Optimierung des Screenings auf Mangelernährung im Krankenhaus durch „Bottom-up“- und „Top-down“-Strategien – das Krefelder Projekt

 

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Zusammenfassung

Mangelernährung findet sich häufig in deutschen Krankenhäusern. Obwohl die Mangelernährung für die Prognose von Erkrankungen und die ökonomischen Auswirkungen eine immense Bedeutung hat, sind nur in wenigen deutschen Krankenhäusern qualifizierte Ernährungsteams vorhanden. Die systematische Fortbildung der Mitarbeiter mit Beteiligung aller Berufgruppen erscheint zur systematischen Erfassung von Mangelernährung zwingend erforderlich. Diese „Bottom-up“-Strategie beinhaltet die systematische Schulung der Mitarbeiter und die validierte Erfassung der Mangelernährung bereits bei der Aufnahme des Patienten mittels eines EDV-implementierten validierten Fragebogens und nachfolgender Weiterbetreuung durch das Ernährungsteam nach standardisierten Vorgaben. Die Zuweisung verpflichtender Verantwortungsbereiche an die beteiligten Berufsgruppen durch den Klinikträger (Dienstanweisung, „Top-down“-Strategie) erscheint für die flächendeckende Erfassung und effektive Bearbeitung der Mangelernährung hilfreich.

Abstract

Malnutrition is frequently detected in German hospitals. Although malnutrition has significant impact on prognosis of numerous diseases and economic burden professional nutritional support teams (NST) are rarely found. However, systematic screening for malnutrition already after admission appears mandatory. This “bottom up” strategy includes frequent education of physician and nurses to detect malnutrition. This may be accomplished by a computerized and validated questionnaire with consecutive support by the NST in case of malnutrition. In addition, a “top down” strategy with a standing instruction of the employer may be helpful to realize a comprehensive coverage of malnutrition.

