nutritionDay 2009 in
Norway
24 units, 449 patients
NATIONAL
REPORT
A snapshot
on nutrition care
an initiative to improve healthcare
supported by
Oivind IRTUN
national project
coordinator
Michael Hiesmayr
international project
coordinator
Dept. of Gastroenterologic
Surgery University Hospital
North-Norway
Medical University Vienna,
Div. CTV Anaesthesia &
Intensive Care
an initiative to improve healthcare
supported by
nutritionDay 2009 / General Idea
Aim and methods
• Aim
–
–
–
–
Increase awareness
Decrease barriers
Increase knowledge
Allow comparison of individual units with national
and international reference bases
© nutritionDay 2009
supported by
nutritionDay 2009 / General Idea
Aim and methods
• Methods
–
–
–
–
One day cross-sectional audit
Get information from caregiver & patients
Hospital outcome evaluation
Unit report for participating units for comparison
with specialty
© nutritionDay 2009
supported by
nutritionDay 2009 / General Idea
Questionnaires harmonisation in 27 languages
One functional unit
an individual ward
caregiver
caregiver
environment
environment
patient
General idea within a defined Functional Unit
© nutritionDay 2009
unit structures
1 page
caregiver‘s view
1 line/patient:
patient‘s view
1page double sided
supported by
nutritionDay 2009 / Perspectives
Unit … Caregiver … Patient
• Unit‘s perspective
– Manpower
– Resources
– Patient population characteristics
– How do similar units work and perform?
© nutritionDay 2009
supported by
nutritionDay 2009 / Perspectives
Unit … Caregiver … Patient
• Patients interests
– Will I recover?
– When will I recover?
– What enhances recovery?
– How long will I have to stay in hospital?
© nutritionDay 2009
supported by
Patient‘s interests
© nutritionDay 2009
supported by
Europe‘s public health view:
economic & social progress
Resources allocation
Outcomes
© nutritionDay 2009
supported by
European participation 2006/2007/2008/2009
•
•
•
•
© nutritionDay 2009
27 languages
32 countries
1902 units/wards
58138 patients
supported by
nutritionDay 2009 / European nutrtionDay participation
Specialities of participating units
Others
Long-term-care
Pediatrics
Psychiatry
Neurosurgery
Cardiothoracic surgery
Gynecology
Infectious diseases
Trauma
Cardiology
Nephrology
Ear Nose Throat (ENT)
Neurology
Orthopedic surgery
Gastroenterology and hepatology
Oncology and Radiotherapy
General internal medicine
Geriatrics
General surgery
0
10
20
30
40
50
60
70
526 Reference Units
© nutritionDay 2009
supported by
80
90 100
nutritionDay 2009 / Participation in your country
Specialities of participating units
Others
Ear Nose Throat (ENT)
Long-term-care
Gynecology
Trauma
Pediatrics
Cardiothoracic surgery
Psychiatry
Neurology
Cardiology
Geriatrics
Infectious diseases
Neurosurgery
Nephrology
General internal medicine
Orthopedic surgery
Gastroenterology and hepatology
General surgery
Oncology and Radiotherapy
0
1
2
3
4
24 Units
© nutritionDay 2009
supported by
5
6
7
8
nutritionDay 2009 / Resources
Unit Size & unit manpower
Actual number of beds
Actual number of beds
6% 2% 7%
4%0% 8%
12%
8%
10%
29%
17%
27%
36%
34%
5
10
15
25
35
50
>50
5
Your country
© nutritionDay 2009
10
15
25
35
Europe
supported by
50
>50
nutritionDay 2009 / Resources
Unit Size & unit manpower
Patients / medical doctor
0%
4%
Patients / medical doctor
9%
14%
21%
10%
22%
52%
11%
24%
13%
2
4
20%
6
8
10
>10
2
Your country
© nutritionDay 2009
4
6
8
Europe
supported by
10
>10
nutritionDay 2009 / Resources
Unit Size & unit manpower
Patients / nurse
Patients / nurse
0%
7%
10%
26%
42%
58%
22%
35%
2
4
6
8
2
>8
Your country
© nutritionDay 2009
4
6
8
Europe
supported by
>8
nutritionDay 2009 / Structures
Nutrition team & guidelines
Nutrition support team
in your hospital?
