Effects of nursing nutrition interventions on outcomes in malnourished hospital inpatients and nursing home residents: A systematic review.

CONTEXT: Malnutrition in institutionalized patients is associated with adverse outcomes and increased costs. Nurses have a crucial role in the recognition and treatment of malnutrition and empowering patients in nutritional care. OBJECTIVE: This systematic review provides an overview of the effectiveness of nursing nutritional interventions to counteract malnutrition. DATA SOURCES: Data were obtained through a systematic search in MEDLINE/PubMed, Cochrane, CINAHL, EMBASE and ISI Web of Science databases from inception to February 15th 2018. DATA EXTRACTION: Studies were eligible for inclusion when published in English, Spanish or German. Primary outcome parameters were nutritional status and dietary intake. DATA ANALYSIS: The Evidence analysis checklist from the American Dietetic Association and GRADE were used to evaluate the methodological quality of the studies. RESULTS: Out of 8162 studies, fifteen studies were included in the study, representing nine hospitals and six long-term care facilities. Two main categories of nursing nutrition interventions were identified; the implementation of 1) a nursing nutrition plan focusing on nursing actions in nutritional care or 2) nursing assistance in feeding support, mostly during mealtimes. Studies were heterogeneous and of most of them of low quality. This hampered drawing conclusions on effectiveness of nursing nutrition interventions on malnutrition related outcomes in clinical care. Nevertheless, six out of 15 studies reported a slightly improved nutritional status and/or clinical outcomes as a result of the interventions. CONCLUSION: This review identified two categories of nursing nutrition interventions to counteract malnutrition. Their effectiveness needs to be further evaluated in future studies. Tweetable abstract: Systematic review of effective Nursing Nutrition Interventions in the management of malnutrition in hospital and nursing home care.

The effects of the administration of oral nutritional supplementation with medication rounds on the achievement of nutritional goals: a randomized controlled trial.

BACKGROUND & AIMS: Oral nutritional supplements (ONS) are often considered for hospitalized patients with acute severe malnutrition, however the compliance to the supplements is known to be variable. The aim of our study was to investigate whether providing a lower volume of ONS at a higher frequency during medication rounds would improve the intake of the supplements. METHODS: In this randomized controlled trial, 234 malnourished inpatients (mean age 71.2 years, 55% male, median LOS 10 days) were randomized to receive ONS (300 kcal and 12 g Protein per 125 ml serving) in one of three different schemes. The usual care group (n = 88) was offered ONS 125 ml twice per day in between meals. This was compared to two intervention groups that were offered ONS during medication rounds: intervention group 1 (n = 66) received 125 ml of ONS twice per day, at 12 and 17 o'clock, and intervention group 2 (n = 80) received 62 ml of ONS four times a day, at 8, 12, 17 and 20 o'clock. Follow-up was performed until discharge or until ONS was no longer needed, with a maximum follow-up period of 30 days. The primary outcome measure was the percentage of patients who consumed at least 75% of the prescribed volume of ONS. RESULTS: No significant differences were observed between the control groups and intervention group 1 (risk difference of -16.0% (95% CI -33.2-1.2). However, the percentage of patients consuming at least 75% of the prescribed ONS was higher in intervention group 2, with a risk difference 23.4% (95% CI 7.8-39.0%) and a mean increased intake of 35 ml (84 kcal) per day, p < 0.001). Median time ONS were taken was 5 days (range 1-17). CONCLUSION: A higher frequency of a lower volume of ONS during medication rounds increased the compliance of patients needing ONS. Clinical trial registration number NTR2535; www.trialregister.nl.