Malnourished adults’ receipt of hospital discharge nutrition care instructions: a pilot study

Abstract

Background Malnutrition remains an important yet under‐recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition‐focused discharge care provided to malnourished adults. Methods We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4‐month period. Results Seventy‐six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake. Conclusions A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post‐discharge nutrition care instructions.

Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance

“…This highlights the need to reach vulnerable groups in the community and to be able to identify issues before they develop. This would include: practical ways of measuring nutritional status and body composition validated against criterion measurements ; improvements in communication after discharge ; and adaptation of the current screening methods according to the circumstances . Improvements in this area have already been made with novel developments in self‐screening tools that are more suitable for community use in the voluntary sector domiciliary care and with social care partners.…”

Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals

“…94 Further, nutrition recommendations at discharge were often inadequate. 93 Adherence to dietitian-prescribed ONS after discharge was lower than when prescribed by the primary care physician. 96 It was suggested that transition care models could improve continuation of malnutrition care into the community.…”

“…Fifteen articles, [70][71][72][86][87][88][89][90][91][92][93][94][95][96][97] including 2 systematic reviews, 86,87 5 RCTs, [70][71][72]88,89 and 3 non-RCT interventions, [90][91][92] focused on postdischarge nutrition care. It was found that dietitian consults after discharge were rare, 95 despite a quarter of medical and surgical patients showing continued weight loss after return to the community.…”

“…It was found that dietitian consults after discharge were rare, 95 despite a quarter of medical and surgical patients showing continued weight loss after return to the community 94 . Further, nutrition recommendations at discharge were often inadequate 93 . Adherence to dietitian‐prescribed ONS after discharge was lower than when prescribed by the primary care physician 96 .…”

How can we tackle malnutrition in patients discharged from hospital?

“…Research also confirms that the majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. In adult patients identified by dietitians as being malnourished, records show that only 6.6% received discharge instructions to consume oral nutrition supplements while almost half (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake (Brooks et al, 2019).…”