This year, Malnutrition Week has been launched across Australia and New Zealand to promote the importance of malnutrition screening and management in our health care settings.
It is running from 6 – 9 October with the theme, ‘Have we missed a diagnosis?’, aiming to promote awareness and to put a spotlight on patients appearing physically healthy, only to show several signs and symptoms of malnutrition once further investigating is done.
Tina Aboltins, ICU Dietitian, explained her goal in nutrition management with critically ill patients is to treat malnutrition or to prevent it. Given the potential of malnutrition is a challenge in hospitals, having dedicated time to talk about it is extremely important.
“We want to prevent patients losing weight, because malnutrition can mean a longer length of stay and a higher risk of complications. When a patient is critically unwell, their body uses a lot of energy and protein due to the stress response in the body and the demand of therapies used in ICU. For example, patients who require ventilation support for more than five days, have energy needs that can be up to 40 per cent more than a healthy individual,” she said.
“In terms of protein, a patient on dialysis has protein needs that are at a minimum 50 per cent more than what they would usually be,” she said.
“When patients don’t get enough nutrition, the body will use its own stores of energy and protein. It will start to use the lean body mass stores, and as Dietitians, we are interested in stopping this loss because some studies have shown that if we can preserve lean body mass, the patient has higher chance of surviving, and a better chance of recovery and rehabilitation,” she added.
Critically ill patients in ICU are often intubated and are not conscious to eat and drink on their own. A part of Tina’s role is looking after these patients and working out a nutrition support plan.
“We work out the best way to give them nutrition, usually through a nasogastric tube and using special enteral nutrition formulations. We always want to feed through the gastrointestinal tract where possible. If this is not possible, they are fed through the vein with specialised intravenous solutions called Total Parenteral Nutrition (TPN). The Dietitian looks at all patients who come to ICU, especially the ones who are a high risk of malnutrition,” she explained.
Ensuring malnutrition is screened for and treated is exceptionally important. An undiagnosed and untreated condition can slow the healing of wounds, weaken the immune system, cause muscle loss and decondition, and can result in a longer hospital stay and increase the risk of mortality.
At Northern Health, patients are screened for malnutrition risk and weighed on admission and weekly thereafter. There are also working groups such as the Nutrition & Hydration Sub-Clinical Improvement Committee, which sits under Standard 5, and the Dietetics Malnutrition Working Group, which drive improvement and quality work around malnutrition awareness, screening and management at Northern Health.