• Literatur

• 1 Russell CA. The impact of malnutrition on healthcare costs and economic considerations for the use of oral nutritional supplements. J Clin Nutr 2007; (Suppl. 01) 25-32
  PubMedGoogle Scholar
• 2 Garel P. Putting medical nutrition onto the international agenda: Actions by the European Nutrition for Health Alliance. Clin Nutr 2007; (Suppl. 01) 39-43
  PubMedGoogle Scholar
• 3 Löser C. Unter- und Mangelernährung im Krankenhaus. Dt Ärzteblatt 2010; 107: 911-919
  PubMedGoogle Scholar
• 4 Pirlich M, Schwenk A, Müller MJ et al. DGEM-Leitlinie enterale Ernährung: Ernährungsstatus. Aktuel Ernahrungsmed 2003; 28: 10-25
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Pirlich M, Schutz T, Norman K et al. The German hospital malnutrition study. Clin Nutr 2006; 25: 563-572
  CrossrefPubMedGoogle Scholar
• 6 Stratton RJ, Green CJ, Elia M. Disease-Related Malnutrition: An Evidence-Based Approach To Treatment. Wallingford, United Kingdom: CABI Publishing; 2003. 824 pages
  Google Scholar
• 7 Russell C, Elia M. Nutrition Screening Survey in the UK in 2008: Hospitals, care homes and mental health units. Redditch: BAPEN; 2009
  Google Scholar
• 8 Kruizenga HM et al. Screening of nutritional status in The Netherlands. Clin Nutr 2003; 22: 147-152
  CrossrefPubMedGoogle Scholar
• 9 Meijers JM et al. Malnutrition prevalence in The Netherlands: results of the annual Dutch national prevalence measurement of care problems. Br J Nutr 2009; 101: 417-423
  CrossrefPubMedGoogle Scholar
• 10 Hiesmayr M et al. Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 2006. Clin Nutr 2009; 28: 484-491
  CrossrefPubMedGoogle Scholar
• 11 Hajjar R et al. Malnutrition In Aging. The Internet Journal of Geriatrics and Gerontology 2004; 1 Number 1. Doi: DOI: 105580/765.
  PubMedGoogle Scholar
• 12 Stratton RJ, Elia M. A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. Clin Nutr 2007; (Suppl. 02) 5-23
  PubMedGoogle Scholar
• 13 Löser Chr. Mangelernährung im Krankenhaus – Prävalenz, klinische Folgen, Budgetrelevanz. Dtsch Med Wschr 2001; 126: 729-734
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: an evidence-based approach to treatment. Oxon: CABI Publishing; 2003
  Google Scholar
• 15 Tucker HN, Miguel G. Cost containment through nutrition intervention. Nutr Rev 1996; 54: 111-121
  PubMedGoogle Scholar
• 16 Council of Europe, Committee of Ministers. Resolution ResAP on food and nutritional care in hospitals. ResAP 12 November 2003
  Google Scholar
• 17 Löser Chr, Lübbers H, Mahlke R et al. Der ungewollte Gewichtsverlust des alten Menschen. Dtsch Ärzteblatt 2007; 49: 3411-3420
  PubMedGoogle Scholar
• 18 Norman K, Richard C, Lochs H et al. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27: 5-15
  CrossrefPubMedGoogle Scholar
• 19 Kruizenga HM, Van Tulder MW, Seidell JC et al. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 2005; 82: 1082-1089
  PubMedGoogle Scholar
• 20 Amaral TF, Matos LC, Tavares MM et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr 2007; 26: 778-784
  CrossrefPubMedGoogle Scholar
• 21 Correia MITD, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariante model analysis. Clin Nutr 2003; 22: 235-239
  CrossrefPubMedGoogle Scholar
• 22 Müller MC, Uedelhofen KW, Wiedemann UCH. „CEPTON-Studie: Mangelernährung in Deutschland“. Erlangen: Bressler Druck; 2007
  Google Scholar
• 23 National Institute for Health and Clinical Excellence (NICE). Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition (clinical guideline 32). London: National Institute for Health and Clinical Excellence (NICE); 2006
  Google Scholar
• 24 Chima CS, Barco K, Dewitt M et al. Relationship of nutritional status to length of stay, hospital costs and discharge status of patients hospitalized in the medicine service. J Am Diet Assoc 1997; 97: 975-978
  CrossrefPubMedGoogle Scholar
• 25 Bernstein LH, Shaw-Stiffel TA, Schorow M et al. Financial implications of malnutrition. Clin Lab Med 1993; 13: 491-507
  PubMedGoogle Scholar
• 26 Elia M, Stratton R, Russell C et al. The cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults. Redditch: BAPEN; 2005
  Google Scholar
• 27 Ockenga J, Freudenreich M, Zakonsky R et al. Nutritional assessment and management in hospitalised patients: implication for DRG-based reimbursement and health care quality. Clin Nutr 2005; 24: 913-919
  CrossrefPubMedGoogle Scholar
• 28 EU-Declaration. Stop disease-related malnutrition and diseases due to malnutrition!. 12. June 2009. Prague/Czech Republic: www.european-nutrition.org
  Google Scholar
• 29 Marienfeld S, Wojzischke J, Zeuzem S et al. Erfassung krankheitsbedingter Mangelernährung und Abbildung der Nebendiagnose Mangelernährung im DRG-System. Aktuel Ernahrungsmed 2013; 38: 18-23
  Article in Thieme ConnectPubMedGoogle Scholar
• 30 Reinbold T, Broß I, Lenfers B. Mangelernährung im G-DRG-System: Effekt eines strukturierten Ernährungsmanagements auf Behandlungsqualität, Kosten und DRG-Erlöse. Aktuel Ernahrungsmed 2013; 38: 24-29
  Article in Thieme ConnectPubMedGoogle Scholar
• 31 Volkert D, Berner YN, Berry E et al. ESPEN Guidelines on enteral nutrition: geriatrics. Clin Nutr 2006; 25: 330-360
  CrossrefPubMedGoogle Scholar
• 32 Arends J, Bodoky G, Bozzetti F et al. ESPEN Guidelines on enteral nutrition – non-surgical oncology. Clin Nutr 2006; 25: 245-259
  CrossrefPubMedGoogle Scholar
• 33 Löser Chr, Aschl G, Hébuterne X et al. ESPEN Guidelines on artificial enteral nutrition – Percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24: 848-861
  CrossrefPubMedGoogle Scholar
• 34 Doig GS, Heighes PT, Simpson F et al. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: a meta-analysis of randomised controlled trials. Injury 2010; 7: 14
  PubMedGoogle Scholar
• 35 Grizas S, Gulbinas A, Barauskas G et al. A comparison of the effectiveness of the early enteral and natural nutrition after pancreatoduodenectomy. Medicina (Kaunas) 2008; 44: 678-686
  PubMedGoogle Scholar
• 36 Senkal M, Mumme A, Eickhoff U et al. Early postoperative enteral immunonutrition: clinical outcome and cost-comparison analysis in surgical patients. Crit Care Med 1997; 25: 1489-1496
  CrossrefPubMedGoogle Scholar
• 37 Senkal M, Zumtobel V, Bauer KH et al. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoingelective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg 1999; 134: 1309-1316
  CrossrefPubMedGoogle Scholar
• 38 Zülch C. Ernährungsteams in deutschen Krankenhäusern – Prävalenz und Struktur. Dissertation. Bochum: Ruhr-Universität; 2010
  Google Scholar
• 39 Finn SC, Zola EM, Sheridan JF. Issues facing nutrition support teams. Drug Intell Clin Pharm 1984; 18: 826-828
  PubMedGoogle Scholar
• 40 Cano NJM et al. Guidelines and position papers from the European Society for Clinical Nutrition and Metabolism. Clinical Nutrition 2006; 25: 359-479
  PubMedGoogle Scholar
• 41 Kondrup J et al. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003; 22: 415-421
  CrossrefPubMedGoogle Scholar
• 42 Curo Gutierrez E, Norman K. Poor performance of mandatory nutritional screening of in-hospital patients. Clin Nutr 2012; 31: 862-867
  CrossrefPubMedGoogle Scholar