Y Hpc TP. m Chi Minh * Tap 21 * So 2 * 2017 Nghien ctru Y hpc
KHAO SAT KET QUA THU'C HIEN TAM SOAT VA DANH GIA TINH TRANG DINH DU'O'NG THEO BIEU MAU CUA BAC SI LAM SANG
TAI BV NGUYEN TRI PHU'ONG NAM 2014
Nguyen Viet Quynh Thu*, Nguyin Thi Dan Thanh**, Le Huy Hdng'**, Ldm Vinh Nien****
TOMTAT
M& dSw: Suy dinh duang binh viin Id mdt thdch th&c cua ngdnh y te'Viit Nam. Vi vdy iheo tieu chi ddnh gid chid lugng benh vien cua Bo Y teve cdng tdc (dm sodt ddnh gid vd can thiip dinh duang, Binh viin Nguyin Tri Phuang dd triih khai mgt bim mdu gi&p cdc bdc si ldm sdng thiec hiin tdi cdng tdc ndy.
Phuang phdp: Nghiin c&u dm chung tdi khdo sdt k^ qua cua die thuc hiin bim mdu sau 3 thdng tiiih khai Tdi cd cdc Kd sa xudi viin trong th&i gian t& 1/12 den 5/12/2014 dugc thu thdp (406 ho sa).
Ke? tjud: Trin 90% binh nhdn nhdp vien dugc do cdc chi sd'nhdn trac (cdn nqng, chieu cao); 68,4% benh nhdn dugc tinh todn chi sd'BMI; tam sodt dinh duang (NRS) dugc thuc hiin tien 81,5% binh nhdn; ddnh gid tinh tiqng dinh duang (SGA) diegc thuc hiin tiin 96,3% benh nhdn co nguy ca suy dinh duang. 68,6% truang hop CO ghi nhdn ke'hoqch can thiip dinh duang tiin biiu mau, nhieng truang hap khdng ghi nhqn phdn l&n (98,17o) thugc nhom benh nhdn khong cA nguy ca suy dinh duang.
Kei lu§n: Cdc bdc si ldm sdng dd buac ddu thuc hiin khd tdi cong tdc tam sodt, ddnh gid vd lin kehoqdi can thiip dinh du&ng. Tuy nhien, device thuc hiin ndy hiiu qud lum tmn co su cdi tim bim mdu, tdng cuang himn luyin vd biin phdp ki^ tia, gidm sdt
Tit khoa: idm sodt dinh dimig, ddnh gid dinh dimig, NRS-2002, SGA ABSTRACT
STUDY ON THE APPUCA'HON OF NUTRTHONAL SCREENING AND ASSESSMENT USING FORMS BY CLINICAL PHYSICIANS AT NGUYEN TRI PHUONG HOSPITAL IN 2014
Nguyen Viet Quynh Thu, Nguyen Thi Dan Thanh, Le Huy Hung, Lam Vinh Nien
* Y Hoc TP. Ho Chi Minh * Vol. 21 ~ No 2 - 2017:95 - 99 Introduction: Hospital malnutrition is a challenge for healthcare service in Vietnam. The Vietnamese Ministry of Health has proposed a set of criteria for evaluation of hospital quality, including screming and assessmmt of nutrition. Nguyen Tri Phuong hospital has adopted these criteria by prodding a form in order to support clinical dodors with this work. Our study is to evaluate the application of the form after 3 months of use
Methods: All of the discharged records during December 1 to December 5,2014 were collected (406 in total).
Results: The results show that anthropometric indices (zveight and height) were dommmied in more than 90% of patients; BMI was cdculated in 68.4% of patimts; nutrition screming (NRS) was performed in 81.5% of patimts; nutrition assessment (SGA) was completed in 96.3% of patients at nutritiorml risk; intervention plans were documented in 68.6% of all records while the records without intervmtion plans were mostly (98.1%) in patimts who were not nutritiormlly at-risk.
