Healthcare News & Insights

Patient malnutrition an undertreated problem in hospitals

Hospitals traditionally sent patients home with discharge instructions and prescriptions. But some hospitals are going even further, sending their patients home with detailed dietary plans to fight a growing problem: malnutrition.

99946745Malnutrition is an often-overlooked problem in hospital patients. According to a press release issued by the Alliance to Advance Patient Nutrition, nearly a third of patients are admitted to the hospital already malnourished – and the condition is rarely recognized.

Result: Patients are treated for other problems while having their nutritional needs ignored, which causes their condition to worsen. This prolongs recovery and makes readmission more likely.

Making nutrition matter

Even if patients aren’t already malnourished when they’re admitted to the hospital, there’s still a significant chance they’ll develop the condition during their hospital stay, as detailed in a report from the Journal of Parenteral and Enteral Nutrition.

A significant number of patients in the hospital have increased nutritional needs because of their conditions. However, many patients have trouble eating while they’re in the hospital due to issues such as lack of appetite, upset stomach or the side effects of various medications.

Together, these factors help contribute to the likelihood that patients will become malnourished. In fact, according to the report, one-third of patients who weren’t malnourished at the start of their hospital stay will develop the condition before they’re released.

Key principles

As a way to combat this problem, the Alliance to Advance Patient Nutrition identified six key principles hospitals can follow to address the problem of malnutrition:

  1. Create an institutional culture where all stakeholders value nutrition. It’s essential to emphasize the importance that proper nutrition has on patient outcomes, and to give support to any interventions that are appropriate to treating malnourished patients.
  2. Redefine clinicians’ roles to include nutrition care. Often, hospitals leave nutrition education solely to dieticians or nutritionists. In reality, all providers, including doctors and nurses, should play a role in helping patients meet their nutritional needs.
  3. Recognize and diagnose all malnourished patients and those at risk. Make sure that all staff are able to identify the signs and symptoms of malnutrition in patients, regardless of their weight. Have clinicians use screening tools to assess and diagnose patients who may be malnourished.
  4. Rapidly implement comprehensive nutrition interventions and continued monitoring. Patients identified as malnourished, or at risk for developing this problem, should receive immediate care. It’s good policy to feed patients within 24 hours of being classified as “at risk,” and their subsequent food intake should be closely tracked and monitored.
  5. Communicate a nutrition care plan. Patients and their families should be told of their status and the planned treatment, and a diagnosis of malnutrition should be documented in the medical record so other providers can follow the established plan of care.
  6. Develop a comprehensive discharge nutrition care and education plan. A detailed nutrition plan should be given to patients and caregivers, and any other providers who will be in charge of the patient’s care upon release. Clinicians should reiterate the importance of proper nutrition and answer any questions patients have before they’re discharged.

Going the extra mile

Following the six steps is a great start. However, other hospitals have gone even further when it comes to improving patients’ nutrition. Instead of merely giving patients printed nutrition plans, they’ve started having meals delivered to patients’ homes.

Several hospitals in Boston are testing out this strategy, as described in an article in the Boston Globe. A group of hospitals run by Steward Health Care hired a local fresh foods company to drop off healthy meals at the homes of heart failure patients.

People with heart disease have some of the highest rates of readmission to the hospital, so Steward decided to specifically target these patients.

Over a one-month period, the health system is forking over $66,000 to purchase meals for 55 heart failure patients, hoping that the investment will pay off in terms of lower readmissions – and fewer penalties from the government for high readmission rates.

The nutritionally balanced prepared meals are low in sodium, which is key to keeping heart failure in check, and made with natural ingredients. Patients will receive three meals each day, along with two snacks.  Options include “egg” salad sandwiches made with tofu, strawberry oat squares, and bean and kale burritos.

Besides these pre-packaged meals, Steward is also giving patients additional nutritional counseling and suggested recipes they can cook themselves after the month-long initiative ends.

Time will tell if their efforts will be successful, but if they are, this could give hospitals across the country another weapon to battle the ever-growing problem of readmissions.


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