Clinical nutrition in Danish hospitals: a questionnaire-based investigation among doctors and nurses

Specific nutrition standards are now developed by the Joint Commission on A ccreditation of Healthcare Organizations (JCAHO) in order to improve the nu tritional status in hospitalized patients. We investigated the use of clini cal nutrition in Danish hospitals acid compared it with the standards of JC AHO by doing a questionnaire-based investigation among doctors and nurses r andomly selected in 40 hospitals including internal medicine, gastroenterol ogy, oncology, orthopedic departments and intensive care units (ICU). Overall, 857 (43.4%) responded to the questionnaire (doctors: 395, nurses: 462). Seventy-seven percent stated that nutritional assessment ought to be performed on admission, but only 24% stated that it was a routine procedure . Forty percent found it difficult to identify risk-patients, and 52% neede d specific screening tools. Twenty-two percent registered body weight in al l patients, and 18% registered nutrient intake routinely. Eighty-four perce nt found that a nutrition plan should be described in the patient record, b ut 39% found it difficult to set up an individual plan, and 79% expressed a need for specific guidelines. Eighty-four percent would only accept a pati ent being on isotonic glucose and/or electrolyte infusion for < 5 days (42% for < 2 days), and 33% would only accept a weight loss of 5% before active nutrition was initiated. About 50% would be restrictive in supplying enter al or parenteral nutrition to patients with impaired liver or kidney functi on. Twenty-seven percent did not use active nutritional therapy at all. Sev enty-six percent found that nutritional assessment should be performed duri ng hospital stays, but only 23% monitored the nutritional status. Sixty-eig ht percent stated that responsibility should be assigned to one or more per sons, but this was the case in only 20%. The use of clinical nutrition in Danish hospitals did not fulfill the stand ards for nutrition support according to the criteria established by JCAHO. Special efforts should be aimed at education, specific screening tools and introduction of guidelines in clinical nutrition.