Delivery of oral nutrition supplement in hospital: Evaluation of professional practices in evaluation of nutritional status and representations of ONS by the caregivers and patients.

ABSTRACT

BACKGROUND: Nutritional evaluation and detection of malnutrition are based on criteria recommended by French health authorities. In practice, doctors do not always ensure strict implementation of the recommendations. The aim of this study is to evaluate professional practices in France regarding nutritional follow-up on arrival, during and after the hospitalization of inpatients who have oral nutritional supplements (ONS) prescribed and to discuss how ONS are seen by medical staff and patients. METHODS: A prospective study including patients consecutively admitted to digestive surgery and endocrinology units of the Dijon university hospital was conducted. Malnutrition risk at hospital admission was identified using anthropometric and biological criteria Body Mass Index, percentage of weight loss, albumin, prealbumin, C-reactive protein and Mini Nutritional Assessment. Nutritional evaluation and monitoring of inpatients on arrival, during and after hospitalization was analyzed. Interviews were held with caregivers and patients to raise the question of their attitudes toward ONS. RESULTS: The sample was composed of 61 patients. At the beginning of hospitalization, nutritional evaluation of patients was satisfactory. Follow-up during hospitalization was not optimal and depends on the degree of malnutrition. Post-hospitalization testing for albumin was rare, whereas ONS were regularly prescribed. ONS was viewed differently by caregivers and inpatients, which makes the status of ONS ambiguous. CONCLUSION: Our results show good evaluation of nutritional status of inpatients at the beginning of hospitalization but low follow-up during and after hospitalization. Representation of ONS differed between caregivers and patients leading to a confusion around them. Therefore, interdisciplinary work is necessary to encourage systematic assessment of nutritional status in patients and standardize the message regarding ONS.