Development of a new tool to monitor and identify inadequate oral intake in hospital

Abstract

BackgroundThere is a need for quick and easy methods to monitor nutritional intake in hospital and identify patients with poor intake. Food record charts are often used in clinical practice, with low levels of accuracy and completion. This study aims to describe the development and evaluate the performance of a new tool to estimate energy and protein intake and identify poor nutritional intake amongst adult hospital patients.MethodsNinety trays were sampled and assessed independently using the new tool ‘Meal Intake Points’ and a weighed (reference) method. The performance was tested by measuring association (Spearman's correlation), agreement (proportion of meals within specified limits of reference method), and sensitivity and specificity to identify poor energy and protein intake.ResultsThis new tool achieved very strong association for energy estimates (r = .91) and strong association for protein estimates (r = .86). Estimates for energy and protein were within 450 kJ and 4.5 g of the reference method in 77.8% and 62.2% of meals, respectively. It also displayed excellent performance as a screening tool (sensitivity 100%; specificity 76%‐80%). Minor revision of the original tool was needed to optimise performance.ConclusionsMeal Intake Points accurately estimates energy and protein intake and identifies patients with poor nutritional intake, providing a clinically relevant tool for use in hospitals to monitor intake and identify patients for proactive nutrition support. Further validation studies are needed to determine its performance in clinical practice and whether it is useful in predicting hospital‐acquired malnutrition.

Can hospitalized patients adequately estimate their own food intake? A cross-sectional pilot study

“…In addition, this method may become obsolete over time due to the advent of new technologies in food service systems. Nevertheless, it is still a quick solution for estimating bedside food intake [23]. Some limitations of the present study should be taken into consideration.…”

“…The direct food-weighing method is the gold standard, but it is unfeasible for clinical practice [6,16,17]. Other methods include dietary assessment methods, such as the 24-hour food recall [9,18,19], food intake Visual/Verbal Analogue Scale [20], digital photography [21], energy and protein intake expressed in points [22,23], and food charts, including visual food-intake percentage-estimation charts [3][4][5]10,11,[24][25][26][27][28][29][30][31][32][33][34][35].…”

“…Most of the methods previously mentioned were performed by health professionals (dietitians or nursing staff) who estimated the patients' food intake, except for the ones performed by the patients themselves [9,11,[22][23][24]26,37]. Few studies have assessed the accuracy of the visual food-intake estimation performed by the patients themselves through instruments that indicate the estimated food intake percentages [21,37].…”

Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review

“…A total of fifteen studies (10%) were randomised controlled trials (26,31,45,48,59,62,68,74,107,132,137,142,143,155,164) . The sample size was reported in 150 studies (97%) and ranged from 9 to 1012 participants with the remaining five papers reporting the number of meals or meal trays rather than number of participants (72,82,147,157,166) .…”

Validation of an electronic food intake tool and its usability and efficacy in the healthcare setting

“…25 Hence, accurate and timely access to dietary intake data to identify individuals at risk of malnutrition and the decline or improvement is of paramount importance in implementing targeted nutrition care to improve care and outcomes. Development of new methods to address the limitations of existing systems continue to be published, 16,26,27 demonstrating the need for innovation and technology to deliver where manual paper systems are failing. As recommended by Palmer et al, 1 there is a need for a simple, time-efficient electronic food intake tool that supports accurate capture of intake data without the need for ongoing training.…”