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Introduction: Aim: the objective of this study was to describe the results of the implementation of a home parenteral nutrition (HPN) care programme (Nutrihome©) in a cohort of patients treated at a tertiary hospital. Methods: retrospective study of the patients included in Nutrihome© at Hospital General Universitario Gregorio Marañón, Madrid, Spain. Nutrihome consists of different modules including pre-discharge nursing hospital visits and nursing home visits, deliveries of the infusion pump, consumables and parenteral nutrition bags, patient training, weekly scheduled nursing home visits, scheduled nursing phone calls, stock control phone calls and 24-hour on-call line manned by the nurses. Results: the study included 8 (75 % women) and 10 (70 % women) patients in the Nutrihome© pilot and Nutrihome© programme, respectively. A total 37 adverse events were reported during Nutrihome© pilot, 26 of which were technical, 9 clinical, 1 was catheter-related and 1 other event. Nutrihome© programme registered a total of 107 adverse events reported, 57 of which were technical, 21 clinical, 16 were catheter-related and 13 were other events. A total of 99 % of these events were solved by Nutrihome© via phone calls or home visits. Conclusions: Nutrihome© programme has been extremely useful during this pandemic, facilitaing both the start of HPN and training at the patient home without the need for hospitalisation. Additionally, the adverse events reported and solved by Nutrihome© not only reduced the physicians' burden during those tough times and the patients´ stress of being hospitalised during a pandemic, but supported the entire healthcare system.

Introduction: Prevalence of disease-related malnutrition in hospitals ranges from 20%-50%. Use of nutritional screening tools should be the first step in the prevention and treatment of patients at risk of malnutrition and/or undernourished., Aims: To implement a nutritional screening tool at admission to a tertiary hospital., Methods: The nutrition unit prepared a protocol for early detection of nutritional risk and selected the NRS 2002 as screening tool. The protocol was approved by the hospital committee of protocols and procedures and disseminated through the intranet. NRS 2002 was included in the diet prescription software to be implemented by the nursing staff of the hospital wards and as a direct communication system with the nutrition unit. Three phases were designed: pilot phase, implementation phase, and consolidation phase., Results: The pilot phase, NRS 2002 was implemented in 2hospital units to monitor software. The implementation phase was carried out in the same units, and all action protocols related to it were verified. The consolidation phase consisted of sequential extension of the protocol to the other hospital units., Conclusions: Implementation of nutritional screening at hospital admission is a long and complex process that requires involvement of many stakeholders. Computer software has allowed for a rapid, simple, and automatic process, so that the results of the screening are immediately available to the nursing staff of the nutrition unit and activate the nutritional protocols when required., (Copyright © 2019 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: To determine the impact of the type of hospital kitchen on the dietary intake of patients., Methods: A cross-sectional, two-centre study, of cooking in a traditional kitchen (TK) and in a chilled kitchen (CK). Subjective global assessment (SGA) was used for nutritional diagnosis. Before study start, a dietician performed a nutritional assessment of the menus of each hospital. All dishes were weighed upon arrival to the ward and at the end of the meal., Results: 201 and 41 patients from the centres with TK and CK respectively were evaluated. Prevalence of malnutrition risk was 50.2% at the hospital with TK and 48.8% at the hospital with CK (p=0.328). Forty-eight and 56 dishes were nutritionally evaluated at the hospitals with TK and CK respectively. Intake analysis consisted of 1993 and 846 evaluations in the hospitals with TK and CK respectively. Median food consumption was 76.83% at the hospital with TK (IQR 45.76%) and 83.43% (IQR 40.49%) at the hospital with CK (p<0.001). Based on the prevalence of malnutrition, a higher protein and energy intake was seen in malnourished patients from the CK as compared to the TK hospital, but differences were not significant after adjustment for other factors., Conclusions: Cooking in a chilled kitchen, as compared to a traditional kitchen, may increase energy and protein intake in hospitalized patients, which is particularly beneficial for malnourished patients., (Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: the implementation of quality management systems (QMS) in the health sector has made great progress in recent years, remains a key tool for the management and improvement of services provides to patients., Aim: to describe the process of implementing a quality management system (QMS) according to the standard ISO 9001:2008 in a Nutrition Unit., Methods: the implementation began in October 2012. Nutrition Unit was supported by Hospital Preventive Medicine and Quality Management Service (PMQM). Initially training sessions on QMS and ISO standards for staff were held. Quality Committee (QC) was established with representation of the medical and nursing staff. Every week, meeting took place among members of the QC and PMQM to define processes, procedures and quality indicators. We carry on a 2 months follow-up of these documents after their validation., Results: a total of 4 processes were identified and documented (Nutritional