Conclusion: The clinical dodors have fundamentally performed nutrition screming, assessment and
* Khoa Dmh dudng va Tiet che, B^nh vi^n FV
**BM Dinh EXrong va V? sinh an loan thtrc pham, Trucmg Dai hoc Y Khoa Pham Ngpc Thach
***Khoa Nhi, B?nh vien Nguyin Tri Phuong,
»»**Khoa Dinh dudng va Tiet chC Benh vien Dai hoc Y duoc TP.HCM
11 j^c gid lii" h^' BSCKII. Nguyen Viet Quynh Thu DT: 0988802216 Email: [email protected] 95
N g h i e n c m i Y hoc Y Hgc TP. H o C h i M i n h * T a p 21 * So 2 * 2017
intervention with acceptable levels. However, refining of form design, more training as well as monitor and audit are needed to improve the employment of the form.
Keyzvords: nutritiond screming, nutritiorml assessmmt, NRS-2002, SGA.
D A T V A N D E
Suy dinh duong (SDD) benh vien la mgt thach thiic ciia nganh Y te The giai noi ehung va Viet Nam noi rieng. Tuy theo phuong phap danh gia ciia timg nghien cuu, ty le SDD a benh nhan (BN) n&n vien dao dong tCr 20-40%, ca biet CO nghien ciiu ty le nay eon hon K)%'^-^^'". Mae dil cac nghien cuu van eon nho le nhung eae so lieu thong ke buoc dau cho thay ty le SDD 6 BN nam vien 6 Viet Nam i^t cao: khoang 50%'^.
SDD anh huong dang ke d a i dien tiai lam sang va ket qua dieu tri, lam suy giam chiic nang mien dich, giam siie co nhu co ho hap, cham lanh vet thuong, gop phan tang ty le nhiem trimg, keo dai thai gian tho may, bien ehiing bung h6 vet mo, keo dai thoi gian nam vien va tang ehi phi dieu tri. Vi vay, viec kiem tra, danh gia DD dinh ky va dieu ehinh che dp DD hpp ly de CO dugc siic khoe tot, eai thien tinh trang SDD, gop phan lam giam ty le biai ehiing, nit ngan thai gian nam vien va giam bat chi phi dieu tri. Nhan tiiiie dupe vai tro quan trpng eua viec tam soat, danh gia va cham soc dinh duang cho BN nam vien, nam 2011, Bo Y te da ban hanh thong tu 08 (08/2011/n-BYT) 'Tiuong d i n ve cong tac dinh dirong tiet che trong benh vien", va den nam 2013 da dua tieu chi "Nguoi benh duoc danh gia, theo doi tinh trang dinh duong trong thoi gian nam vien" vao tieu ehuan danh gia chat lugng benh vien nhSm dua hoat dong tam soat, danh gia va cham soc dinh duang tro thanh thuong quy cho tat ca cae BN nhap vien.
