The Health Information and Quality Authority (HIQA) has today published a guide to the Authority’s review of nutrition and hydration in public acute hospitals. This review is part of HIQA’s evolving approach in monitoring healthcare providers’ compliance with the National Standards for Safer Better Healthcare published in 2012. The review will use self-assessment as well as unannounced inspections of a number of care environments.

Phelim Quinn, HIQA’s Chief Executive, explained: “Malnutrition affects more than one in four patients admitted to Irish hospitals and compromises the quality of life for patients; it affects recovery and causes unnecessary illness and death. Evidence shows that malnutrition and dehydration often occur together. Dehydration occurs when more fluid is lost than taken in. It has been reported that patients already malnourished on admission are more likely to lose weight during their hospital stay, and their weight loss is proportionately higher. It has a higher incidence in specific patient populations. More vulnerable patient populations include older persons, cancer patients, surgical patients and gastrointestinal patients. We believe that these issues form an important barometer of the quality and safety of services and a key indicator of how well the National Standards are understood and implemented.”

“In addition to clinical consequences, there are also economic consequences. In 2007, annual healthcare costs associated with malnourished Irish patients were estimated to be over €1.4 billion, representing more than 10% of the healthcare budget that year. In Ireland, it is estimated that 140,000 adults are malnourished or at risk of malnutrition at any given time.”

The aim of this programme is to assess if hospitals have the essential elements of good nutrition and hydration care in place with a particular focus on nutrition screening and assessment. Inspection teams will visit hospital wards during mealtimes to see first-hand if patients get good quality meals, a choice of food and that they are helped with eating when necessary.

All public acute hospitals in the country, other than stand-alone maternity and paediatric hospitals, will be expected to complete a self-assessment questionnaire and submit it to the Authority. HIQA will then carry out unannounced inspections in approximately 13 hospitals to verify results in order to gain an understanding of how nutrition and hydration care in the hospital is delivered and how this is experienced by patients at any given time.

The Authority’s new guide for hospitals, Guide to the Health Information and Quality Authority’s review of nutrition and hydration in public acute hospitals, outlines the procedure for the monitoring process and how the Authority expects hospitals to respond to findings on nutrition and hydration care.

Phelim Quinn continued: “We want to ensure that patients are adequately assessed, managed and evaluated to effectively meet their individual nutrition and hydration needs. Initially, hospitals will self-assess their position. The information provided by hospitals in self-assessments will inform the programme of unannounced inspections, which is due to start later this year.”

The Authority wants to encourage hospitals to adopt and implement evidence-based best practice in nutrition and hydration care. The Authority will assess if hospitals have the essential elements of good nutrition and hydration care in place for patients, with a particular focus on nutritional screening and assessment, arrangements at mealtimes and the patient’s own experience.

Phelim Quinn concluded: “These inspections will be used to validate self-assessment findings provided by hospitals and promote a process of continuous improvement. A national overview of our findings will be published in 2016.”

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA
01 814 7481/ 086 244 7623, mwhelan@hiqa.ie

Notes to the Editor: 

• In 2009, the Department of Health and Children published guidelines on food and nutritional care in hospitals and recommended that nutritional risk screening must be carried out for every patient within 24 hours of admission to hospital. However, it was reported in 2013 that less than 10% of hospitals in Ireland routinely screen patients for malnutrition.
• The 2010 Nutrition Screening Week Survey screened 1,602 patients across 27 Irish hospitals. It found that, overall, one in three patients (33%) were malnourished (of which 25% were high risk and 8% were medium risk). The survey was repeated in 2011 when 1,102 patients were screened on admission to hospital. It found that 27% of patients were at risk of malnutrition (20% high risk, 7% medium risk).
• The self-assessment questionnaire for hospitals will be made available on the Authority’s website, and is based on national and international best practice and input from an expert advisory group that included patient representatives and people with relevant expertise from across the Irish health service. Self-assessments will give the Authority baseline information about nutrition and hydration care in Irish hospitals.
• Dehydration happens when you use up or lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. Malnutrition, in this case under-nutrition, occurs when your body does not get enough nutrients. It can result in weight loss and have adverse effects on body composition, function and clinical outcome.

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