Screening, Diagnosis, and Assessment of Malnutrition Risk Factors in a Hospital Care Setting Prior and Post a Multidisciplinary Educational Intervention

Abstract

Hospital malnutrition among newly admitted hospital patients has been reported to impose deteriorating outcomes on the health status of hospitalized patients and impose burdens on the hospitals and healthcare systems. Early detection, identification of risk factors, and appropriate multidisciplinary treatment of malnutrition remain crucial in attenuating its effects. This study aimed to identify malnourished patients using two screening tools: Mini Nutritional Assessment (MNA) and Nutrition Risk Screening-2002 (NRS-2002), and three diagnostic tools: European Society for Clinical Nutrition and Metabolism (ESPEN) criteria, Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) criteria, and Global Leadership Initiative (GLIM) consensus. In addition, it aimed to assess the potential risk factors of malnutrition, their change with the use of different tools of identification, and evaluate the impact of an educational intervention on the nurses’ knowledge and practices regarding malnutrition. This single center, quasi-experimental study recruited and screened a total of 579 patients, 121(20.90%) of which were identified as nutritionally at risk on the screening tools. Diagnostic assessment revealed that 9.30% of the patients were malnourished on the ESPEN diagnostic tool, 20.62% on the AND/ASPEN tools, and 20.30% on the GLIM consensus. The risk factors of malnutrition differed based on the method used for screening or assessment. Body mass index (BMI), presence of pressure ulcers (PU), and Charlson Comorbidity Index (CCI) score remained significant (p<0.0001) across different logistic regression models for various identification tools. The educational intervention, which was conducted for 101 nurses, revealed significant improvement in knowledge of the nurses regarding their role in malnutrition (p<0.0001). However, only slight advancement in practice was detected as the agreement of the initial malnutrition screening, using the NRS-2002, between the nurses and the dietitians improved from a slight agreement (k=0.612) to a fair agreement (k=0.241). In conclusion, focusing on appropriate screening and assessment of newly hospitalized malnourished patients, identifying potential risk factors of malnutrition, and optimizing multidisciplinary care plans yields better outcomes for patients and health care systems.