Multidisciplinary provision of food and nutritional care to hospitalised adult in-patients: A scoping review protocol v1

Abstract

O bj e cti ve : O bj e cti ve : The review will examine the evidence and characteristics of multidisciplinary care interventions in food and nutritional care provision for adult in-patients. Introducti on:Introducti on: Providing appropriate nutritional care is fundamental in patient-centred care. Nutritional care requires a coordinated approach to the delivery of food and fluids by different healthcare professionals and the wider hospital staff. Evidence demonstrates improved patients' clinical outcomes by enhancing hospital food and providing nutritional care throughout a patient's pathway. While there are good examples of nutritional care initiatives, implementing appropriate nutritional care remain a challenge. Managing malnutrition particularly with adult in-patients on admission or at risk of becoming malnourished requires multidisciplinary care; the hospital team plays a crucial role in ensuring these patients' nutritional needs are met. The review aims to identify the evidence with specific focus on reported multidisciplinary coordination and collaboration excluding artificial nutritional support (enteral and parenteral nutrition)a domain where wellestablished evidence already exists.Incl usi on cri te ri a : Incl usi on cri te ri a : The context is limited to the hospital setting with an adult in-patient population. Studies involving healthcare professionals or the wider hospital staff will be included. Me thods:Me thods: Primary evidence will be included from both published and unpublished sources. The search strategy will follow the three-step process recommended by Joanna Briggs Institute' (JBI). Data will be extracted after screening from relevant papers by two or more independent reviewers and one or more verifier using a developed data extraction tool. A narrative description of findings will be reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Introducti on Introducti onKey nutrition interventions and strategies to reduce malnutrition have been recommended and some integrated into standard guidelines and policies. For instance, the recommendations for nutrition screening in routine practice to identify people with (or at risk of) malnutrition using validated malnutrition screening tools by the European Society for Clinical Nutrition and Metabolism, British Association of Parenteral and Enteral Nutrition and the National Institute for Clinical Excellence in the UK. 13,14 Nutrition screening as the first step enables appropriate interventions with subsequent monitoring and assessment to be implemented. Global consensus on core diagnostic criteria for malnutrition has also been proposed to enable comparison of malnutrition prevalence,

Prevalence of hospital‐acquired malnutrition and modifiable determinants of nutritional deterioration during inpatient admissions: A systematic review of the evidence

“…Non-dietetics professionals from the multidisciplinary team may be assigned a greater level of responsibility in the detection and management of malnutrition by understanding nutrition risk factors and allowing nursing staff autonomy with implementing low risk nutrition care activities. 4,[68][69][70][71] For example, initiating food and fluid charts, previously established enteral nutrition (EN) orders in the interim when awaiting dietetics reviews, and obtaining patient weights when malnutrition is suspected. Allowing dietitians a greater level of autonomy with nutrition care activities such as ordering privileges for therapeutic diets, prescribing oral nutrition supplements or enteral nutrition regimens, and requesting serology can eliminate delays in waiting for physician sign-off.…”

“…Furthermore, it is recommended to redefine the roles of members within the multidisciplinary team in the provision of nutrition care. Non‐dietetics professionals from the multidisciplinary team may be assigned a greater level of responsibility in the detection and management of malnutrition by understanding nutrition risk factors and allowing nursing staff autonomy with implementing low risk nutrition care activities 4,68–71 . For example, initiating food and fluid charts, previously established enteral nutrition (EN) orders in the interim when awaiting dietetics reviews, and obtaining patient weights when malnutrition is suspected.…”