CONCLUSIONS

DIRECTIONS

SPANISH RECOMMENDATIONS FOR PREVENTION, DIAGNOSIS AND TREATMENT OF MALNUTRITION

• More than 20 medical societies have participated in a consensus process designed to establish recommendations on the prevention, screening, diagnosis, treatment and monitoring of hospital malnutrition-related disease.

• The implementation of the SIGN criteria ensures the formulation of recommen-dations based on the best available clinical evidence.

• The heterogeneity of participating organizations and their level of involvement will facilitate the successful implementation of the recommendations.

• The Consensus paper is a step forward in the deployment of the action plan to implement the continous improvement process of Spanish Society for Parenteral and Enteral Nutrition (SENPE) in its fight agains malnutrition.

SCREENING

•Universal screening at 24-48 hours of admission with the most feasible method:

• Minimum: BMI, involuntary weight changes and changes in normal intake

• Ideal: NRS 2002.

•Assessment by health professionals involved in direct patient care.

•Re-evaluation of nutritional risk at least 1 time per week when initial screening is negative.

•Application of diagnostic-therapeutic protocol in patients with positive initial screening.

SCREENING

•Universal screening at 24-48 hours of admission with the most feasible method:

• Minimum: BMI, involuntary weight changes and changes in normal intake

• Ideal: NRS 2002.

•Assessment by health professionals involved in direct patient care.

•Re-evaluation of nutritional risk at least 1 time per week when initial screening is negative.

•Application of diagnostic-therapeutic protocol in patients with positive initial screening.

INTERVENTION

•After diagnosis of malnutrition, nutritional requirements definition based on clinical condition and underlying pathology.

•Inadequate intakes: causes evaluation, systematic inspection and adaptation of menu to personal needs.

•Prescription of treatment * (oral supplements) if insufficient response to initial dietary intervention.

•Prescription of treatment* (enteral nutrition) if it persists despite oral intake of dietary intervention and oral supplementation (requires confirmation of GI tract function unaltered).

•Parenteral nutrition* is reserved if here is contraindication to enteral nutrition or it is insufficient.

* Compliance, tolerability and efficacy of treatment will be monitored and recorded

INTERVENTION

•After diagnosis of malnutrition, nutritional requirements definition based on clinical condition and underlying pathology.

•Inadequate intakes: causes evaluation, systematic inspection and adaptation of menu to personal needs.

•Prescription of treatment * (oral supplements) if insufficient response to initial dietary intervention.

•Prescription of treatment* (enteral nutrition) if it persists despite oral intake of dietary intervention and oral supplementation (requires confirmation of GI tract function unaltered).

•Parenteral nutrition* is reserved if here is contraindication to enteral nutrition or it is insufficient.

* Compliance, tolerability and efficacy of treatment will be monitored and recorded

Recommendations outside hospital setting

Recommendations at hospital admission

Recommendations during hospitalization

Asociación Española de Cirujanos (AEC)

Asociación Española de Dietistas-Nutricionistas (AEDN)

Asociación Española de Gastroenterología (AEG)

Foro español de pacientes

Fundación Española de la Nutrición (FEN)

Sociedad Española de Cardiología (SEC)

Sociedad Española de Documentación Médica (SEDOM)

Sociedad Española de Endocrinología y Nutrición (SEEN)

Sociedad Española de Farmacia Hospitalaria (SEFH)

Sociedad Española de Geriatría y Gerontología (SEGG)

Sociedad Española de Medicina de Familia y Comunitaria (SEMFyC)

Sociedad Española de Medicina Interna (SEMI)

Sociedad Española de Médicos de Atención Primaria (SEMERGEN)

Sociedad Española de Médicos de Residencias (SEMER)

Sociedad Española de Nefrología (S.E.N)

Sociedad Española de Neumología y Cirugía Torácica (SEPAR)

Sociedad Española de Nutrición (SEN)

Sociedad Española de Oncología Médica (SEOM)

Sociedad Española de Oncología Radioterápica (SEOR)

Sociedad Española de Patología Digestiva (SEPD)

Sociedad Española para el Estudio de la Obesidad (SEEDO)

Participating SocietiesParticipating Societies

TOOLSEVIDENCE

DIRECTIONS

• In 2009, the Spanish Society for Parenteral and Enteral Nutrition (SENPE) set-up a continuous improvement process with a final objective: to ameliorate malnutrition and achieve better outcomes in hospitalized patients.

• In 2010, a nationwide, cross-sectional study (the PREDyCES® study) estimated the burden of disease-related malnutrition in 1,597 patients recruited in 31 randomly selected hospitals: one fourth of hospitalized patients were fount to be malnourished, and they were associated to a 50% additional cost for the National Health System (NHS)1.

• The results of the PREDyCES® study helped to define further actions within the SENPE continuous improvement process. The development of an inter-speciality consensus paper to address hospital nutrition was the main project to be completed during 2011.

• The “Consensus paper: position statements to fight Consensus paper: position statements to fight against hospital malnutritionagainst hospital malnutrition”” endorsed by several medical and scientific Spanish societies has established recommendations to facilitate the prevention, screening, diagnostic-therapeutic approach and evaluation of results of clinical intervention in patients with hospital malnutrition-related disease.

• Herewith, we describe the results of a multisciplinary approach aimed to develope the Consensus Paper .

Literature search

Literature review

Consensus conference

Final recommendations

SING classification(Scottish Intercollegiate

Guidelines Network)

PROJECT METHODS

BACKGROUND

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Non-malnourished Malnourished (only on

admission)

Malnourished (on admission and

discharge)

Malnourished (only on

discharge)

Hospitalisation costL

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of

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y (

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ys

)

p<0.05(except A vs B and B vs C)

1 Planas Vila M, Álvarez Hernández J, García de Lorenzo A, Celaya Pérez S, León Sanz M, García Lorda P, Brosa M. The burden of hospital malnutrition in Spain: methods and development of the PREDyCES study. Nutr Hosp 2010;25:1020-1024.

MULTIDISCIPLINARY CONSENSUS ON HOSPITAL MALNUTRITION IN SPAIN: MULTIDISCIPLINARY CONSENSUS ON HOSPITAL MALNUTRITION IN SPAIN: A step forward of the Spanish Society for Parenteral and Enteral Nutrition (SENPE) to its compromise on the fight against A step forward of the Spanish Society for Parenteral and Enteral Nutrition (SENPE) to its compromise on the fight against

malnutritionmalnutrition

Dr. Abelardo García de Lorenzo – SENPE President

The final version of the Consensus Paper was formally presented at the Ministry of Health