Development and evaluation of a nutritional monitoring protocol and form

Includes bibliographical references (pages 107-114)The purpose of this research was to develop and evaluate a\ud protocol and form for monitoring the nutritional status of patients in\ud a community hospital who are either at high risk of developing, or who\ud have been assessed as having protein-calorie malnutrition. An\ud important aspect of the nutritional care of patients involves\ud nutritional monitoring to determine if the goals of nutrition therapy\ud are being met, and if there is a need to change the nutrition\ud prescription. While there is much information in the literature\ud regarding initial nutritional assessment, there is little clear-cut\ud information regarding the most appropriate means of nutritionally\ud monitoring patients.\ud A Nutritional Monitoring Protocol and Form were designed to\ud provide appropriate information for monitoring the nutritional status\ud of patients that would be acceptable to doctors and dietitians involved\ud in nutrition assessment and support.\ud The methodology in developing the Protocol and Form involved\ud assimilating information received from the literature, community\ud hospital dietitians and laboratory supervisors, and health insurance\ud companies. The Protocol was designed to be a brief manual which\ud includes an explanation of nutritional monitoring and discussions of\ud the parameters and additional information needed to monitor patients.\ud The information in the Protocol provides assessment of fat stores,\ud somatic and visceral protein stores and the immunologic competence of\ud the patient. This information is needed to diagnose and classify the\ud different categories of protein-calorie malnutrition. The Form was\ud developed to provide a means of recording the information obtained from\ud the Protocol.\ud The evaluation of the Protocol and Form involved an analysis of\ud a Questionnaire completed by 13 experts in the field of nutrition\ud assessment and support. The evaluation Questionnaire was designed to\ud determine if the Protocol and Form provided appropriate information\ud that would be acceptable to clinicans using them.\ud The results of the evaluation were very positive with\ud constructive suggestions given to improve the Protocol and Form.\ud Eighty-three percent of the experts indicated that the Protocol\ud provided appropriate information for making decisions regarding\ud nutrition therapy. There was general agreement that all of the\ud parameters as presented in the Protocol were appropriate. The\ud inclusion of additional parameters was suggested by several experts to\ud improve the assessment of somatic protein and fat stores. However,\ud these evaluators stated the measurements are not sensitive to early\ud nutrition repletion. All of the experts had positive to very positive\ud overall reactions to the Protocol and Form.\ud The Nutritional Monitoring Protocol and Form developed and\ud evaluated in this research, with minor changes, would be very useful in\ud hospitals for providing optimum nutritional monitoring of malnourished\ud and/or high-risk patients