Adherence to hospital nutritional status monitoring and reporting guidelines

AIMS OF THE STUDY: Despite the widespread existence of guidelines regarding undernutrition monitoring and reporting, there is scarce information whether they are followed. We aimed to evaluate the adherence to guidelines regarding undernutrition monitoring and reporting as well as their determinants in a university hospital. METHODS: Retrospective analysis of discharged patients with data on Nutritional Risk Screening score (NRS-2002) from the department of internal medicine of the Lausanne University Hospital for years 2013–14. Adherence to the hospital monitoring guidelines, i.e.: 1) discharged patients with NRS-2002 score≥3 should have prealbumin levels measured, and 2) discharged patients with prealbumin levels<0.20 g/l should be rechecked 7 days afterwards, was assessed. Reporting of nutritionally ‘at-risk’ status in the discharge letter was also assessed. Multivariable logistic regression was used to examine potential determinants of adherence to guidelines. RESULTS: Of the 2,539 discharged patients with NRS-2002 data, 1,605 (63.0%) were nutritionally ‘at-risk’. Complete adherence to the monitoring guideline was observed in 238 (14.8%) of ‘at-risk’ patients. After multivariable analysis, adherence to the first step of monitoring guideline was associated with older age (≥ 80 years) [OR (95% CI): 2.03 (1.29–3.18)], high comorbidity index [1.36 (1.05–1.77)], and nutritional management [5.57 (4.38–7.07)]. Nutritional management was also associated with adherence to the second step of monitoring [3.98 (2.33–6.78)]. Adherence to the reporting guideline was observed in 343 (21.4%) of ‘at-risk’ patients. Multivariable analysis showed that adherence to the reporting guideline was associated with NRS-2002 score>4 [1.97 (1.47–2.64)], nutritional management [3.80 (2.85–5.07)], and adherence to the monitoring guideline [3.33 (2.35–4.71)]. CONCLUSIONS: Our results show a poor adherence to guidelines regarding undernutrition monitoring and reporting, possibly due to lack of training, staff, and time.