Implementation of nutritional guidelines in a university hospital monitored by repeated point prevalence surveys.

BACKGROUND/OBJECTIVES: 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. SUBJECTS/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.

[Weight and weight gain in pregnancy]. / Vekt og vektøkning hos gravide.

This article reviews different aspects of maternal weight before and during pregnancy and weight gain in pregnancy, e.g. causes of undernourishment (hyperemesis, anorexia nervosa and bulimia nervosa). Physiological weight gain during pregnancy is normally between 10 and 16 kg, representing 20% of the body weight before pregnancy. The increase in weight is usually lowest during the 1st trimester and greatest between the 17th and the 24th week of pregnancy. Low maternal weight at conception may cause low birthweight. Undernourishment may cause premature delivery or low birthweight, or both. There is an increased risk of gestational diabetes and macrosomia, as well as preterm delivery and hypertension in pregnant women who are overweight. There is also an increased risk of complications arising during general anaesthesia and operative delivery in severely overweight women. These women should be offered heparin or dextran as thrombosis prophylaxis where a caesarean section is to be performed. They should also be given antibiotic prophylaxis. A weight gain of between 7 and 12 kg reduces the risk of complications in overweight patients.