The implementation of evidence-based nutrition guidelines in an acute geriatric setting

Introduction: Malnutrition is a frequently occurring health-problem in eldery patients and has a number of consequences for both the patient and the hospitals, hence the significant need to track and treat malnutrition adequately. The aim of this study was to optimize nutritional care in acute geriatric settings. This was realized through an improved prospecting, the identification of malnourished patients and by conducting an adequate nutritional policy. Methods and Materials: A practice oriented research was conducted throughout 6 months on eight different geriatric wards in 2008. Malnutrition was traced by means of the Mini Nitritional Assessment. The attitude of the nurse staff was measured by means the Nutritional Nursing Care scale (SANN). Finally general patient characteristics were collected using a questionnaire. Results: The study included 634 geriatric patients. One out of three were undernourished on admission. The prevalence increased with the age of the patient and the presence of underlying diseases, e.g. cancer, dementia or a cerebro-vascular accident. The nutritional status of each geriatric patient was assessed and those who were malnourished (or had an increased risk) received a multidisciplinary treatment approach. Follow up took place by observing nutrition intake and weight evolution. A raised awareness was realized among the nursing staff by education. Despite the positive behaviour change, the attitude of the nurses did not show the expected alteration. A neutral attitude was found at the end of the study in the majority of the nursing staff. Conclusion: The practice oriented research allowed to implement evidence-based guidelines successfully. Success could be explained by the aim to fit the organization structure and the constructive dialogue with the different stakeholders. Feasible, individualized strategies were adapted to the ward and acquired by the nursing staff. This offered an optimal guaranty toward permanent quality enhancement.