Is malnutrition screening and risk assessment being conducted according to NICE guidance for patients admitted to care of Elderly wards in Kettering General Hospital?

Abstract

Introduction: Malnutrition is a common health problem defined as a deficiency in minerals, vitamins, proteins, and other nutrients with harmful health consequences. (1) It is estimated that malnutrition alone cost England about £19.6 billion in 2011-2012, equivalent to nearly 15% of the entire expenditure on healthcare and social care (£101.6 billion), with about 5% of the entire English population being either malnourished or at risk of malnutrition. (2) The British Association for Parenteral and Enteral Nutrition (BAPEN) surveyed 1543 adults (mean age was 70) across the UK in 2022, 45% of them were at risk of malnutrition, with almost a third being at high risk. (3) Malnutrition prevalence was higher in those with frailty, and cancer and those with gastrointestinal, respiratory, and neurological disorders. (3) NICE recommends screening all patients at their first appointments in outpatient clinics. Moreover, all patients admitted to the hospital must have a screening for malnutrition, which must be repeated every week for inpatients or if there is a clinical concern for outpatients. (1) Application of these guidelines can result in a tremendous saving of resources; for example, about £63.2 – 76.9 million net cost saving was achieved when NICE guidelines and quality standards were applied to those with high risk of malnutrition. (2) Several factors can explain why malnutrition costs are very high. Malnutrition is associated with an increased risk of re-hospitalisation, prolonged length of hospital stay, overall functional decline, and even death. (4) Materials and methods: We conducted a prospective audit in the Care of Elderly wards in Kettering General Hospital. We collected data from the nursing charts of patients admitted from September to December 2023. We only included inpatients aged 65 years old or above. The primary measures of the audit were whether the nursing team did the MUST (Malnutrition Universal Assessment Tool) score at admission and whether they repeated it one week after the admission. Other secondary measures included whether dietitian referrals were made where appropriate and whether the nursing team informed other multidisciplinary team members (doctors, physiotherapy team, pharmacy, and discharge team) on the electronic Care Flow connect system. Results and discussion: Figure 1 summarises the main findings of the audit. The mean age of patients in our audit was 82.6 years. About 77%of patients had a MUST score done at admission. Meanwhile, 23% didn't have one at admission. The MUST score after one week showed a similar compliance rate (was done in 76% of cases). Referral to a dietitian was made in 79% of cases. However, 21% of cases didn't have a dietitian referral where it was indicated. Other team members were informed about the dietitian referral in 65% of cases, while they were not informed in 35%. Conclusions: The compliance rate with NICE guidelines for screening for malnutrition was overall good in our wards.