Introduction The 2006 NICE guidelines on “Nutrition support in adults” recommend screening and identification of patients at risk of refeeding syndrome (RS). Despite the implementation of local hospital policies, RS still occurs. This may, in part, be due to a lack of awareness amongst clinicians responsible for at risk patients. We aimed to assess the knowledge and awareness of RS amongst medical doctors in our Trust.
Methods We conducted a questionnaire survey of doctors’ practises between April and August 2008. In total 68 doctors, working in medical specialities, from FY1 to Consultants, were surveyed.
Results The overall response rate was 40 (59%). Only 10% were unaware of RS (all FY doctors). However, only 35% were aware of the importance of correcting electrolyte imbalance when commencing enteral feeding. 30% would not monitor electrolytes daily with 25% of the respondents unaware of the important electrolytes to monitor. Although 90% of respondents recognised thiamine as important supplementation, only 20% indicated they would prescribe this to all at risk patients. Only 58% stated they would provide Vitamin B Co-strong and only 63% multivitamins or trace element supplements.
Conclusion RS is potentially fatal. It is essential that clinicians are aware and able to identify at risk patients. This survey highlights that, although many clinicians are familiar with RS and its effects, there is a lack of awareness regarding the NICE guidelines and practise aimed at its prevention in those patients at high risk. Most strikingly, 65% of the doctors surveyed did not consider starting enteral feed prior to or alongside correcting any electrolyte imbalances. Delaying the onset of enteral feed may put patients at greater risk of malnutrition. Further education and training about RS are necessary for all grades, particularly junior doctors.
Disclosure of Interest None Declared
Mehanna HM, Moledina J, Travis J, Refeeding syndrome: what it is, and how to prevent and treat it. BMJ 2008; 336:1495–1498
NICE guidelines for nutritional support in adults. http://www.nice.org.uk/cg32
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