4%
Nutrition support team
in your hospital?
29%
71%
96%
NO
NO
YES
Your country
© nutritionDay 2009
YES
Europe
supported by
nutritionDay 2009 / Structures
Nutrition team & guidelines
Is someone interested in Nutrition
Support in your unit?
Is someone interested in Nutrition
Support in your unit?
28%
46%
54%
72%
NO
NO
YES
Your country
© nutritionDay 2009
YES
Europe
supported by
nutritionDay 2009 / General
Recruitment
Proportion of patients
Proportion of patients
13%
15%
14%
21%
53%
56%
15%
13%
<50
50-75
75-90
90-100
Your country
© nutritionDay 2009
<50
50-75
75-90
90-100
Europe
supported by
The recruitment
proportion is calculated
as number of patients
participating divided by
number of actual beds.
In most units nearly all
patients present were
recruited and this
increases the validity of
the results for this unit.
nutritionDay 2009 / Demographics
Gender
Female gender proportion
0%
9%
Female gender proportion
7%
0%
35%
6%
20%
26%
56%
41%
<20
21-40
41-60
61-80
81-100
<20
Your country
© nutritionDay 2009
21-40
41-60
Europe
supported by
61-80
81-100
nutritionDay 2009 / Demographics (europe vs your country)
Age categories in years
Age distribution
missing
>100
100
90
80
70
60
50
40
30
20
10
europe
your country
0
5
10
15
20
25
% patients
© nutritionDay 2009
supported by
30
nutritionDay 2009 / Europe vs your country
Affected organs
no affected organs
pregnancy
others
ischaemia
eye, ear
skin
nose, throat
blood, bone marrow
liver
endocrine system
infection
kidney, urinary tract
lung
brain, nerves
skeleton, bone,
heart, circulation
cancer
gastrointestinal tract
europe
your country
0
10
20
30
% patients
© nutritionDay 2009
supported by
40
nutritionDay 2009 / Europe vs your country
Comorbidities
no comorbidities
myocardial infarction
stroke
europe
COPD
your country
cardiac insufficiency
diabetes I/II
others
0
20
40
60
% patients
© nutritionDay 2009
supported by
80
nutritionDay 2009 / Europe vs your country
Weight loss before admission
missing
I don’t know
europe
your country
No, I’ve gained weight
No
Yes
0
10
20
30
40
% patients
292/449 patients (65%) answered this question in your country, in Europe (79%)
© nutritionDay 2009
supported by
nutritionDay 2009 / Europe vs your country
Weight loss before admission
missing
not sure
>15 kg
europe
your country
9-15 kg
5-8 kg
1-4 kg
0
10
20
30
40
50
% patients
100% = all patients with weight loss
© nutritionDay 2009
supported by
60
nutritionDay 2009 / Europe vs your country
Last weeks eating
missing
quarter less
europe
half less
your country
bit less
normal
0
10
20
30
40
% patients
292/449 patients (65%) answered this question in your country, in Europe (79%)
© nutritionDay 2009
supported by
nutritionDay 2009
Body Mass Index
Europe:
•BMI (Med) 24.4
14.1%
•BMI  20
13.9%
•BMI > 30
0.20
proportion
0.15
0.10
0.00
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
0.05
BM I
© nutritionDay 2009
Your country:
•BMI (Med) 24.5
•BMI  20
9.8%
•BMI > 30
7.6%
supported by
nutritionDay 2009 / Europe vs your country
BMI
missing
>40
30-40
europe
your country
25-30
18.5-25
<18.5
0
5
10
15
20
25 30
35
40
45
% patients
© nutritionDay 2009
supported by
50
55
nutritionDay 2009 / Nutrition Care (europe vs your country)
Nutrition given to patients
missing
Others
Protein supplement
EN+PN
europe
your country
PN
EN
Special diet
Hospital food
0
10
20
30
40
50
% patients
© nutritionDay 2009
supported by
60
70
S H E E T 3 b Pat.N °.
