It has been estimated that malnutrition affects 50% of hospice patients. Nutritional assessment and support is vital in palliative care, since inadequate hydration and nutrition results in skin and muscle wasting, vulnerability to the development of pressure ulcers, and susceptibility to infection.
Method Clinical and catering staff established a nutritional steering group with the brief of introducing an assessment tool and improving the evaluation and management of nutritional risk in the hospice.
The group identified several nutritional assessment tools and concluded that none were ideal for use in the hospice setting. The Nutritional Screening Tool was adapted to identify significant risk of nutritional problems in inpatients. The group devised a new policy and procedure for nutritional care along with an information leaflet for patients and families to support them in managing their own nutritional risk. Inpatients were given the opportunity to choose meals, snacks and drinks. Training for all staff on nutritional assessment using the tool and management of nutritional risk was provided
Results Following staff training and implementation of the assessment tool, an audit was undertaken which showed:
96% of patients had a nutritional assessment completed within 24 h of admission.
100% of patients requiring an individualised care plan had one formulated.
89% of all patient meals were recorded by catering team.
Conclusion This simple intervention made a significant improvement in the assessment and management of nutritional risk in the hospice inpatient population compared to the baseline audit prior to the revised policy. Clinical and Catering staff working together has made a positive impact on practice for inpatients. In recognition that people admitted to the hospice are often frailer and more likely to already have established malnutrition, the nutritional tool has now been introduced to the hospice outpatient services. This will hopefully delay the onset of malnutrition in these patients.
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