Benh vien Nguyen Tri Phuang, Dinh duang da chinh thiic trien khai viec 1am soat va danh gia tinh trang dinh duong eho tat ca cae BN nhap vien trong vong 24-48 gio theo bieu mautir thang 08/2014, khoa. Bieu mau da duac thong qua hgi dong khoa hpe ciia Benh vien va gbm 2 phan chinh dua tren su ket hgp ciia hai cong cu tam soat danh gia linh t r ^ g dinh duong pho bi«i va
duge chap nhan rgng rai do la Danh gia tong the ehii quan (SGA) va Tam soat nguy ea dinh duong (NRS-2002). Phuang phap tam soat NRS- 2002 dugc khuyoi nghi boi Hpi dinh duong lam sang Chau Au (EPSEN) - miic do AP*^*).Chiing toi chgn lua chi su dung phan ^ m soat nhanh eua eong eu nay nham phSn Igai benh nhan vao vien thanh 2 nhom: Nhom co nguy ca suy dinh duong va khong nguy co. Trong khi do, cong eu SGA la mgt cong cu danh gia linh trang dinh duong cho ket qua nhanh chong, dang tin cSy va de dang thirc hien<^, tuy nhien de giam bat su chu quan ciing nhu giiip cho viec danh de dang va nhanh chong han, chiing toi su dung phien ban SGA aia tac gia Pham Thu Huang (Vien dinh duong quoc gia)(^*, trong do tac gia ap dyng each tinh di^m de phan loai. Viee thue hien bieu mau gom 2 buoe: buoe 1 la tam soat nhanh (theo NRS-2002), neii ket qua la "eo nguy eo" se tien hanh Ihue hien tiep viec phan danh gia ttieo SGA (Bieu mau kem theo). Tai BV Nguyen Tri Phuong, ehiing toi Men hanh tap hu&i cho tat ca cac nhan vien y te true tiep ti^ nhan va dieu tri benh nhan, trong do tat ea eae benh nhan nhap vien trong vong 24-48h deu dupe ^ m soat nhanh, khi ket qua la "eo nguy ca" se ti&i hanh danh gia tiep vai SGA. Ngoai ra bieii mau con gom cac phan gom Thong tin co ban, Cae ket qua sinh hoa eo lien quan d&i dinh duong, Ke hoach can thiep, theo doi.
Sau mgt thoi gian trien khai viec tam soat va danh gia tinh trgng dinh duang eho tat ca cac benh nhan moi nhap vien trong vong 24-48 gio, chiing toi tim hanh nghien eiiu nh3m muc tieu:
khdo sdt kei qud thuc hiin tam sodt vd ddnh gid tinh trqng dinh duong theo bieii mdu tqi bv nguyen tri phuang ndm 2014.
DdlTlAaNG-FHUtlNGPHAPNGHlENajtJ Phuong phap nghien cmi
M6 ta hang loat ea.
96
Y Hpc TP. Hb Chi Minh * T^p 21 * So 2 * 2017 Nghien cihi Y hpc Doi hrong nghien ciiu
Tat ca cac ho so xuat vien trong thai gian tir ngay 1/12 /2014 den ngay 5/12/2014.
D i a d i ^
Benh vien Nguyen Tri Phuong.
Tong eong eo 406 ho so phii hgp voi yeu eau ciia nghien cihi.
KET Q U A - BAN LUAN
Danh gia viec ghi nhan chieu cao va can nang vao bieu mau
G h i n h a n Chi@U c a o (%} Ghi nhan can nang (%) 9 . 1 % 8.6%
nhan ehi so BMI la do khong tinh dugc (thieu cae so Ueu can thiet ve can nang, ehieu cao).
Tyle(%)
100 1 Thi
50 0
28.9
Hhdi l.Ty lihd sa cd ghi nhdn chieu cao vd cdn nqng Ly do khong ghi nhan
Chieu cao Cdn nqng
Khong tinh dirac Khong lam Hinh 3. Ly do khdng ghi nhdn dii sd'BMI vdo lid sa Tam soat dinh dudng nhanh theo NRS- 2002
Van con mgt ty Ie dang ke eae truong hgp khong dugc tam soat dinh duang nhanh (18,5%).
Trong nhiing truang hpp dupe danh gja, ket qua cho thay mot ty le Ion (52,9%) benh nhan nhap vien CO nguy ca dinh duang trong vong 24-48 gia sau nhap vien.
TylS
t—I Khdng do dugt^LZJ Khang ldm
Hinh 2.Ly do khdng ghi nhqn chieu cao vd cdn nqng vdo ho sa
Cac chi so can nang va ehieu cao dupe ghi nhan kha day dii (>90%). Trong so eae truang hgp khong khi nhan chi so, phan Ion la do nhan vien y te khong lam (<60%), con lai khoang 30% la do khong do dupe (cac truang hpp benh nhan nang, hon me, dang trong tinh trang cap Clhi,...).
