Nutritional screening is the first and rather quick evaluation of a patient’s nutritional condition. The end result of nutritional screening is to find if there is any indication for detailed nutritional assessment and possibly a nutritional intervention. Nutritional assessment is an in-depth evaluation of a patient to identify and quantify specific nutritional needs and intervention. The end result of nutritional assessment is a nutritional plan which is based upon specific nutritional problems of the patient.
Nutritional screening should be
done for all patients admitted in hospital and nutritional assessment is done
only for indicated patients. This is mandated by many regulatory and
accreditation authority across the world including NABH of India. While
nutritional screening can be done either by a dietician, a doctor or a nurse,
detailed nutritional assessment should be done by a qualified dietician.
There are research evidences that
nutritional needs, if not addressed, adversely affect the treatment outcome of
patient. Hence, a hospital that is committed to provide good quality
healthcare, must include nutritional screening and nutritional assessment as an
integral part of their clinical practices. This is also an accreditation
requirement.
Following important points must be ensured for nutritional
screening and assessment.
NUTRITIONAL SCREENING
1. Nutritional screening should be done for every admitted patient within 24 hours of admission, preferably on same day of admission.2. In OPD patients, nutritional screening can be done selectively, such as for patients of Obstetrics, Paediatrics, Oncology, geriatric care etc.
3. Nutritional screening should be done by a dietician or a doctor or a nurse who has been trained for screening
4. A standard format or checklist should be used for screening. While most parameters under nutritional screening remains same for all patients, some additional parameters may be required for specific patients such as cancer patient, patients on haemodialysis and paediatric patients. The format of nutritional screening must address screening needs of all types of patients that are served by the hospital
5. The nutritional screening must include basic parameters such as height, weight, BMI, food habit, any recent history of reduction/increase in food intake, presence of any symptom that may indicate nutritional problems (such as muscle wastage, generalized weakness, paleness etc.)
6. The nutritional screening should be quick but cover all necessary parameters
7. The nutritional screening must result into the information on ‘whether the patient needs further nutritional assessment or not’
8. If a further nutritional assessment is indicated, the dietician must be informed, who must then conduct a detailed nutritional assessment
9. The findings of nutritional screening should be kept in the medical file of the patient
NUTRITIONAL ASSESSMENT
1. Nutritional assessment should be done only for those patients who has been identified through nutritional screening2. Nutritional assessment should be done by qualified dietician
3. The assessment should be done immediately after indicated by nutritional screening
4. Assessment points may differ depending upon type of patient. For example, a cancer patient may have additional assessment point
5. A standard format must be used for doing nutritional assessment. Depending upon type of patients’ hospital is dealing with, different formats can be used for assessing different types of patients.
6. The nutritional assessment should be detailed and should result in a nutritional management plan
7. The assessment must cover following key points
a.
Clinical and nutritional history
b.
Anthropometric measurements
c.
Current medications and medical tests findings
d.
Physical findings focused on nutritional aspects
e.
Nutritional diagnosis
f.
Nutritional plan or interventions required
g.
Monitoring plan
8. The assessment must be documented and kept in the patients’ file
9. Patients should receive diet according to the nutritional plan recommended
