Introduction Malnutrition is well recognised as a treatable cause and result of ill-health. The recognition and management of malnutrition hinges upon the quality of organisation of nutrition services as well as the quality of the interventions themselves. Malnutrition is common amongst inpatients and decisions regarding management are often complex. The care of patients with complex nutritional needs can be optimised by combining the expertise of those from multiple allied disciplines. These principles are highlighted in the 2006 NICE guideline: Nutrition Support in Adults. This study analyses the progress made at an organisational level in providing nutrition services in hospitals across the North East of England, with reference to recommendations made by NICE.
Methods Nutrition service provision was evaluated by distributing questionnaires to all acute hospitals in the North East region in 2003, 2007 and 2012. Questionnaires were completed by a dietician from each hospital. The questionnaire addressed the provision of Nutrition Support Teams. We analysed the representation of team members from different disciplines, frequency of meetings and topics discussed. We also sought qualitative and quantitative data regarding inpatient and outpatient use of Total Parenteral Nutrition (TPN), the use of malnutrition screening tools and access to obesity services.
Results Response rates were 92% in 2003 and 100% in 2007 and 2012. Over 9 years the percentage of hospitals with Nutrition Support Teams has increased from 19% to 42%. Each team discusses an increasing number of patients as well evaluating and developing their local policies and procedures. In line with NICE recommendations, 100% of acute trusts have a Nutrition Steering Committee in 2012, rising from 31% in 2003 and 94% in 2007. The number of patients able to access inpatient TPN has increased across the region whilst the provision of home TPN has been concentrated towards larger, tertiary facilities. The use of standardised inpatient screening tools has increased from 80% in 2003 to 100% in 2012. Screening of outpatients in acute hospitals has increased from 15% in 2003 to 33% in 2012.
Conclusion Nutrition service provision has evolved beyond recognition over the last 9 years in the North East. Significant progress has been made in forming focused Nutrition Support Teams, expanding TPN delivery and detecting malnutrition, particularly among the inpatient population. Areas for improvement include the development and promotion of efficient and practical methods to screen outpatients for malnutrition. Ultimately, it is hoped that we can demonstrate our developments have had a significant and sustained impact upon patient care and outcomes.
Disclosure of Interest None Declared.
Nutrition support in adults (CG32): 2006 NICE guideline