Efficacy of nutrition as medication in malnourished hospitalised patients is strongly influenced by environmental factors

Aim: To evaluate the use of Nutrition as Medication (NAM) as a dietary intervention strategy in a sample of malnourished renal and geriatric hospital inpatients. Methods: In the study period of 1 July to 30 August 2009, patients admitted to the acute renal or geriatric wards of a large general hospital and assessed as malnourished or at risk of malnutrition and suitable to commence NAM were eligible for inclusion in this pilot clinical cohort study. Medication charts of the study patients were audited and opportunistic observations of patients receiving NAM were conducted. Comparisons of receival and refusal rates of NAM between chart audits and observations were made. Environmental influences on administration, delivery and consumption were noted. Results: Eighteen patients were included in the study. Audits of their medication charts indicated 943 doses of NAM were prescribed in the study period. The receival rate of NAM was 66.4% and refusal rate was 8.9%. Forty-eight incident observations of the NAM process were conducted noting a receival rate was 58.3% and refusal rate of 3.6%. Environmental factors such as adequate supplies and location of NAM stock influenced the receival rate of NAM. Conclusions: In the present study, receival of NAM by renal and geriatric inpatients was suboptimal. The strategy was strongly influenced by environmental factors such as nurse administration of NAM. However, when NAM was received as prescribed, refusal was rare. Further exploration is warranted of NAM receival and consumption in other malnourished groups and of the environmental factors influencing NAM delivery.