“Assessment of Malnutrition Care Practices and Knowledge in Lebanese Hospitals

Abstract

Undernutrition is a debilitating and highly common condition in the acute hospital setting and it is associated with devastating adverse health and economic outcomes. Several guidelines aim to standardize and optimize hospital malnutrition care practices; however such practices are still insufficient in certain areas due to several barriers especially in developing countries like Lebanon. Data on the current situation of malnutrition care practices in Lebanese hospitals is still unavailable. Therefore, this study aims to describe the quality of malnutrition care in Lebanese hospitals and explore barriers and facilitators to these practices in order to ultimately implement potential strategies to achieve optimal practice. The study is of an observational cross-sectional design where data was collected online through validated questionnaires by the Malnutrition Quality Improvement Initiative MQii addressing actual malnutrition practices, malnutrition knowledge and awareness, as well as the hospitals’ readiness to implement initiatives pertinent to malnutrition care. In addition, semi-structured interviews were held with eight dietitians to acquire qualitative data mainly on the barriers and facilitators of proper malnutrition care. Fifty-eight out of 95 hospitals completed the practice questionnaire. Results showed that private hospitals scored better than governmental hospitals for the malnutrition practice questionnaire (80.4% of private hospitals scored in the “Good Practice” category versus 37.5% for governmental hospitals: P-value= 0.009) and that the presence of a documented malnutrition care protocol was significantly associated with this practice score (P-value = 0.045). Moreover, for malnutrition knowledge and awareness score, the mean average was 8.56 ± 3.22 out of 17 and it was significantly associated with the hospital academic affiliation (P-value = 0.016), location (P-value = 0.006), and size (P-value = 0.036). In addition, the most common barriers identified from the interviews were related to human and financial resources and potential facilitators were mostly related to inter-professional communication and protocol standardization. In conclusion, practice gaps and areas of development were identified in this study in order to serve as a first step for hospitals eager to apply a quality improvement initiative for their malnutrition management systems.