A snapshot on nutrition care

Transcription

1 nutritionday 2006 unit 544/5542 General surgery A snapshot on nutrition care an initiative to improve healthcare supported by

2 Karin SCHINDLER national project coordinator Michael Hiesmayr international project coordinator Arbeitsgemeinschaft für klinische Ernährung Medical University Vienna, Div. CTV Anaesthesia & Intensive Care an initiative to improve healthcare supported by

3 nutritionday 2006 / General Idea Aim and methods Aim Increase awareness Decrease barriers Increase knowledge Allow comparison of individual units with national and international reference bases

4 nutritionday 2006 / General Idea Aim and methods Methods One day cross-sectional audit Get information from caregiver & patients Hospital outcome evaluation Unit report for participating units for comparison with specialty

5 nutritionday 2006 / General Idea Questionnaires harmonisation in 23 languages One functional unit an individual ward caregiver caregiver environment environment patient General idea within a defined Functional Unit unit structures 1 page caregiver s view 1 line/patient: patient s view 1page double sided

6 nutritionday 2006 / Perspectives Unit Caregiver Patient Unit s perspective Manpower Resources Patient population characteristics Howdo similarunitsworkand perform?

7 nutritionday 2006 / Perspectives Unit Caregiver Patient Patients interests Will I recover? When will I recover? What enhances recovery? How long will I have to stay in hospital?

8 Patient s interests nutritionday History Risk factors Dependency Disability Death How much am I eating? Why am I eating less? What will happen?

9 Europe s public health view: economic & social progress nutritionday Resources allocation Outcomes History Risk factors Dependency Disability Death How much am I eating? Why am I eating less? What will happen?

10 European participation 23 languages 25 countries 748 units/wards patients

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12 nutritionday 2006 / European participation Specialities of participating units General internal medicine Gastroentero-, hepatology Oncology, radiotherapy Cardiology Infectious diseases Geriatrics Neurology Psychiatry Ear Nose Throat (ENT) General surgery Cardiothoracic surgery Orthopedic surgery Trauma Neurosurgery Gynecology Long-term-care Others Units

13 nutritionday 2006 / Resources (europe vs your unit) Unit Size & unit manpower Actual number of beds 8% 5% 6% 6% 9% 34% 32% * >50 * your unit is in this category

14 nutritionday 2006 / Resources (europe vs your unit) Unit Size & unit manpower Patients / medical doctor 3% 9% 10% 35% 14% 29% * 2 4 6* 8 10 >10 your unit is in this category

15 nutritionday 2006 / Resources (europe vs your unit) Unit Size & unit manpower Patients / nurse 5% 2% 18% 40% 35% 2 4 6* 8 >8 * your unit is in this category

16 nutritionday 2006 / Structures (europe vs your unit) Nutrition team & guidelines Nutrition support team in your hospital? 26% 74% NO* YES * your unit is in this category

17 nutritionday 2006 / Structures (europe vs your unit) Nutrition team & guidelines Is someone interested in Nutrition Support in your unit? 42% 58% NO* YES * your unit is in this category

18 nutritionday 2006 / General (europe vs your unit) Recruitment Proportion of patients 10% 17% 56% 17% < * The recruitment proportion is calculated as number of patients participating divided by number of actual beds. In most units nearly all patients present were recruited and this increases the validity of the results for this unit. * your unit is in this category

19 nutritionday 2006 / Demographics (europe vs your unit) Gender Female gender proportion 5% 15% 14% 34% 32% < * * your unit is in this category

20 nutritionday 2006 / Demographics (speciality vs your unit) Age distribution Age categories in years > speciality your unit % patients

21 nutritionday 2006 / Speciality vs your unit Affected organs nose, throat blood, bone marrow eye, ear brain, nerves ischaemia kidney, urinary tract lung skin endocrine system infection liver others skeleton, bone, heart, circulation cancer gastrointestinal tract speciality your unit % patients

22 nutritionday 2006 / Speciality vs your unit Comorbidities stroke myocardial infarction COPD cardiac insufficiency speciality your unit diabetes I/II others % patients

23 nutritionday 2006 / Speciality vs your unit Weight loss before admission missing I don t know No, I ve gained weight speciality your unit No Yes % patients

24 nutritionday 2006 / Speciality vs your unit Weight loss before admission missing not sure > 8 kg speciality your unit 5-8 kg 0-4 kg % patients

