The problem of hospital malnutrition has been identified only over the last thirty years or so. It is an issue that occurs frequently, with 15 to 30% of hospitalised children in industrialised nations qualifying as malnourished [1–3] and with nearly 50% at risk for malnutrition during their hospital stay . Because it increases morbidity and mortality risk for the subjects affected (through issues such as infections, metabolic disorders, pressure ulcers and postoperative complications), malnutrition is potentially serious .
Hospital malnutrition is an underestimated problem. As many as half of malnourished children do not receive appropriate treatment for this issue, even in university hospital centres [6, 7]. One of the main obstacles to the provision of quality care to malnourished children is their dispersal among a hospital’s various medical departments . In addition, this care requires the coordinated involvement of physicians, dieticians, nurses, paediatric auxiliary nurses and physiotherapists.
The Committee on Nutrition of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has issued recommendations to establish nutrition support teams in paediatric hospitals, to implement screening for nutritional risk, to identify patients who require nutritional support, to provide adequate nutritional management, to educate and train hospital staff, and to audit practice . In order to extend the management of malnutrition in health care facilities, multidisciplinary teams focusing on clinical nutrition were established on an experimental basis in France starting in 2007 . These multidisciplinary nutrition teams comprise physician nutrition specialists, nurses and dieticians. Such forms of organisation should facilitate the treatment of malnutrition in hospitals, involving clinical teams in systematic nutritional assessment that enables screening and leads to appropriate treatment . The introduction of such teams should make it possible to reduce the prevalence of complications linked to malnutrition, improve the prescription of nutritional supplements and promote the dissemination of good practice, thereby leading to substantial economic savings .
The establishment of such teams within hospital facilities remains nonetheless difficult. In addition, the Nutritional Support Team (NST) is not always addressed appropriately, and an intervention strategy is required. We have consequently developed a multifaceted intervention that was coordinated by the NST and that aimed to:
Raise awareness regarding the malnutrition issue,
Train clinical teams regarding guidelines for good practice,
Facilitate the screening of malnourished children through the use of an electronic alert system,
Assist in decision making regarding the clinical teams’ care and treatment of malnourished children, with either a dietician or the NST enlisted to provide expertise,
Coordinate nutritional care among several categories of health care professionals (nurses, auxiliaries, physicians and dieticians).
French guidelines for good practice relative to hospital malnutrition refer to a nutritional care algorithm that uses the children’s weight/height and height/age ratios . The integration of this algorithm, as an automated decision support tool within the hospital data processing system, should improve the relevance of the multidisciplinary nutrition team’s interventions on hospitalised malnourished children .
This study aims to evaluate the impact of a multifaceted intervention (including electronic medical alerts) coordinated by a NST, in compliance with to recommended practices for the care of malnourished children, among health care workers of a paediatric university hospital.