Hospitals must do more to deal with malnutrition, Hiqa says

Nutrition and hydration care is not viewed as a priority for some Irish hospitals though malnutrition costs the State an estimated €1.5 billion a year, the Health Information and Quality Authority (Hiqa)has said.

Malnutrition affects more than one in four patients admitted to hospital. Despite this, 21 per cent of public acute hospitals do not have a system of screening in place for the risk of malnutrition, the authority found in its latest audit.

It recommends that every patient should be screened for the risk of malnutrition within 24 hours of admission to hospital, but Hiqa found that only half of the 42 hospitals surveyed are doing this in at least three-quarters of their wards.

Hiqa head of healthcare Susan Cliffe said hospitals need to introduce malnutrition programmes "without delay".

Hiqa also found that many hospitals do not have a hydration programme despite the importance of ensuring that patients are properly hydrated.

Fresh water

Inspectors found that less than a third of hospitals have a system to replenish water jugs with fresh water. Drinking water was only topped up by staff during the day in most inspected hospitals if a jug was seen to be empty or at a patient’s request.

In a number of emergency departments, Hiqa found patients who were immobile and could not access the water cooler were not routinely being offered drinks. In addition there was a lack of consistency in the meals offered to patients in emergency departments.

As part of the review, Hiqa analysed information from 42 hospitals, carried out unannounced inspections in 13 of these hospitals, spoke with 579 patients and 363 staff, and reviewed 322 patient healthcare records.

While many hospitals demonstrated a commitment to promoting and leading improvements in nutrition and hydration, there was a wide variation in findings.

Hiqa recommended that all hospitals should have a nutrition steering committee in place and all patients admitted to hospital should be screened for the risk of malnutrition.

In addition, hospitals should audit compliance with all aspects of patients’ nutritional care and engage with patients about food variety and choice, Hiqa added.

Satisfaction

In response the Health Service Executive (HSE) noted that a large majority (86 per cent) of patients surveyed expressed satisfaction at the hospital food.

The HSE pointed out that patients had expressed surprise to inspectors about the high quality of the food and commented that prior to coming to hospital that they had low expectations of hospital food.

Thirty of the 42 hospitals reported that they had a nutritional steering committee in place and 21 of the 42 hospitals stated they had implemented screening in all wards.

The HSE has identified two strategic priority actions in the National Service Plan for 2016 in relation to improving food and nutrition in hospitals:

“The development of a hospital food and nutrition policy and a quality improvement programme in relation to nutrition and hydration,” it said.