One in four patients admitted to hospital is affected by malnutrition

Nutrition and hydration care is not viewed as a priority for some Irish hospitals according to a new review published today by the Health Information and Quality Authority (HIQA).

Malnutrition affects more than one in four patients admitted to hospital. Despite this, 21% of public acute hospitals don’t have a system of screening in place for the risk of malnutrition.

The annual healthcare costs associated with disease-related malnutrition were estimated at €1.5 billion in a 2012 study.

Susan Cliffe, HIQA’s Head of Healthcare, said: “Food should be seen as an integral part of a patient’s treatment, rather than a ‘hotel service’ provided by the hospital. Many patients experience unintentional weight loss of over 10% of their body weight prior to admission and their nutritional status often deteriorates while in hospital. Nutrition and hydration is fundamental to their treatment and recovery plan of care.

“It is recognized internationally that malnutrition and dehydration can compromise the quality of life of patients, affect their recovery and cause unnecessary illness and death. In patients at risk, it can go undetected unless systems are in place to identify and manage it.”

As part of the review, HIQA analyzed information from 42 hospitals, carried out unannounced inspections in 13 of these hospitals, spoke with 579 patients and 363 staff, and reviewed 322 patient healthcare records.

While many hospitals demonstrated a commitment to promoting and leading improvements in nutrition and hydration, there was a wide variation in findings.

Susan Cliffe added: “Every patient should be screened for risk of malnutrition within 24 hours of admission to hospital. Our review shows that only half of the 42 hospitals are doing this on more than 75% of wards. One in five hospitals has no system of screening for risk of malnutrition in any area of the hospital. Hospitals who have not introduced such screening to date must now proceed, without delay, to implement a system to ensure that all patients are screened for the risk of malnutrition on admission to hospital in line with evidence-based practice”.

Offering and providing drinking water for patients is a basic care requirement. However, HIQA found examples of where the hydration needs of individual patients were not being met.

This mainly applied to patients in emergency departments who were deemed to be admitted, but who remained there for lengthy periods while waiting for a bed in the main hospital.

While all 42 hospitals had stated in advance of inspections that patients had access to fresh drinking water, HIQA inspectors found that drinking water was only topped up by staff during the day in most inspected hospitals if a jug was seen to be empty or at a patient’s request.

In a number of emergency departments, patients who were not mobile and could not access the water cooler were not routinely being offered drinks. In addition there was a lack of consistency in the meals offered to patients in emergency departments.

Less than one in three hospitals inspected had a system to replenish water jugs with fresh water during the afternoon so as to ensure that patients always had access to fresh water.

Access to drinking water should not depend on relatives and visitors and hospitals must ensure that all patients have access to fresh drinking water as required.

Susan Cliffe concluded: “Hospitals need to improve governance of nutrition and hydration to support improvements in screening patients for risk of malnutrition, develop evidence-based policies and audit nutrition and hydration care. Hospitals should strive to improve patients’ experience of hospital food and drink by engaging with patients about food variety and choice. A key feature of this process is the evaluation of patients’ experience of nutritional and hydration care and using patients views to inform and direct change or to reinforce good practices where they exist.”

Ends.

Further Information:

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA 01 814 7480 / 086 2447 623 mwhelan@hiqa.ie

Notes to the Editor:

During the course of this review, HIQA monitored how nutrition and hydration care was provided in hospitals against the National Standards for Safer Better Healthcare, continuing HIQA’s commitment to supporting ongoing quality improvement.

This review was developed and carried out by members of HIQA’s Healthcare Team, who are authorized to monitor compliance with standards, in accordance with section 70(1)(a) of the Health Act 2007.

The Inspection Team was supported by an Expert Advisory Group including patient representatives, healthcare professionals and service providers.

HIQA’s review took place over two phases, as follows:

• Phase-one consisted of a self-assessment questionnaire that was sent to 42 public acute hospitals in July 2015. These were received back from hospitals by HIQA in August 2015 and analyzed.
• Phase-two consisted of unannounced on-site inspections by HIQA and an on-site review of systems and practices in operation in 13 acute hospitals, carried out between October 2015 and February 2016.
• Listening to the experiences of patients played a central role in the HIQA review, and is one of the core recommendations for hospitals.

The four key areas for improvement are:

1. All hospitals should have a nutrition steering committee in place.

2. All patients admitted to hospital should be screened for the risk of malnutrition.

3. Hospitals must audit compliance with all aspects of patients’ nutritional care and share the findings with all relevant staff groups involved in food service and patient care.

4. Hospitals should strive to improve patients’ experience of hospital food and drink by engaging with patients about food variety and choice.