[Complete process of implantation of a nutritional risk screening system in the university hospital la paz, madrid].

Nutricion hospitalaria : organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral

PubMedID: 24506397

Gómez-Candela C, Serrano Labajos R, García-Vazquez N, Valero Pérez M, Morato Martínez M, Santurino Fontecha C, González Madroño A, Palma-Milla S, Comisión de Nutrición del Hospital Universitario La Paz. [Complete process of implantation of a nutritional risk screening system in the university hospital la paz, madrid]. Nutr Hosp. 2014;28(6):2165-74.
Disease-Related Malnutrition (DRM) is present in a high percentage of patients admitted to hospital and their impact is diverse and of great importance. Objectives: Nutrition Department of University Hospital La Paz, in collaboration with all members of the Nutrition Committee, we decided to implement some method of screening in our centre which allowed us to detect as many patients with malnutrition risk as possible. Results: Due to the large size of our centre, with about 1,500 beds and the few human resources in our unit, we chose to use the CONUT system (Nutritional Control), a 100 % automatic method based on analytical parameters, very easy to use, low cost and whose validity is confirmed, characteristics that fulfilled our needs. The method collects information from databases of Admission Service (affiliation, age, date) and Laboratory (albumin, cholesterol, total lymphocytes) and generates, in the report of analytical results, "alert" information about each patient''s nutritional risk and also nutritional recommendations based on the risk identified. Prior to its implantation several evaluations were performed in order to allow us to better know the extra workload, as it was the main factor that could limit our ability to assume that screening method and also many training activities for doctors and hospital health professionals who were increasingly assuming responsibilities in the nutritional treatment of their patients. This screening system has been working from June of 2010 and it has detected risk of malnutrition in 32% of the evaluated patients. In general, only in those cases where the alert corresponded to a high-risk nutritional situation, which represents approximately 10% of the total, specialized intervention by the Clinical Nutrition Unit was required. Later, as we have detected some possible causes that justify the system does not work properly; the screening system has undergone several changes . In this sense, we have made a retrospective evaluation of 233 patients admitted to the General Surgery plants and documented that those entering for scheduled surgery, having a alarm of malnutrition( 50 % of cases ), its presence increases significantly the hospital stay and mortality. Conclusions: The implementation of this nutritional screening method has led to a change in the "nutritional" culture of our centre respect to DRM in most of our professionals: doctors and nurses and even in the management team, so all of them understand the importance of the process and know about the available tools and knowledge to indicate an adequate and early nutritional support.