Evaluation of hospital dietic services in seven Caribbean countries

OBJECTIVE: To improve the delivery of dietic services in hospitals in the Caribbean, an assessment was carried out of the extent to which nutrition intervention was included in the medical management of patients. METHODS: The documentation of the nutritional intervention at secondary care facilities was the focus of a medical record audit of hospitalised patients. Medical records from 491 patients in 88 wards from 15 hospitals in Monsterrat, Jamaica, Guyana, British Virgin Islands, Grenada, Dominica and St. Vincent were audited. In each hospital at least 20 percent of the medical records of inpatients were audited. The medical records were randomly selected from each ward and were audited for selected anthropometric data, height and weight measurements, laboratory and clinical data, diagnosis, diet prescription and documentation of a "nutrition note" by dietetic personnel as well as nutrition-specific information in the "progress notes" and "nurses notes". RESULTS: The provision of nutrition intervention was relatively low or not adequately documented by any category of the relevant health care staff (medical, nursing and dietetic) in any of the countries. Except for anthropometric data, there was adequate baseline information (diagnosis, laboratory and clinical data) to initiate nutrition intervention. The absence of a diet prescription by the physician in more than 50 percent of the records in most countries indicated that insufficient attention is being paid to the contribution of nutrition in the delivery of medical care. Of the 15 hospitals assessed, 8 were operating without a professional dietitian or nutritionist. CONCLUSIONS: While primary prevention remains a main focus, we must provide adequate care and rehabilitation for those already afflicted. The study shows that there is a clear need to strengthen the nutritional care offered to hospitalized clients in the Caribbean so as to facilitate their early rehabilitation and quick return to productivity in society. At the forefront of realizing this goal is the availability of adequate resources in nutrition, specifically, human resources. (AU)

A cost effective way to recovery and better health through improved hospital dietetic services

The quest for optimal health care at an affordable cost is worldwide. Each component of health care continues to determine the most economic and essential aspects. This concept paper addresses the role of dietetics as an essential aspect of medical care with clear implications for optimizing health care in a cost effective manner. The relationship between the medical condition and nutritional status of hospitilized patients is addressed in this concept paper. The paper emphasizes hospital dietetic services as a vital link in the medical care management chain of hospitalized patients - a link which most times is undervalued or misunderstood. The paper proposes that hospital dietetic services may be evaluated through the establishment of indicators in relation to structure, process and outcome. Information obtained from this evaluation along with other relevant data such as common medical conditions addressed at particular institution should form the base on which long term management plans are made. It is being proposed that an objective evaluation of the part played by hospital dietetic services in the management of hospitilized patients will lead to improved decision making and the adoption of cost effective strategies. Such strategies should improve hospital services and offer better recovery and health care. (AU)

Clinical nutrition: renal disorders

Covers various diets suggested for the treatment of renal failure

Clinical nutrition: hepatic disorders

Covers various diets recommended as treatment for hepatic disorders

Clinical nutrition: gastro-intestinal disorders

Advises on various diets for the treatment of gastrointestinal diseases

Clinical nutrition: miscellanous

Advises on the treatment of disorders by diet theraphy

Clinical nutrition: metabolic disorders and eating disorders

Advises on the treatment of obesity, eating disorders, and diabetes mellitus by dietetics

Clinical nutrition: nutritional support

Advises on the use of diet supplementation, enteral or parenteral feedings or a combination of these as means of nutritional support

Structure, function and information flows in the Nutrition and Dietetics Division, Ministry of Health, Jamaica

Presents the division's objective as promoting and maintaining optimal nutrition for the Jamaican population through monitoring of the health system, training and education and providing research and advisory services in diet therapy, nutrition, production, processing and enrichment and distribution of food. Discusses the division's organisational structure of three sections: nutrition, dietetic and administration and their special areas of responsibility for the four programmes. Contends that communication and information flows are effected through regular meetings held at various levels, thorugh submission of monthly, quarterly and annual reports and through a published manual. Examines the impact of the contraction of the health budget on the divisional sections, particularly in the nutrition section. Recommends regular evaluation of projects, dissemination of research findings, and sensitization of the dietetic staff to the omportance of research. (AU)