Risk of Malnutrition and Pressure Ulcer in a mixed hospital population. Nutritional risk screening predicting pressure ulcer.

Abstract Background and aim Malnutrition and pressure ulcer represent significant health problems for hospital inpatients, in addition to having a considerable impact on local and national health care cost. Sufficient nutritional status is crucial for proper wound healing, and malnutrition is a prominent risk factor for pressure ulcer development. Risk of malnutrition can be identified using standardized screening tools, such as the Nutritional Risk Screening (NRS) 2002. The objective of this study was to examine the prevalence of risk of malnutrition and pressure ulcer, and whether the NRS 2002 could predict risk of pressure ulcer for hospital inpatients. Methods The data was collected as part of a larger cross-sectional study conducted at Lovisenberg Diaconal Hospital in Oslo, Norway on 10 pre-selected screening days between September 2012 and May 2014. All adult inpatients (≥18 years) admitted to medical or elective orthopedic surgical wards on the screening days were asked to participate. Patients admitted to Hospice or an intensive care unit, with cognitive impairment or unable to read Norwegian were excluded. Second year nursing bachelor students and ward nurses conducted the NRS 2002 initial screening and skin examinations for pressure ulcer using European Pressure Ulcer Advisory Panel classification (Stage I-IV). A registered clinical dietician conducted all NRS 2002 final screenings. Results Of the 1082 patients hospitalized on the 10 screening days, 651 (77 %) had complete screening data and skin examinations and were included in the analysis. The sample included 52% women and mean age was 62.9 years (SD 17.3). Based on the initial NRS 2002 screening, 52 % of the sample was at Possible risk of malnutrition. Final screening identified 34 % At risk for malnutrition. Most (65 %) of the 339 patients identified as Possible risk by initial screening were identifies as At risk in the final screening. The skin examinations indicated an 8 % prevalence of pressure ulcer (Stage I-IV). Patients identified as being at Possible risk by the initial screening or At risk by the final NRS 2002 screening, were more likely to have pressure ulcer (OR=2.58, p=0.011 and 2.55, p=0.008 respectively) than patients at low nutritional risk after controlling for sex, age, hospital department, and BMI. Among the three initial screening items, the strongest predictors of PU were Is BMI<20? (OR 2.73, p=0.006) and Ate less past week? (OR=1.91, p=0.046) Conclusion This current study confirms that risk of malnutrition and pressure ulcers still are common in a Norwegian hospital setting. In addition it suggests the significance of nutritional risk screening, using the NRS 2002, in predicting the presence of pressure ulcer in the studied hospital population. The prevalence of pressure ulcer was lower and risk of malnutrition higher than expected prior to the study. The final screening was a slightly stronger predictor of pressure ulcer compared to the initial NRS 2002 screening. However, given that the initial screening requires less time from ward personnel, the initial screening is considered to be adequate for identifying patients at risk of developing pressure ulcer. This could enable more efficient screening routines to promote optimal implementation, execution and satisfactory patient safety results.