Initials firs t nam e
las t nam e
C e ntre
D ate
Unit
P l e a s e tic k a c irc l e fo r e a c h m e a l to in d ic a te h o w m u c h y o u a te a n d d ra n k to d a y ( s e e e x a m p l e ):
a ll
1 /2
1 /4
I d id no t e a t e v e ry thing b e c a use :
n o th in g
E
O I w a s no t hung ry
x
O I had nause a/ v o miting
am
pl
x
e
a ll
1 /2
O c a k e s/ sw e e ts
O I c a nno t e a t w itho ut he lp
O I
X
n o th in g
O sa n d w ic h
O b isc u its
O fre sh fru its
D IN N E R
O c a k e / sw e e ts
O fre sh fru its
© H ie sm a y r / Schindle r (E S P E N /A K E A u str ia)
Nu tr itio n D ay in E ur o pe - a c r o ss- sec tio n al m u ltin atio n al au d it
© nutritionDay 2009
I
I
I
I
I
I
O sa n d w ic h
O I a m c lumsy
O I d o no t lik e to e a t
2
1
O sa n d w ic h
I
I
I
I
I
I
O p re fe rre d d ish
O n oth in g
O I was tired
w a s n ot h u n g ry
O I n orm a lly e a t le ss
h a d n a u sea /v om itin g
O I a m c lu m sy
w a s n ot a llow e d to e a t
c a n n ot e a t w ith ou t h e lp O I d o n ot lik e to e a t
O I d id n ot lik e th e sm e ll
d id n ot lik e th e ta ste
h a d a n e xa m in a tion /su rg e ry a n d m isse d m y m e a l
O b isc u its
O
O
O
O
O
O
SNAC K 3
+
O I no rma lly e a t le ss
b
3
t
e
e
h
S
O fre sh fru its
LU N C H
O c a k e s/ sw e e ts
N um be r
I d id no t e a t e v e ry thing b e c a use : (p le a se tic k )
D rink s Sup p le me nt
O I w a s n ot h u n g ry
O I was tired
O I h a d n a u sea /v om itin g
O I n orm a lly e a t le ss
O I w a s n ot a llow e d to e a t
O I a m c lu m sy
N um be r
O I c a n n ot e a t w ith ou t h e lp O I d o n ot lik e to e a t
O I d id n ot lik e th e ta ste
O I d id n ot lik e th e sm e ll
O I h a d a n e xa m in a tion /su rg e ry a n d m isse d m y m e a l
O
O
O
O
O
O
SNAC K 2
d id no t lik e the ta ste
O I w as tired
X
O I d id no t lik e the sme ll
O I ha d a n e xa mina tio n/ surg e ry a nd misse d my me a l
1 /4
M O R N IN G
SNAC K 1
O I w a s no t a llo w e d to e a t
(p le a se tic k )
O p re fe rre d d ish
w a s n ot h u n g ry
O
h a d n a u sea /v om itin g
O
w a s n ot a llow e d to e a t
O
c a n n ot e a t w ith ou t h e lp O
d id n ot lik e th e ta ste
O
h a d a n e xa m in a tion /su rg e ry
O b isc u its
O p re fe rre d d ish
Co m m ents:
O n oth in g
I was tired
I n orm a lly e a t le ss
I a m c lu m sy
I d o n ot lik e to e a t
I d id n ot lik e th e sm e ll
a n d m isse d m y m e a l
O n oth in g
1
supported by
~ 200m l
S H E E T 3 b Pat.N °.
