Improving nutritional care quality in the orthopedic ward of a Septic Surgery Center by implementing a preventive nutritional policy using the Nutritional Risk Score: a pilot study

Eur J Clin Nutr. 2019 Feb;73(2):276-283. doi: 10.1038/s41430-018-0345-1. Epub 2018 Oct 18.

Abstract

Background/objectives: Septic Surgery Center (SSC) patients are at a particularly high risk of protein-energy malnutrition (PEM), with a prevalence of 35-85% found in various studies. Previous collaboration between our hospital's SSC and its Clinical Nutrition Team (CNT) only focussed on patients with severe PEM. This study aimed to determine whether it was possible to improve the quality of nutritional care in septic surgery patients with help of a nutritional policy using the Nutritional Risk Score (NRS).

Subjects/methods: Nutritional practices in the SSC were observed over three separate periods: in the 3 months leading up to the implementation baseline, 6 months after implementation of preventive nutritional practices, and at 3 years. The nutritional care quality indicator was the percentage of patients whose nutritional care, as prescribed by the SSC, was adapted to their specific requirements. We determined the septic surgery team's NRS completion rate and calculated the nutritional policy's impact on SSC length of stay. Data before (T0) and after (T1 + T2) implementation of the nutritional policy were compared.

Results: Ninety-eight patients were included. The nutritional care-quality indicator improved from 26 to 81% between T0 and T2. During the T1 and T2 audits, septic surgery nurses calculated NRS for 100% and 97% of patients, respectively. Excluding patients with severe PEM, SSC length of stay was significantly reduced by 23 days (p = 0.005).

Conclusions: These findings showed that implementing a nutritional policy in an SSC is possible with the help of an algorithm including an easy-to-use tool like the NRS.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hospital Units
  • Humans
  • Male
  • Middle Aged
  • Nutrition Assessment
  • Nutritional Support*
  • Orthopedic Procedures*
  • Pilot Projects
  • Postoperative Complications / prevention & control
  • Protein-Energy Malnutrition / prevention & control*
  • Quality Improvement
  • Sepsis / prevention & control*
  • Switzerland
  • Young Adult