Sergio Santana Porbén

Sistema de control y aseguramiento de la calidad: Su lugar dentro de un programa de intervención alimentaria, nutrimental y metabólica

A design proposal for a HQCAS Hospital Quality Control and Assessment System of the nutritional and feeding care processes conducted in a hospital environment is presented in this article. The design proposal is accompanied of the results of inspections conducted by the hospital NST Nutritional Support Group between 2005-2010. The system design includes quality policies that should rule the useful and safe conduction of such processes, the recording and documentary foundations of the System, and the quality control and assessment exercises for the continuous verification of such established policies. The current state of the conduction of these processes was documented from secondary records opened by the NST after satisfying consultation requests from the medical care teams of the institution. Inspections conducted by the NST revealed that less than half of clinical charts contained information minimally enough for elaborating nutritional judgments, almost one-fifth of the assisted patients were on Nils Per Oris, for whom no nutritional support schemes were prescribed, and a low prescription and usage of artificial nutrition schemes. Corrective measures adopted by the NST served to significantly increase the rates of successful completion of inspected processes. Quality assurance of feeding and nutritional care processes is a practical as well as an intellectual activity subjected to constant remodeling, in order to always warrant the fulfillment of quality policies advanced by the NST, and thus, that the patient benefits from the prescribed nutritional intervention strategy.

State of malnutrition in hospitals of Ecuador

RATIONALE Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. OBJECTIVES To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. MATERIALS AND METHODS The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women: 37.5%; Ages ≥ 60 years: 35.1%; Length of stay ≤ 15 days: 91.2%) admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. RESULTS Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patients age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. CONCLUSIONS Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care.

State of malnutrition in Cuban hospitals; a needed update

RATIONALE The Cuban Study of Hospital Malnutrition, as conducted during 1999 - 2001 with 1,905 patients assisted in 12 hospitals from 6 provinces of the country, revealed a hospital malnutrition rate of 41.2%. Having elapsed a decade after the first edition of the enquiry, update of this estimate is mandatory. OBJECTIVE To update the state of hospital malnutrition in Cuba. MATERIAL AND METHOD Presence of malnutrition in 1,664 patients admitted to 12 hospitals from 8 provinces of the country between March 2012 and March 2014 was documented with the Subjective Global Assessment (SGA) survey of the nutritional status. The state of hospital processes of food and nutritional care was assessed by means of the Hospital Nutrition Survey (HNS). RESULTS Current hospital malnutrition rate was 36.9% (Δ = +4.3%; p < 0.05). Completion rates of hospital exercises of nutritional assessment and of use of nutritional replenishment therapies were higher. CONCLUSIONS Having elapsed 10 years after the first edition of the ELAN CUBA Study, modest advances are seen in the identification and treatment of malnutrition in Cuban hospitals. It is perceived that formation and insertion of nutritionists verticalized in hospital care has contributed to the observed change. In addition, the activity of the Cuban Society of Clinical Nutrition and Metabolism in the advancement of the disciplines of nutritional therapy, artificial nutrition and metabolism might have served for a better recognition of the health problem posed by hospital malnutrition.

Estado de la desnutrición en los hospitales del Ecuador

RATIONALE Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. OBJECTIVES To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. MATERIALS AND METHODS The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women: 37.5%; Ages ≥ 60 years: 35.1%; Length of stay ≤ 15 days: 91.2%) admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. RESULTS Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patients age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. CONCLUSIONS Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care.