Patients admitted to NSW Health facilities are a heterogenous group with a wide range of nutritional and dietary needs. The Nutrition Standards provide guidance as to the baseline requirements when designing a menu to meet the requirements for most patients. Readily available small and large serves supports the wide variety of patient appetite and nutrient needs.
Nutritional status categories
Patients in NSW Health facilities can be classified into four nutritional categories:
Previously healthy patients with good appetite and dietary needs in line with the general population. These patients may be admitted for:
- minor illnesses or elective surgery
- acute illnesses resulting in a short inpatient stay (3 nights or less).
Characteristics may include:
- poor appetite or inadequate food intake on or prior to admission
- previous unexplained or unintentional weight loss
- physical difficulty eating and/or drinking, including poor dentition leading to eating fatigue and lack of interest in food
- acute or chronic illness or medical treatments affecting appetite and food intake
- cognitive and communication difficulties, creating difficulties with ordering appropriate food and drinks (a higher proportion of the paediatric patient group fall into this category)
- prolonged or multiple episodes of fasting
- anticipated to stay in hospital for more than three nights.
Including patients:
- with increased nutritional requirements due to cachexia, trauma, surgery and/or burns
- who are malnourished or have faltering growth (paediatrics)
- pregnant and lactating women.
Including patients:
- requiring therapeutic diets due to specific diseases
- requiring texture-modified food and drinks
- with cultural, religious dietary needs and practices (such as halal and kosher meals).
Importance of nutrition
Food intake is often reduced during times of illness or injury. This can be exacerbated when people require care in a healthcare facility due to:
- the physiological effects of illness, e.g. pain, nausea, fatigue, reducing a person’s ability or desire to eat1, 2
- changes to the types and quantity of food a patient can eat, such as provision of test diets (fluid diets) or fasting requirements (nil by mouth)
- interruptions at mealtimes, such as doctor’s rounds and tests
- limited flexibility with mealtimes and available food, such as limited access to nourishing snacks between meals, and limited food choices
- lack of assistance to eat
- lack of identification and monitoring of patient’s nutritional status and food intake.
Patients in health facilities may also have increased nutrition requirements, increased nutrient losses or experience malabsorption.
All of these factors increase the risk of patients admitted to a health facility having or developing poor nutritional status or malnutrition. Patients may also be at risk of, or be malnourished, at the time of their admission.3, 4
Malnutrition rates in an acute hospital setting can be as high as 40% of all admitted patients.5 The risk of malnutrition becomes more acute for patients as they age, or the longer they stay in hospital.4, 5, 6 Patients in mental health facilities also have an increased risk of chronic diseases.
Food provided in a healthcare facility
Food and fluids provided in a healthcare facility should meet a patient’s nutritional needs and support their recovery. Patients expect the food provided in a healthcare facility is good for them, while also being acceptable and familiar in terms of their developmental, cultural and psychosocial needs.5, 6, 7
Food provided in a healthcare facility also supports psychological wellbeing. Mealtimes in a healthcare facility are often looked forward to and are a welcomed routine in the day. Eating may be one of few opportunities many patients have to retain independence, make choices, and take control over an aspect of their care, providing a positive milestone on the road to recovery. Familiar foods can provide comfort and security in unfamiliar situations.5
Anecdotally, patients continue to consume foods similar to those provided in hospital when they are discharged. This is because patients assume the food provided as a patient is appropriate for their clinical condition, may be healthier than their diet prior to hospitalisation and will support a prompt recovery.
References
- Frost J, Baldwin A. ‘Food for thought’: The importance of nutrition to patient care and the role of the junior doctor. Clin Med. 2021;21(3): e272-e274. DOI: 10.7861/clinmed.2020-0707
- Leach R, Brotherton A, Stroud M, et al. Nutrition and fluid balance must be taken seriously. BMJ. 2013;346 (feb08 1): f801-f801. DOI: 10.1136/bmj.f801
- Barker L, Gout B, Crowe T. Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. Int J Environ Res Public Health. 2011;8(2):514-527. DOI: 10.3390/ijerph8020514
- Australian Commission on Safety and Quality in Health Care. Hospital Acquired Complication - Malnutrition. Sydney: ACSQHC; 2018 [cited 22 Mar 2022].
- NSW Agency for Clinical Innovation. NSW Health Policy - Nutrition Care (PD2017_041). Sydney: ACI; 2017 [cited 21 Mar 2022].
- Walton K. Treating malnutrition in hospitals: Dietitians in the driving seat? Nutr Diet. 2009;66(4):202-205. DOI: 10.1111/j.1747-0080.2009.01371.x
- Naber T, Schermer T, de Bree A, et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr. 1997;66(5):1232-1239. DOI: 10.1093/ajcn/66.5.1232