NUTRITIONAL SCREENING AND ASSESSMENT OF PATIENTS; THE FIRST NATIONAL PROGRAM ON PREVENTION AND CONTROL OF MALNUTRITION IN HOSPITALS

Background and Aim: This national program is going to apply standardized nutrition consultation in hospitals in order to prevent and control of malnutrition in hospitals. The other specific goals are: shortening the duration of hospitalization, help to accelerate treatment, patient satisfaction, setting up a coordinated and standard nutritional assessment, nutrition consultation and patient education before discharging for control of diseases and improving lifestyle. This program is applying in national scope and all of the provinces and universities engaged with this program.Methods: Malnutrition is a common problem in hospitalized patients. The consequence of malnutrition is broad and ultimately affect quality of life. It increases length of staying in hospital, risk of unsuccessful treatment, mortality and morbidity risk and costs of hospitalizations. For the first time, National Clinical Nutrition Program in IRAN was implemented in hospitals in 2011. This program focused on nutritional assessment of bed ridden patients because nutritional monitoring and evaluation of patient is the first step in nutritional care in hospital. Before implementation of nutritional assessment form, there was no national standard guide for dietitians to assess, monitor and evaluate nutritional status of bedridden patients in hospitals, no cooperation with medical team and any interaction with physicians and nurses in case of patients’ nutritional care. In this case, clinical nutrition executive committee developed 3 forms included: a form for nutritional screening of patients by nurses and 2 other forms for nutritional assessment and fallow up of patients by dietitians. Also we developed a guideline for implementing these forms. All the dietitians in hospitals were trained about applying the forms and communicating with physicians and nurses in the case. The concrete deliverables of the project are: 1. More than 300 national and provincial scientific workshops in 10 topics on diet therapy. 2. 17 national protocols in nutritional consultation in diseases 3. Biannual provincial reports of process and outcome indicators on food and dietetics activities in hospitals Conclusion: When the implementation of the clinical nutrition program started at the first time in hospitals, there were different problems due to gap of standards, lack of nutritional evaluation forms and protocols, a well-defined food catering process, dietitians practice checklist and terms of reference for dietitians. Developing nutrition evaluation forms and standardized food catering in hospitals and planning and conducting training courses for clinical dietitians were the initial outputs of the committee. According to a comprehensive national report based on provincial reports, one year after completing implementation of clinical nutrition program in hospitals and hospital accreditation (from March 2016 to March 2017) we achieved successful results in field of nutrition standards. For example satisfaction of patients in nutritional consultation increased up to 8%, the number of patients that received nutritional consultation in time of discharge increased up to 13%, coverage of nutritional care of patients with kidney disease, dialysis and transplantation increased up to 10%, coverage of nutritional care of patients in ICU and PICU increased up to 9% and coverage of nutritional care of patients with burns increased up to 13%.

کلیدواژه ها:

Screening ، Assessment ، Malnutrition ، Hospital