title: Implementation of nutritional guidelines in a university hospital monitored by repeated point prevalence surveys.
abstract: OBJECTIVE
  Malnutrition is present in 20-50% of hospitalized patients, and nutritional care is a challenge. The aim was to evaluate whether the implementation of a nutritional strategy would influence nutritional care performance in a university hospital.
  
  
  METHODS
  This was a prospective quality improvement program implementing guidelines for nutritional care, with the aim of improving nutritional practice. The Nutrition Risk Screening (NRS) 2002 was used. Point prevalence surveys over 2 years to determine whether nutritional practice had improved.
  
  
  RESULTS
  In total, 3604 (70%) of 5183 eligible patients were screened and 1230 (34%) were at nutritional risk. Only 53% of the at-risk patients got nutritional treatment and 5% were seen by a dietician. The proportion of patients screened increased from the first to the eighth point prevalence survey (P=0.012), but not the proportion of patients treated (P=0.66). The four initial screening questions in NRS 2002 identified 92% of the patients not at nutritional risk.
  
  
  CONCLUSIONS
  Implementation of nutritional guidelines improved the screening performance, but did not increase the proportion of patients who received nutritional treatment. Point prevalence surveys were useful to evaluate nutritional practice in this university hospital. In order to improve practice, we suggest using only the four initial screening questions in NRS 2002 to identify patients not at risk, better education in nutritional care for physicians and nurses, and more dieticians employed. Audit of implementation of guidelines, performed by health authorities, and specific reimbursement for managing nutrition may also improve practice.
authors.affiliation: Kavli Research Centre for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway. randi.tangvik@helse-bergen.no
authors.forename: R J
authors.initials: RJ
authors.lastname: Tangvik
authors.forename: A B
authors.initials: AB
authors.lastname: Guttormsen
authors.forename: G S
authors.initials: GS
authors.lastname: Tell
authors.forename: A H
authors.initials: AH
authors.lastname: Ranhoff
mesh_terms: D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D004046:Dietetics; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D008403:Mass Screening; D044623:Nutrition Therapy / Q000592:standards*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D058996:Quality Improvement; D012306:Risk