25 nutritionday 2006 / Speciality vs your unit Last weeks eating missing quarter less half less speciality your unit bit less normal % patients

26 nutritionday 2006 in European Hospitals Body Mass Index proportion BMI Europe: BMI (Med) BMI 20 BMI > 30 Your unit: BMI (Med) BMI 20 BMI > % 17.6% % 19.0%

27 nutritionday 2006 / Speciality vs your unit BMI missing > speciality your unit < % patients

28 nutritionday 2006 / Nutrition Care (speciality vs your unit) Nutrition given to patients EN+PN PN EN speciality your unit Special diet Hospital food % patients

29 SHEET 3b Pat.N. Initials first name last name Date Centre Unit Please tick a circle for each meal to indicate how much you ate and drank today (see example): all 1/2 1/4 nothing I did not eat everything because: (please tick) XO I was tired + Example MORNING SNACK 1 LUNCH SNACK 2 DINNER SNACK 3 x all 1/2 1/4 nothing O I was not hungry O I had nausea/vomiting O I was not allowed to eat O I cannot eat without help O I did not like the taste O I normally eat less O I am clumsy O I do not like to eat X O I did not like the smell O I had an examination/surgery and missed my meal I did not eat everything because: (please tick) O I was not hungry O I was tired O I had nausea/vomiting O I normally eat less O I was not allowed to eat O I am clumsy O I cannot eat without help O I do not like to eat O I did not like the taste O I did not like the smell O I had an examination/surgery and missed my meal O cakes/ sweets O fresh fruits O sandwich O biscuits O preferred dish O nothing O I was not hungry O I was tired O I had nausea/vomiting O I normally eat less O I was not allowed to eat O I am clumsy O I cannot eat without help O I do not like to eat O I did not like the taste O I did not like the smell O I had an examination/surgery and missed my meal Sheet 3b O cakes/ sweets O fresh fruits O sandwich O biscuits O preferred dish O nothing O I was not hungry O I was tired O I had nausea/vomiting O I normally eat less O I was not allowed to eat O I am clumsy O I cannot eat without help O I do not like to eat O I did not like the taste O I did not like the smell O I had an examination/surgery and missed my meal O cake/ sweets O fresh fruits O sandwich O biscuits O preferred dish O nothing Number 2 1 Drinks Supplement Number Hiesmayr/Schindler (ESPEN/AKE Austria) NutritionDay in Europe - a cross-sectional multinational audit Comments: 1 ~ 200ml

30 Please tick a circle for each meal to indicate how all 1/2 1/4 nothing Example x much you ate and drank today (see example): I did not eat everything because: (please tick) O I was not hungry O I was tired O I had nausea/vomiting O I normally eat less O I was not allowed to eat O I am clumsy O I cannot eat without help O I do not like to eat XO I did not like the taste O I did not like the smell O I had an examination/surgery and missed my meal X + Number 2 1

31 nutritionday 2006 / Nutrition (speciality vs your unit) Lunch eaten on nutritionday missing nothing quarter speciality your unit half all % patients

32 Lunch eaten on nutritionday Specialty % patients all half quarter nothing missing Death in hospital before 30 days following ND Specialty % patients all half quarter nothing missing

33 nutritionday 2006 / Outcome (speciality vs your unit) Hospital discharge? missing readmitted others death discharge home rehabilitation speciality your unit transfered to long-term-care transfered to other hospital still in hospital % patients

34 nutritionday 2006 / Outcome (speciality vs your unit) Length of stay Length of stay in days missing > % patients your unit speciality Remark: Length of stay (LOS) calcuted from ND relates only to the patients actually present in the unit and thus does not match mean LOS as known by the hospital administrators for all their patients. Please use only to determine which group of patients predominates within your patient population compared with the reference specialty.

35 nutritionday 2006 / Conclusion nutritionday 2006 in European Hospitals ND increases awareness ND information: High prevalence of weight loss & reduced intake before admission in hospitalised patients Large effect on hospital resource utilisation High variability between units Please use this information to review and, perhaps, change practice in your unit

36 nutritionday 2006 / Future nutritionday 2006 in European Hospitals Consider repeating nutritionday data collection on a regular basis (every year) to monitor changes or stability in your practice.... or changes in your speciality More information about nutritionday on: office@nutritionday.org