Terapia nutricional no estado de Minas Gerais: avaliação de qualidade

Abstract

Introduction: The implementation of nutrition therapy (NT) quality management, with the establishment of clinical protocols and monitoring tools, are strategies that contribute with the decrease of malnutrition and, improve the cost-effectiveness of NT. However, in Brazil there are very few data on this topic. Objective: The present study evaluated the practice of Nutritional Therapy in the state of Minas Gerais, according to the laws n ° 272/1998 and n ° 63/2000 in public, private, philanthropic and university hospitals. Methods: This was an observational and descriptive study whose data collection was carried out directly with members of the clinical and nutritional staff of the hospitals, with the help of a questionnaire addressing the referred laws. Patients medical records were also randomly audited. Nonprobabilistic (intentional) and probabilistic (random) sampling techniques were used for the selection of the hospitals in Belo Horizonte, the metropolitan region, as well as in medium and small cities in several regions of the state. Results: Thirty-three hospitals were included (10 public, 10 philanthropic, 9 private and 4 university). Twenty-six institutions had nutrition therapy teams (NTT). Of these, protocols for the indication, prescription, follow-up and NT were identified in 73.1% of the hospitals. Protocols for roles/attitudes of the pharmacist, nurse and dietetic were found in 73.1%, 84.6% and 88.5%, respectively. Twenty NTT had quality control indicators. Inspection of 172 medical records showed that screening was performed more frequently (59.6%) in public, university (31%) and philanthropic (25%) hospitals (p <0.05). The nutritional evaluation was more registered in the university (89.7%) than in the private ones (60.5%) and philanthropic hospitals (54.7%) (p <0.05). Nutrition diagnosis and plan were identified more frequently in university than in private and philanthropic institutions (p <0.05). The estimated caloric and protein requirements were more frequently registered in the public (92.3%) and university (82.8%) than in the private (47.4%) and philanthropic (47.2%) hospitals (p<0,05). Daily evolution was seen more frequently in the private (65.8%) (p <0.05). Adverse events were more frequently registered in the university hospitals (79.3%). The registry of the prescribed nutrition requirements was more observed in the public hospitals (p <0.05) and of the received requirements were higher in the university institutions (58.6%) (p <0.05). Biochemical labs were more seen in the public hospital records (42.3%) (p <0.05). Conclusion: The present study indicates that there are Nutrition therapy teams in the majority of the hospitals and that most of them have nutrition protocols and quality indicators. However, real practice nutrition care is not adequately fulfilled in most of the institutions.