Initials firs t nam e
las t nam e
P l e a s e tic k a c irc l e fo r e a c h m e a l to in d ic a te h o w m u c
a ll
1 /2
1 /4
n o th in g
E
O I w
O I ha
x
am
O I w
x
pl
e
me
I d id
C e ntre
D ate
O I ca
O I
X
di
O I ha
Unit
I d id n
N um be r O I w
O Ih
O Iw
+
O Ic
O Id
2
1O Ih
1 /2d a y ( s e e1 e
/4x a m p l e
no
w m u c h y o u a te aa lln d d ra n k to
):th in g
I d id no t e a t e v e ry thing b e c a use :
O I w a s no t hung ry
O I had nause a/ v o miting
O I w a s no t a llo w e d to e a t
O I c a nno t e a t w itho ut he lp
O I
X
M O R N IN G
d id no t lik e the ta ste
(p le a se tic k )
O I w as tired
X
O I no rma lly e a t le ss
O I a m c lumsy
O I d o no t lik e to e a t
O I d id no t lik e the sme ll
O I ha d a n e xa mina tio n/ surg e ry a nd misse d my me a l
NA
CaKt 1e v e ryO
c a kbees/c a
sw
e e: ts (p leOa se
fre tic
sh kfru
I d id Sno
te
thing
use
) its
© nutritionDay 2009
supported by
O sa nSup
d wpic
h
O
le me nt
D rink s
nutritionDay 2009 / Nutrition (europe vs your country)
Lunch eaten on nutritionDay
missing
nothing not allowed
nothing allowed
europe
your country
quarter
half
all
0
10
20
30
40
% patients
279/449 patients (62%) answered this question in your country, in Europe (76%)
© nutritionDay 2009
supported by
Death in hospital
before 30 days
following ND
Europe
% patients
% patients
Lunch eaten on
nutritionDay
Europe
35
30
25
20
15
10
5
0
10
9
8
7
6
5
4
3
2
1
0
all
ha
all
ha
lf
lf
q
r te
ua
n
© nutritionDay 2009
r
ed
i ng
ed
s
w
w
s
q
llo
llo
mi
a
a
t
ing
no
h
t
g
n
no
thi
o
n
r te
ua
supported by
r
in
oth
ga
no
we
llo
d
n
ng
i
h
t
ot
d
we
o
l
al
i ng
s
s
mi
30
% patients
Lunch eaten on
nutritionDay
Your country
25
20
15
10
5
0
all
ha
all
ha
lf
10
% patients
Death in hospital
before 30 days
following ND
Your country
12
8
6
er
d
ed
ar t
we
u
ow
o
l
l
q
l
al
ga
ot
n
i
n
th
ng
no
thi
o
n
i ng
s
s
mi
4
2
0
lf
q
r te
ua
n
© nutritionDay 2009
supported by
r
in
oth
ga
no
we
llo
d
gn
n
i
th
ot
d
we
o
l
al
i ng
s
s
mi
nutritionDay 2009 / Outcome (europe vs your country)
Hospital discharge?
readmitted
missing
others
death
europe
discharge home
your country
rehabilitation
transfered to long-term-care
transfered to other hospital
still in hospital
0
10
20
30
40
% patients
© nutritionDay 2009
supported by
50
60
nutritionDay 2009 / Outcome (europe vs your country)
Length of stay
Remark:
Length of stay (LOS) calcuted
from ND relates only to the
patients actually present in the
unit and thus does not match
mean LOS as known by the
hospital administrators for all
their patients.
missing
Length of stay in days
>100
100
50
25
Please use only to determine
which group of patients
predominates within your
patient population compared
with the European reference.
15
10
5
0
10
20
30
% patients
your country
© nutritionDay 2009
europe
40
50
Patients still in hospital are
excluded.
supported by
nutritionDay 2009 / Conclusion
nutritionDay 2009 in European Hospitals
•ND increases awareness
•ND information:
–High prevalence of weight loss &
reduced intake before admission in
hospitalised patients
–Large effect on hospital resource
utilisation
–High variability between units
•Please use this information to
review and, perhaps, change
practice in your unit
© nutritionDay 2009
supported by
Publications (in Clinical Nutrition)
Decreased food intake is a risk factor for mortality in hospitalised
patients: The nutritionDay survey 2006 (Clin Nutr 2009 28 (4))
Hiesmayr M., Schindler K., Pernicka E., Schuh C., Schoeniger-Hekele A., Bauer P., Laviano A.,
Lovell A.D., Mouhieddine M., Schuetz T., Schneider S.M., Singer P., Pichard C., Howard P.,
Jonkers C., Grecu I., Ljungqvist O. and The NutritionDay Audit Team
The first nutritionDay in nursing homes: Participation may improve
malnutrition awareness (Clin Nutr 2009 28 (2), 109-116)
Valentini L., Schindler K., Schlaffer R., Bucher H., Mouhieddine M., Steininger K., Tripamer J.,
Handschuh M., Schuh C., Volkert D., Lochs H., Sieber CC., Hiesmayr M.
© nutritionDay 2009
supported by
nutritionDay 2009 / Future
nutritionDay 2009 in European Hospitals
•Consider repeating nutritionDay data
collection on a regular basis (every year) to
monitor changes or stability in your practice
• . . . . or changes in your speciality
More information about nutritionDay on:
http://www.nutritionday.org
email:office@nutritionday.org
© nutritionDay 2009
supported by