SKELETONS IN THE HOSPITAL CLOSET

“Every careful observer of the sick will agree in this that thousands of patients are annually starved in the midst of plenty, from want of attention to the ways which alone make it possible for them to take food.” wrote Florence Nightingale in 1859.

The same can be said in 2018.

Malnutrition is overlooked, undiagnosed and untreated.

It is the “skeleton in the hospital closet”.

Malnutrition describes any imbalance in nutrition.

It can be over-nutrition or under nutrition.

In acute hospitals, up to 40% of patients have malnutrition.

The outcomes for patients who have malnutrition is

  1. higher rates of infection and complications.
  2. increased muscle loss
  3. impaired wound healing
  4. longer length of hospital stay
  5. increased morbidity and mortality.

All (or any) of these outcomes means that malnourished patients need more nursing care.

Despite the additional resources that are used because of malnourished patients, a simple correction to a patient’s nutritional status is regularly overlooked or not considered a priority.

The factors that lead to malnutrition in patients are many.

From a patient’s standpoint, the factors that contribute to malnutrition are

  • Age
  • Apathy/depression
  • Disease
  • Inability to buy, cook or consume food
  • Inability to chew or swallow
  • Limited mobility
  • Sensory loss
  • Treatment and drugs that interfere with the above.

Just as important as the personal factors are the organizational factors such as

  • Failure to record height and weight
  • Failure to record patient intake
  • Lack of adequate intake
  • Lack of staff to assist with feeding
  • Failure to recognise malnutrition
  • Lack of nutritional screening or assessment
  • Lack of nutritional training
  • Confusion regarding nutritional responsibility.

Admission is the best time to identify a malnourished patient.

A simple tool that everyone can use to assess malnutrition is the Malnutrition Screening Tool (MST).

It has been validated with general medical, surgical and oncology patients.

Once a patient has been identified at risk, dietetic referral and intervention can occur.

MST assesses recent weight and appetite loss using three simple questions (Points are in brackets) –

  1. Have you lost weight recently without trying?    No (0) or Unsure (2)
  2. If yes, how much weight (kilograms)have you lost?    1-5 (1) 6-10 (2) 11-15 (3) >15 (4) Unsure (2)
  3. Have you been eating poorly because of a decreased appetite?  No (0)  Yes (1)

The maximum total score is 7 points.

A score of 2 or more is a risk of malnutrition.

With a score less than 2, having no risk of malnutrition.

The higher the score, the greater the priority for nutritional intervention.

Patients should be assessed weekly when they are an inpatient.

With this tool, nurses can sweep that skeleton out of the hospital closest.

To learn more about malnutrition,

Barker LA, Gout BS, Crowe TC. Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. International Journal of Environmental Research and Public Health. 2011;8(2):514-527.