Is the presence of a validated malnutrition screening tool associated with better nutritional care in hospitalized patients?

Abstract

Objective: The aims of this study were to evaluate the association between the use of clinical guidelines and the use of validated screening tools, evaluate the nutritional screening policy in hospitals, and examine the association between the use of validated screening tools and the prevalence of malnutrition and nutritional interventions in hospitalized patients.

Methods: This was a cross-sectional, multicenter study. Data were collected using a standardized questionnaire on three levels: institution (presence of a guideline for malnutrition), department (use of a validated screening tool), and patient (e.g., malnutrition prevalence).

Results: In all, 53 hospitals with 5255 patients participated. About 45% of the hospitals indicated that they have guidelines for malnutrition. Of the departments surveyed, 38.6% used validated screening tools as part of a standard procedure. The nutritional status of 74.5% of the patients was screened during admission, mostly on the basis of clinical observation and patient weight. A validated screening tool was used for 21.2% of the patients. Significant differences between wards with and without validated screening tools were found with regard to malnutrition prevalence (P = 0.002) and the following interventions: referral to a dietitian (P < 0.001), provision of energy-enriched snacks (P = 0.038), adjustment of consistency (food/drinks; P = 0.004), monitoring of the nutritional intake (P = 0.001), and adjustment of the meal ambiance (P < 0.001).

Conclusion: Nutritional screening with validated tools in hospitalized patients remains poor. Generally, the nutritional status of patients is screened with unreliable parameters such as clinical observation and body mass index. The results of the present study suggest that the use of validated malnutrition screening tools is associated with better nutritional care and lower malnutrition prevalence rates in hospitalized patients.

Keywords: Dietitian; Guideline; Hospital; Interventions; Malnutrition; Screening.