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Is hospital acquired malnutrition a preventable harm?

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As we head into nutrition and hydration week (12-18th March), Sarah Moppett questions where more can be done to prevent malnutrition in hospitals. 

sarah moppett

I don’t want to completely give my age away, but as a student nurse in the late 80’s , I remember being quite disturbed by an essay I wrote which discussed how the treatment of patients within the acute care system frequently contributed to or caused their malnutrition.

Worse still, I got a decent mark for critical analysis of whether malnutrition in hospitals is preventable.

In contrast, as a young surgical staff nurse, I thought nothing of patients developing pressure ulcers whilst in my care. Stage 3 pressure ulcers were considered an inevitable consequence of ill health; my priorities were to document and treat.

“I can confidently say that year-on-year our patients have developed fewer pressure ulcers and our goal is to totally eradicate pressure ulcers in the sickest patients in our care”

Today, the critical care nurses in our trust have a very different attitude. They care for the sickest, most unstable patients in our region. But they are devastated whenever a patient in their care develops an ulcer; they are scathing when a patient is transferred to them with one that has already developed.

For each ulcer, they analyse systematically to see if it could have been prevented. Our link nurses are constantly searching for innovative ways of preventing them. For the last 8 years I can confidently say that year-on-year our patients have developed less pressure ulcer and our goal is to totally eradicate pressure ulcers in the sickest patients in our care.

As we approach nutrition and hydration week, the question I ask myself is: have we have applied the same rigour to the prevention of malnutrition? Many of those avoidable pressure ulcers have malnutrition as a potential root cause - maybe I may have answered my own question?

If we miss a prescribed turn we worry that we may have contributed to pressure damage in our patients. But if a patient rejects their main meal course, do we accept this or attempt to find something more inviting?

“Within our critical care unit, a simple sticker thought up by a band 5 staff nurse has reduced moisture lesions by 30% in the last year”

Do we consider the nutritional value of each mouthful and the lost nutrition in each mouthful not consumed?

We are increasingly mindful of the diversity of the patients we care for. How well do we consider their diversity in how they might like their food presented, served, their preferred speed of eating, company or solitude?

There is some incredible nurse led work taking place around the nutrition agenda. I am proud of colleagues at our hospitals who have introduced a memory menu, full of food which patients have told us evoke good memories of eating; it’s packed full of traditional favourites.

When we launch this menu shortly, our challenge will be to ensure that we do it justice by taking as much effort to encourage our patients to eat as we do to prevent their tissue damage.

Within our critical care unit, a simple sticker thought up by a band 5 staff nurse has reduced moisture lesions by 30% in the last year. During this year’s nutrition and hydration week, what simple change will you inspire in your care setting?

What nurse led initiative will move us one step closer to making hospital acquired malnutrition a thing of the past?

Sarah is deputy chief nurse operations at Nottingham University Hospitals NHS Trust and is the nursing lead for nutrition.

 

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