status assessment, Nutritional treatment, Monitoring of nutritional treatment and Planning and control of oral feeding) and 13 operating procedures in which all the activity of the Unit were described. The interactions among them were defined in the processes map. Each process has associated specific quality indicators for measuring the state of the QMS, and identifying opportunities for improvement. All the documents associated with requirements of ISO 9001:2008 were developed: quality policy, quality objectives, quality manual, documents and records control, internal audit, nonconformities and corrective and preventive actions. The unit was certified by AENOR in April 2013., Conclusion: the implementation of a QMS causes a reorganization of the activities of the Unit in order to meet customer's expectations. Documenting these activities ensures a better understanding of the organization, defines the responsibilities of all staff and brings a better management of time and resources. QMS also improves the internal communication and is a motivational element. Explore the satisfaction and expectations of patients can include their view in the design of care processes., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Home Parenteral Nutrition (HPN) is a practice in continually growing by the significant advantages involved for the patient and the healthcare system. Today, in the investigation of health outcomes is essential to assess the patient s opinion. Among the measures focused on patients with HPN, several studies about quality of life have been done, but the degree of satisfaction with this treatment modality has not been evaluated., Objective: To evaluate the degree of satisfacion of patients and their caregivers receiving HPN with doctors, pharmacists and nurses in a hospital., Material and Methods: An anonymous survey was distributed, which consisted of 48 closed questions to patients and their caregivers receiving HPN who voluntarily answered. With survey responses a database in SPSS with the following variables was created: personal, sociocultural, clinical and related to HPN data and valoration of health personnel involved (nutrition area of the Pharmacy Service and Nursing and Medical Nutrition Units) and hospital facilities related to HPN. Also a section of open response suggestions was included., Results: 24 surveys were distributed, 12 to patients and 12 to caregivers. Response rate was 91.7% in the case of patients and 58.3% in the caregivers. 63.6% of patients and 42.9% of caregivers were women. Mean age was, respectively, 46.1 years (SD: 13.7) and 47.0 years (SD: 3.6). Most of patients (55.6%) and caregivers (60.0%) had secondary studies and were pensoniers (72.7% and 71.4%, respectively). Underlying diseases of patients were: radiation enteritis (27.3%), intestinal obstruction (18.2%), intestinal carcinomatosis (45.5%) and Chron s disease (9.1%). With respect to items assessing satisfaction with physicians, nurses and pharmacists, in general both patients and caregivers were satisfied. Suggestions made were: greater amplitude of delivery schedule of HPN and inclusion of audiovisual information., Conclusions: The degree of satisfaction of patients receiving HPN and their caregivers with the care given by doctors, pharmacists and nurses is appropriate, but it s possible to make improvements to optimize the quality of the whole process., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Dysphagia is a highly prevalent symptom, which may be due to multiple disease processes, both structural and functional, and located at the oropharyngeal or esophageal level. Oropharyngeal dysphagia can cause malnutrition even in 1/3 of patients as a result of alterations in the efficiency of swallowing and cause changes in the security of swallowing (penetration and aspiration) in up to 2/3 of the patients who present it, with high risk of aspiration pneumonia and respiratory infections. In neurological, elderly or institutionalized patients its prevalence may range from 30 to 60%, with different degrees of severity that may become necessary artificial nutrition. It is also related to greater disability, prolonged hospital stays and increased mortality. Therefore, early diagnosis is critical and the establishment of an effective treatment that includes postural exercises, nutritional support and rehabilitation. All this wouldn't be possible without a nutritional team that takes part of the multidisciplinary team patients with dysphagia required. It is the only way to ensure a longterm care to these patients in order to decrease the morbidity and mortality.

Objective: To investigate the effectiveness of an oral nutritional supplement that is rich in protein and enriched with arginine, vitamin C and zinc on the healing of pressure ulcers., Method: Thirty-nine patients with grade III or IV pressure ulcers were enrolled into this open intervention study. Subjects received an oral nutritional supplement daily for three weeks. Wound area and the wound condition of the ulcers were assessed weekly., Results: After three weeks of supplementation, median wound area reduced significantly (p < 0.001) from 23.6 cm2 (1.6-176.6 cm2) to 19.2 cm2 (1.2-132.7 cm2), a reduction of 29%. Median healing of wound area was 0.34 cm2 per day, taking approximately two days to heal 1 cm2. Within three weeks the amount of exudate in infected ulcers (p = 0.012) and the incidence of necrotic tissue (p = 0.001) reduced significantly., Conclusion: Nutritional intervention in the form of a specific oral nutritional supplement resulted in a significant reduction in wound area and an improvement in wound condition in patients with grade III and IV pressure ulcers within three weeks.