tantangan upaya penanggulangan malnutrisi di rs 30jan201 (1).ppt

7/29/2019 Tantangan Upaya Penanggulangan Malnutrisi di RS 30jan201 (1).ppt

1/23

Tantangan Upaya

Penanggulangan Malnutrisi di RS

S Sunatr io

Perhimpunan Nutrisi Enteral Parenteral Indonesia

(PERNEPARI)


2/23

Di kebanyakan negara TTG

dikembangkan oleh Perhimpunan

Nasional Nutrisi Enteral Parenteral

Di Indonesia jumlahnya masih dpt dihitung

dgn jari

Keberadaannya masih dalam tahap awal

Perlu dukungan dari DEPKES

TIM TERAPI GIZI (NST)


3/23

The wise men shouldconsider that health is

the greatest of humanblessings. Let food be

your medicine.

---Hippocrates


4/23

Hospital Malnutrition:

Critical Evidence

The Skeleton in the Hospital Closet

Height not recorded in 56% of cases

Body weight not recorded in 23% of cases

61% of those whose weight was recorded lost > 6 kg

37% had albumin < 3.0 g/dL

Butterworth CE. Nutr Today1974

I am convinced that iatrogenic malnutrition has become a significantfactor in determining disease outcomes in many patients.


5/23

Hospital Malnutrition:Prevalence

Numerous studies on hospital malnutrition have

been published.

Prevalence of malnutrition in U.S. hospitals today

ranges from 30% to 50%. Patients nutritional status declines with extended

hospital stay.

Coats KG et al. J Am Diet Assoc1993


6/23

Malnutrition Among Hospitalized Patients:

A Problem of Physician Awareness

Up to 50% of hospitalized patients may be

malnourished on admission

Before nutritional assessment training: Only 12.5% of malnourished patients are

identified

After 4 hours of training:

100% of patients are identified

Roubenoff et al.Arch Intern Med1987


7/23

Prevalence of Malnutrition in

Hospitalized Patients

69%

AdequateNutritional

State

21%

Moderately

Malnourished

10%

Severely Malnourished

Detsky et al. JPEN1987


8/23

Prevalence of Malnutrition in

Hospitalized Patients

In a published British study:

46% of general medicine patients

45% of patients with respiratory problems

27% of surgical patients

43% of elderly patients

Percentage of malnourished patients at time ofadmission

McWhirter et al. Br Med J1994


9/23

Hospital Malnutrition in Brazil

Findings:

12.6% severe malnutrition

35.5% moderate malnutrition

Prolonged length of stay directly linked to malnutrition Little awareness about the importance of nutritional status

of hospitalized patients

Waitzberg et al. Nutrition 2001

Study of 4,000 patients in 25 hospitals to evaluate theprevalence of hospital malnutrition and awareness byhealth care providers.


10/23

Malnutrition in the hospital

Prevalence of malnutrition in hospitalized patients, SLMC, 2000-2004


11/23

Hospital Malnutrition

A problem of physician awareness

Cipto Mangunkusumo Hospital (government)Jakarta 1989: on adm: 45.9%

Sumber Waras Hospital (private) Jakarta 1995:on adm: 42.26%

Army Hospital (government) Jakarta 2001: onadm: 41.42%; need nutritional intervention:

78.57% Hasan Sadikin Hospital (government) Bandung

2006: on adm: 71.8%, severe: 28.9%


12/23

TNT 12

Hospital Malnutrition:

Currently

A number of enteral & parenteral formula are

available

adequate NS could be given

Incidence of Hospital Malnutrition still high

+

Increased metabolic complication & infection


13/23

The 11th PENSA 13

The development of the medical D/ equipmentlarge and heterogenic spectrum of diseases

Knowledge did not develop equally; high wallslie between different disciplines :

Physicians,

- Lack of interest in nutritional therapy

- Minimal information on clinical nutrition

topics in the medical schools and residentialtraining programs

Problem Identification


14/23

The nutritional management of pts isincreasingly gaining interest

The gaining is slow, due to inadequacy

of doctors knowledge about nutrition Nutrition content in the medical

curriculum (under & post graduate) is

not sufficient to allow the doctor toprovide nutritional thx


15/23

Current status of awareness

Varies among specialists

Highest : Digestive surgeon,

Internal medicine specialist

(Gastro-enterologist, Metabolic

endocrinologist), Intensivist Lower: other specialists


16/23

The 11th PENSA 16

Nurses,

- Lack of established programs onNutritional Therapy

- Belief of not being the nursesresponsibility

Registered dieticians,

- Lack of knowledge to determine the best

way to remedy deficiencies in diets,particularly special dietary needs

- Minimal knowledge of thepathophysiology of diseases

Problem Identification


17/23

Halsted (1997); Heimburger,(2000); Hark & Morrison (2000)

17

Nutritional therapy is based onpathophysiology of the disease &metabolism nutrient of organs

Since World War II, experts became awarethat management of NT needed more thana single Organ-disease-agent-base-specialist. It required involvement of

physicians who had followed specificNutritional Training & could work as part ofa multi-disciplined team

Solution


18/23

Solution

Heimburger (2000):

To Improve the management ofFoodservices Department in hospitals

Activate the use of Nutri t ional Special ist

Physic ians in NST (Nutr.Sp.Ph., Dr, RD,Ns, Pharm. etc)


19/23

Do we need a nutrition support team?

Increased referrals and workload to clinical dietitians 1997-98 vs. 2000-03, SLMC


20/23


*

*p < 0.05 y2001 < y2000A

Days of inadequate intake in stroke tube fed patients were decreasing from 43% to 20% while

improvement in adequate intake increased from 57% to 80% (SLMC, 2000-2001)


21/23



22/23

SUSUNAN PERSONEL TTG

TTG beranggotakan :

Dokter spesialis gizi klinik/dokter spesialis yg

berkompetensi gizi klinik/dokter yg

berkompetensi gizi klinik

Dietisien

Perawat

Ahli Farmasi


23/23

tantangan upaya penanggulangan malnutrisi di rs 30jan201 (1).ppt

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