Multidisciplinary provision of food and nutritional care to hospitalised adult in-patients: A scoping review protocol v1

Objective: The review will examine the evidence and characteristics of multidisciplinary care interventions in food and nutritional care provision for adult in-patients. Introduction: Providing appropriate nutritional care is fundamental in patient-centred care. Nutritional care requires a coordinated approach to the delivery of food and fluids by different healthcare professionals and the wider hospital staff. Evidence demonstrates improved patients’ clinical outcomes by enhancing hospital food and providing nutritional care throughout a patient’s pathway. While there are good examples of nutritional care initiatives, implementing appropriate nutritional care remain a challenge. Managing malnutrition particularly with adult in-patients on admission or at risk of becoming malnourished requires multidisciplinary care; the hospital team plays a crucial role in ensuring these patients’ nutritional needs are met. The review aims to identify the evidence with specific focus on reported multidisciplinary coordination and collaboration excluding artificial nutritional support (enteral and parenteral nutrition)a domain where well-established evidence already exists. Inclusion criteria: The context is limited to the hospital setting with an adult in-patient population. Studies involving healthcare professionals or the wider hospital staff will be included. Methods: Primary evidence will be included from both published and unpublished sources. The search strategy will follow the three-step process recommended by Joanna Briggs Institute’ (JBI). Data will be extracted after screening from relevant papers by two or more independent reviewers and one or more verifier using a developed data extraction tool. A narrative description of findings will be reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Introduction Key nutrition interventions and strategies to reduce malnutrition have been recommended and some integrated into standard guidelines and policies. For instance, the recommendations for nutrition screening in routine practice to identify people with (or at risk of) malnutrition using validated malnutrition screening tools by the European Society for Clinical Nutrition and Metabolism, British Association of Parenteral and Enteral Nutrition and the National Institute for Clinical Excellence in the UK.13,14 Nutrition screening as the first step enables appropriate interventions with subsequent monitoring and assessment to be implemented. Global consensus on core diagnostic criteria for malnutrition has also been proposed to enable comparison of malnutrition prevalence, interventions, and outcomes across the world.15 Other strategies include the Protected Mealtime policy (2004) implemented in the UK aimed at avoiding all non-urgent activity on the wards during mealtimes and allowing patients to have uninterrupted meals.16 Mealtime volunteers have been shown to provide valuable support on the ward to assist with eating and drinking processes.17 However, barriers to the effective implementation of this model into practice have been reported.18,19 While supportive interventions are reported to have a beneficial effect for patients, the specific features of collaborative working approaches remain unclear. In providing nutritional care, hospital staff play a significant role in ensuring that patients’ nutritional needs are met. Some studies, guidance documents, and reports have similarly highlighted the importance of implementing an multidisciplinary approach to address the problem with the emphasis on a person-centred approach.2,21,22 The use of the term ‘nutritional care’ in this paper refers to a coordinated approach to the delivery of food and fluids by different healthcare professionals and views the patient as an individual with needs and preferences.23 In a systematic review, Feinberg et al.24 reported a lack of quality evidence that examined different forms of nutrition support including general support, fortified foods, and artificial nutrition support. Rasmussen et al.25 suggested from a systematic review and meta-analysis that providing multidisciplinary nutrition support for older patients may have a positive effect on patients’ clinical outcomes, mortality and quality of life. This review sought to assess the effectiveness of multidisciplinary nutrition support studies including randomised controlled trials and excluding heterogeneous studies on multidisciplinary interventions of interest to this review. Moreover, the nature of the multidisciplinary coordinated approach merits more exploration. Evidence on the impact of complex nutritional care is well documented, including enteral or parenteral nutrition as part of artificial nutritional support for some patients.26-28 In contrast, knowledge on the coordinated delivery of other forms of nutritional care such as support for patients in the meal environment including meal support and eating support, is sparse. The present review aims to map and identify the nature of the evidence for the provision of food and nutritional care with a specific focus on reported multidisciplinary coordination and collaboration. The present study aims to map the diverse literature about multidisciplinary care and to review what has been studied and how it has been studied. Review questions The scoping review will be guided by this research question and the following sub-questions: What are the features of multidisciplinary collaborative care approaches implemented to improve the provision of food and nutritional care to hospitalised adult inpatients? What disciplines are involved in the multidisciplinary collaborations and what component of nutritional care are implemented? What collaborative activities, processes and outcomes of multidisciplinary nutritional care are reported?