Viec tinh toan chi so BMI va ghi nhan vao bieu mau
Ty le tinh toan chi so BMI vao bieu m l u chua cao (68,4%). Phan ICBI eae truong hpp khong ghi
Co nguy ca Khong nguy co Hinh 4. Kei qud tdm sodt dinh duang nhanh theo NRS-2002
Danh gia dinh duong theo SGA tren benh nhan "co nguy co dinh duong"
G ^ nhu toan bp eae ho so dupe danh gia SGA (96,3%) khi ket qua tam soat nhanh NRS- 2002 la "eo nguy co". Ket qua danh gia tinh trang dinh duong eho thay da so (62,0%) benh nhan mai nhap vien co Khong suy dinh duong (SGA- A), 25,3% suy dinh duang nhe/vira (SGA-B), co mpt ty le dang ke (12,7%) suy dinh duong nang (SGA-C).
N g h i e n cihi Y hQC TJI«(%)
Y Hpc TP. Ho Chf M i n h * T i p 21 • S o 2 • 2017
60.0 45.0 30.0 15.0 0.0
6Z.U
U^
• m
A B C
Hinh S.TylecdckB qud ddnh gid dinh duong theo SGA
Danh gia vi^c ghi nh§n ke hoach dieu trj Ty le ho sa CO ghi nhan ke hoach dieu tri (dinh duong) eon chua cao 68,6%, trong do nguyen nhan ehii yeu ma cac nhan vien y te thuong bo qua phan nay la do phan tam soat dinh dirong nhanh theo NRS-2002 la "khong co nguy co" (75,8%), va 22,3% la do khi danh gia lai bang SGA cho ket qua la SGA-A. Mot ty le nho (1,9%) la khong giai thich dugc viec khong ghi nhan ke hoach dieu tri.
a
NRS khong SGA A Khic• •'
113 nsuy CffHinh 6. Ly do khdng ra dua ki'hoqch diiu tri Danh gia ly do moi hpi chan dinh dudng
Cae truang hgp moi hpi ehan dinh duong deu dung chi djnh, trong do 67,7% la do ket qua danh gia tinh trang dinh duang la SGA-C, con lai (32,3%) la do ket qua danh gia linh trang dinh duong la SGA-B va Albumin/mau <30 g/1.
8tf4i?a
SGA-C SGA-B va albumin mau<30g/l Hinh 7. Ddnh gidlydo m&i hgi di&i dinh di^ng KET L U A N - KIEN NGHI
Nhu vay qua ket qua nghien cuu viee thuc hien ^im soat va danh gia tinh trang dinh duong theo bieu mau ciia eae bac si lam sang tai benh vi&i Nguyen Tri Phuong cho thay cac bac si da buoc dhi ttiuc hien kha tot cong tac ^im soat va danh gja linh trang dinh duong va len ke hoach ean thiep dinh duang cho b?nh nhan. Tuy nhien de v i ^ thi^c hien nay dupe hieu qua hon chiing ta can co su eai tiai bieu mau, dong ihoi tang cuong viec huah luyen ^ m soat va danh gia tinh t r ^ g dinh duong cho cae khoa lam sang mpt each djnh ky. Nen co su ung hp tir phia Ban giam doe benh vien cung n h u su phai hgp dong bp, chat che giira khoa dinh duong, cae khoa lam sang va phong ke hoach tSng hgp de eo bien phap kiem tra, giam sat ch^t che va de ra eae hi|n phap hanh chanh phii hop.
TAI LIEU THAM KHAO
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4. Kondrup J, Allison S P, Eiia M, VeUas B, Plauth M (20O3).
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Ngdy nhgn bdi bdo: 10111/2016 Ngdy phdn bien nh&n xet bdi bdo. 18/11/2016 Ngdy bdi bdo dwgc ddng: 01/03/2017
