Evaluation of hospital dietic services in seven Caribbean countries

OBJECTIVE: To improve the delivery of dietic services in hospitals in the Caribbean, an assessment was carried out of the extent to which nutrition intervention was included in the medical management of patients. METHODS: The documentation of the nutritional intervention at secondary care facilities was the focus of a medical record audit of hospitalised patients. Medical records from 491 patients in 88 wards from 15 hospitals in Monsterrat, Jamaica, Guyana, British Virgin Islands, Grenada, Dominica and St. Vincent were audited. In each hospital at least 20 percent of the medical records of inpatients were audited. The medical records were randomly selected from each ward and were audited for selected anthropometric data, height and weight measurements, laboratory and clinical data, diagnosis, diet prescription and documentation of a "nutrition note" by dietetic personnel as well as nutrition-specific information in the "progress notes" and "nurses notes". RESULTS: The provision of nutrition intervention was relatively low or not adequately documented by any category of the relevant health care staff (medical, nursing and dietetic) in any of the countries. Except for anthropometric data, there was adequate baseline information (diagnosis, laboratory and clinical data) to initiate nutrition intervention. The absence of a diet prescription by the physician in more than 50 percent of the records in most countries indicated that insufficient attention is being paid to the contribution of nutrition in the delivery of medical care. Of the 15 hospitals assessed, 8 were operating without a professional dietitian or nutritionist. CONCLUSIONS: While primary prevention remains a main focus, we must provide adequate care and rehabilitation for those already afflicted. The study shows that there is a clear need to strengthen the nutritional care offered to hospitalized clients in the Caribbean so as to facilitate their early rehabilitation and quick return to productivity in society. At the forefront of realizing this goal is the availability of adequate resources in nutrition, specifically, human resources. (AU)