Screening and increased treatment to prevent malnutrition is planned for all patients admitted to Irish hospitals, as part of a new National Clinical Guideline on patient nutrition released recently.

The key protocol is the roll-out of nutrition screening, as part of all admissions to public hospitals.

Those identified as at-risk because of weight loss and inadequate intake will typically receive high-protein and energy diets while in hospital, together with oral nutrition supplements (ONS) as needed.

Nurses will conduct screening and higher-risk patients will be referred to hospital dietitians for assessment and follow-up. All inpatients are to be re-screened weekly.

The guideline, Nutrition Screening and Use of Oral Nutrition Support for Adults in the Acute Care Setting, has been developed through the National Clinical Effectiveness Committee (NCEC) and published by the Department of Health.

The guideline has been mandated for implementation across hospitals by the Minister for Health Simon Harris and released early, as the recommended screening and treatments are relevant to patients admitted with Covid-19.

To date, some hospitals have already introduced nutrition screening, while some have not, with significant differences across the country. 

The publication has been welcomed by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN), which was a key contributor.

IrSPEN President and Guideline Development Group Co-Chair, Consultant Surgeon Prof John Reynolds, acknowledged current pressures on hospital services, but encouraged hospitals to work towards implementation.

“Malnutrition is estimated to affect 3 per cent of the Irish population (circa 150,000), including people who live with serious diseases, who have difficulty swallowing, people with dementia, and frail older people. However, this population accounts for 30 per cent of public hospital admissions, has three times the rate of complications and stays 30 per cent longer in hospital,” he said.

IrSPEN Director and Nutrition Consultant Ms Niamh Rice said the guideline would bring better outcomes for vulnerable patients and cost savings for the health system.

“Ensuring that this cohort of vulnerable patients become identified and properly nourished while in our hospitals will reduce complication and infection rates, get patients back home sooner and reduce their chance of re-admissions.”

The national guidelines were developed by a multidisciplinary group led by Clinical Specialist Dietitian Ms Carmel O’Hanlon.

Ms O’Hanlon, who also co-authored guidance for nutrition support of ICU patients, described how the protocol is important for healthcare professionals treating coronavirus patients.

“Many patients admitted to hospital with the virus are likely to have been unwell for up to 10 days while at home and have had significant loss of appetite. Even patients with obesity are at risk, so all should be screened and potentially treated. Most of the post-ICU Covid-19 patients will also have difficulty getting back to full diet and need a nutritional follow-up.

“While acknowledging that our health services are under unprecedented pressure, the guideline presents an opportunity to support outcomes for Covid-19 patients,” she said.

Data published by Prof Charles Normand and Ms Rice in 2012 estimated the human and financial cost of malnutrition in Ireland to be enormous, with most incurred in acute care settings.

The new publication is accompanied by a detailed Budget Impact Analysis, which shows that by treating the identified patients with oral nutritional supplementation, 31,750 bed days (across all hospitals) can be released back into the system annually. The net savings, taking into account additional dietetic and nursing resources required, are estimated at €24 million.

Guideline Development Group Co-Chair and Consultant Geriatrician Dr Declan Byrne amplified the relevance of strong nutrition support during the Covid-19 crisis: “The average age of people dying with Covid-19 is above 80. This is the same population with the most under-nutrition and the group where this guideline can have the biggest positive impact.

“There is a likelihood that the prevalence of malnutrition on admission will be even higher than usual this year because of delayed presentation of patients with non-Covid conditions. We therefore need to work towards applying screening and treatments across our hospitals.”

The clinical guidelines were developed through the National Clinical Effectiveness Committee (NCEC) by a multi-professional Guideline Development Group Co-Chaired by Prof John Reynolds and Dr Byrne.

Nutrition Screening and Use of Oral Nutrition Support for Adults in the Acute Care Setting can be viewed at www.gov.ie/en/collection/c9fa9a-national-clinical-guidelines/ (guideline 22). See also www.irspen.ie.