1. A snapshot on nutrition care an initiative to improve healthcare supported by nutritionDay 2009 in Norway 24 units, 449 patients NATIONAL REPORT

2. Michael Hiesmayr international project coordinator Medical University Vienna, Div. CTV Anaesthesia & Intensive Care an initiative to improve healthcare supported by Oivind IRTUN national project coordinator Dept. of Gastroenterologic Surgery University Hospital North-Norway

3. © nutritionDay 2009 supported by Aim and methods Aim –Increase awareness –Decrease barriers –Increase knowledge –Allow comparison of individual units with national and international reference bases nutritionDay 2009 / General Idea

4. © nutritionDay 2009 supported by Aim and methods Methods –One day cross-sectional audit –Get information from caregiver & patients –Hospital outcome evaluation –Unit report for participating units for comparison with specialty nutritionDay 2009 / General Idea

5. © nutritionDay 2009 supported by Questionnaires harmonisation in 27 languages unit structures 1 page caregiver‘s view 1 line/patient: patient‘s view 1page double sided nutritionDay 2009 / General Idea General idea within a defined Functional Unit caregiver environment One functional unit an individual ward caregiver environment patient

6. © nutritionDay 2009 supported by Unit … Caregiver … Patient Unit‘s perspective –Manpower –Resources –Patient population characteristics –How do similar units work and perform? nutritionDay 2009 / Perspectives

7. © nutritionDay 2009 supported by Unit … Caregiver … Patient Patients interests –Will I recover? –When will I recover? –What enhances recovery? –How long will I have to stay in hospital? nutritionDay 2009 / Perspectives

8. © nutritionDay 2009 supported by Patient‘s interests

9. © nutritionDay 2009 supported by Resources allocation Outcomes Europe‘s public health view: economic & social progress

10. © nutritionDay 2009 supported by European participation 2006/2007/2008/2009 27 languages 32 countries 1902 units/wards 58138 patients

11. © nutritionDay 2009 supported by Specialities of participating units nutritionDay 2009 / European nutrtionDay participation

12. © nutritionDay 2009 supported by Specialities of participating units nutritionDay 2009 / Participation in your country

13. © nutritionDay 2009 supported by Unit Size & unit manpower nutritionDay 2009 / Resources EuropeYour country

14. © nutritionDay 2009 supported by Unit Size & unit manpower nutritionDay 2009 / Resources EuropeYour country

15. © nutritionDay 2009 supported by nutritionDay 2009 / Resources Unit Size & unit manpower EuropeYour country

16. © nutritionDay 2009 supported by nutritionDay 2009 / Structures Nutrition team & guidelines EuropeYour country

17. © nutritionDay 2009 supported by nutritionDay 2009 / Structures Nutrition team & guidelines EuropeYour country

18. © nutritionDay 2009 supported by nutritionDay 2009 / General The recruitment proportion is calculated as number of patients participating divided by number of actual beds. In most units nearly all patients present were recruited and this increases the validity of the results for this unit. Recruitment EuropeYour country

19. © nutritionDay 2009 supported by Gender nutritionDay 2009 / Demographics EuropeYour country

20. © nutritionDay 2009 supported by Age distribution nutritionDay 2009 / Demographics (europe vs your country)

21. © nutritionDay 2009 supported by Affected organs nutritionDay 2009 / Europe vs your country

22. © nutritionDay 2009 supported by Comorbidities nutritionDay 2009 / Europe vs your country

23. © nutritionDay 2009 supported by Weight loss before admission nutritionDay 2009 / Europe vs your country 292/449 patients (65%) answered this question in your country, in Europe (79%)

24. © nutritionDay 2009 supported by Weight loss before admission nutritionDay 2009 / Europe vs your country 100% = all patients with weight loss

25. © nutritionDay 2009 supported by Last weeks eating nutritionDay 2009 / Europe vs your country 292/449 patients (65%) answered this question in your country, in Europe (79%)

26. © nutritionDay 2009 supported by Body Mass Index Europe: BMI (Med) BMI  20 BMI > 30 nutritionDay 2009 Your country: BMI (Med) BMI  20 BMI > 30 24.5 9.8% 7.6% 24.4 14.1% 13.9%

27. © nutritionDay 2009 supported by BMI nutritionDay 2009 / Europe vs your country

28. © nutritionDay 2009 supported by Nutrition given to patients nutritionDay 2009 / Nutrition Care (europe vs your country)

29. © nutritionDay 2009 supported by

31. Lunch eaten on nutritionDay nutritionDay 2009 / Nutrition (europe vs your country) 279/449 patients (62%) answered this question in your country, in Europe (76%)

32. © nutritionDay 2009 supported by Lunch eaten on nutritionDay Europe Death in hospital before 30 days following ND Europe

33. © nutritionDay 2009 supported by Lunch eaten on nutritionDay Your country Death in hospital before 30 days following ND Your country

34. © nutritionDay 2009 supported by Hospital discharge? nutritionDay 2009 / Outcome (europe vs your country)

35. © nutritionDay 2009 supported by Length of stay nutritionDay 2009 / Outcome (europe vs your country) Remark: Length of stay (LOS) calcuted from ND relates only to the patients actually present in the unit and thus does not match mean LOS as known by the hospital administrators for all their patients. Please use only to determine which group of patients predominates within your patient population compared with the European reference. Patients still in hospital are excluded.

36. © nutritionDay 2009 supported by nutritionDay 2009 in European Hospitals ND increases awareness ND information: –High prevalence of weight loss & reduced intake before admission in hospitalised patients –Large effect on hospital resource utilisation –High variability between units Please use this information to review and, perhaps, change practice in your unit nutritionDay 2009 / Conclusion

37. © nutritionDay 2009 supported by Publications (in Clinical Nutrition) The first nutritionDay in nursing homes: Participation may improve malnutrition awareness (C lin Nutr 2009 28 (2), 109-116) Valentini L., Schindler K., Schlaffer R., Bucher H., Mouhieddine M., Steininger K., Tripamer J., Handschuh M., Schuh C., Volkert D., Lochs H., Sieber CC., Hiesmayr M. Decreased food intake is a risk factor for mortality in hospitalised patients: The nutritionDay survey 2006 ( Clin Nutr 2009 28 (4)) Hiesmayr M., Schindler K., Pernicka E., Schuh C., Schoeniger-Hekele A., Bauer P., Laviano A., Lovell A.D., Mouhieddine M., Schuetz T., Schneider S.M., Singer P., Pichard C., Howard P., Jonkers C., Grecu I., Ljungqvist O. and The NutritionDay Audit Team

38. © nutritionDay 2009 supported by nutritionDay 2009 in European Hospitals Consider repeating nutritionDay data collection on a regular basis (every year) to monitor changes or stability in your practice.... or changes in your speciality More information about nutritionDay on: http://www.nutritionday.org email:office@nutritionday.org nutritionDay 2009 / Future