related malnutrition among hospitalised patients and nursing home residents. The aim of this project is to increase awareness and knowledge regarding disease-related malnutrition in hospitalised patients and the elderly.
Background In 1977 poor nutritional status and malnutrition was already detected in surgical patients. Still, disease-related malnutrition is a much underrated public health issue and has also become an enormous economical concern. It is estimated that over 50 million Europeans are at risk. A study performed in the UK in 2005 estimated the cost of malnutrition to the UK to be €10.6 b per year, double the projected €5.1 b cost of obesity. Two population groups are at particularly high risk: hospitalized patients and residents of nursing homes. Disease-related malnutrition can be responsible for a prolonged hospital stay, morbidity and premature mortality in hospitalized patients. Research has shown that approximately 31% of all hospitalized patients can be considered malnourished or at nutritional risk. Previous nutritionDay studies have shown that malnutrition is a major health concern that still gets too little attention in hospitals and nursing homes. Malnutrition, as it has been shown in many studies, increases infection rates, affects the patient's wound healing, leads to cardiac complications, and also prolongs hospital stay.
Obesity and Disease related Malnutrition Generally health care focuses mainly on the increasing incidence of obesity. Initially, health providers believed only patients with low body weight or low body mass index (BMI < 18.5 kg/m2) could be malnourished. However, studies show that BMI is not always a good parameter to detect malnutrition, and other screening tools should be used. Analysis shows that a high percentage of body fat reduces the sensitivity of BMI to detect nutritional depletion.
Disease related Malnutrition in Hospitals Internationally, the issue of disease-related malnutrition was raised in various forums, most clearly in the adoption of a resolution by the Council of Europe. Resolution ResAP (2003)3 on Food and Nutritional Care in Hospitals of the Committee of Ministers of the Council of Europe emphasizes inter alia the unacceptable number of undernourished people in hospitals and the beneficial effects of adequate food service and nutritional care in hospitals on patients’ recovery and quality of life. The resolution identifies a long list of actions to be undertaken to remedy the situation.
nutritionDay worldwide – The Project The project “nutritionDay worldwide” addresses improved patient safety and quality of care by raising awareness and increasing knowledge about disease-related malnutrition. NutritionDay establishes a worldwide chart in which nutritional status and prevalence of malnutrition are portrayed. Further, it documents relevant nutritional infrastructures in hospitals and nursing homes. The aim of the project is to emphasize the importance of adequate clinical nutrition in both settings. In January 2006 the project was conducted for the first time under the direction of Univ. Prof. Dr. Michael Hiesmayr (Medical University of Vienna) with support of the Austrian Society of Clinical Nutrition (AKE) and the European Society for Clinical Nutrition and Metabolism (ESPEN). A subsequent audit took place in January, 2007, when the project was extended to intensive care units (ICU) and nursing homes. Since then, nutritionDay is performed in all 3 settings. In 2012 “oncology nutritionDay” was performed as the first disease-specific nutritionDay. The audit is unit and patient-centered. Information about the actual nutrition care and nutrition monitoring on participating wards is gathered using four questionnaires. This happens on one single day worldwide. The hospital ward as an organizational unit is of particular interest. The ward, with all its specific characteristics and local culture, is the direct centre of care for a group of patients within the hospital. The direct interview of patients is a characteristic specific to “nutritionDay project”. Ward patients are surveyed about their eating habits on the day (“how much of your meal did you eat?”) and about the reasons for not eating.
Transnational multilingual Approach
Hospital wards and nursing homes from 51 countries have already participated in nutritionDay. In January, 2013, the nutritionDay database counts more than 132.000 datasets from patients and nursing home residents. The questionnaires are available in over 30 languages. This enables the project to include minority groups of patients (e.g. immigrants, non-native speakers).
Performance of the nutritionDay audit On one specific first or second Thursday in November, the “nutritionDay” takes place every year. On this day, participating hospital wards and nursing homes collect data on the nutritional status of their patients and residents and record supply structures relevant for nutritional care. Thus, participants receive an actual snapshot of their hospital unit or nursing home. After a specified period (30 days for ward patients, 60 days for ICU patients and 6 months for nursing home residents) of time, a follow-up evaluation is performed which gives information on the patients’ outcome. After data collection, the hospital staff transfers the data into a database that is accessible over the website http://www.nutritionday.org. An individual code guarantees anonymity of participants. Promoting compliance with HIPPA (Patient privacy act) Each unit receives an online feedback report about its nutritional care position compared to all other participating units of the same specialty type. Repeated participation in the audit allows benchmarking designed to enhance learning within units and to track changes in local practice and international trends.
… excerpt ends here. Continue reading the full article.
