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

Abstract

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.

Keywords: Compliance; Disease-related malnutrition; Hospitalized patients; Medication rounds; Nutritional support; Oral nutritional supplementation.