Michel C, Spinewine A, Mouzon A, Hecq J-D, Jamart J, Dive A, Krug B

Detection and management of hospital malnutrition: general guidelines versus “on the ward” sensitization as part of person-centered healthcare
International Journal of Person Centered Medicine (2012) 2:288-293

Background and aims:
This study aims to evaluate impact of a clinical pharmacist on detection and management of malnutrition
in hospitalised patients as part of the development of person-centered healthcare.

Methods:
A cluster-randomized controlled study. Six care units were randomised into two groups, each including
one medical, one surgical and one mixed unit. In the intervention group a clinical pharmacist worked with
other healthcare professionals to improve the screening and management of malnutrition.
Predefined quality indicators were collected during a baseline period (two months) and an experimental
period (6 months). The pharmacist was unaware of them.

Results:
The percentage of patients with a complete malnutrition screening was significantly higher in the intervention
group (48.2% versus 27.0%). The percentage of patients with enteral nutrition prescribed did not differ,
but there were significantly more prescriptions for parenteral nutrition in the intervention group (17.4 vs 6.6%).
During parenteral nutrition, triglycerides, glycemia and extended serum electrolytes were significantly more
frequently measured in the intervention group.

Conclusions:
Moving from a passive to a more active approach contributed to better sensitization of the hospital front
professionals resulting in a better screening at admission within the 72 hours and the higher number of
admitting weight and heights. Parenteral nutrition was more frequently prescribed, which may question
the appropriateness of the route of artificial nutrition. The biochemical monitoring remained suboptimal.