Nutritional Support Teams in Greece – Recent Advances in Hospital Malnutrition Legislation
Country – Greece
Prevalence rates of malnutrition in hospitalized patients in Greece vary from 25-40%. Since malnutrition largely goes by undetected and untreated the role of dietitians is essential in malnutrition screening and management.
In 29.2.2012 a new legislation devised by the Ministry of Health and Social Solidarity came into force. Law n. 4052/ Chapter n.134 refers comprehensively to Clinical Nutrition issues and addresses disease related malnutrition in Greek hospitals. Among the core objectives is ensuring appropriate nutrient intake for all patients according to their nutritional status, length of stay and possible changes in their clinical condition. The new legislation was the result of a concerted effort of the Hellenic Dietetic Association (HDA), the Hellenic Association of Hospital Dietetians (PASINOD) - both representing dietitians in Greece - and the multidisciplinary Society for Clinical Nutrition (GrESPEN).
The most important step against malnutrition the law recognizes is the establishment of the Nutritional Support Teams (NSTs) at every hospital. The Nutritional Support Team will primarily function through its multidisciplinary composition. Since nutritional care is and should be a responsibility of many disciplines, integrating the activities is absolutely essential. The NST will consist of a hospital dietitian, a nurse and a medical doctor. The doctors and nurses of the hospital that have gained postgraduate clinical nutrition education, or have at least attended relevant live courses will be selected for inclusion in the NST team. If necessary the hospital pharmacist will also be consulted.
NST will identify and treat those at risk for malnutrition. Useful measurements include recording nutritional intake, adverse effects associated with food intake, digestion and absorption, and food-drug interactions. NST will implement nutritional support when needed, and the outcome of the intervention recorded and evaluated. Special care will be given to the post-discharge patients at risk for malnutrition.
The hospital dietitian in collaboration with the NST will also be responsible for the provision of enteral or parenteral nutritional supplements, according to the nutritional plan. The new legislation clearly states that the hospital dietitian is responsible for the development of each patient’s nutritional plan, and the definition of the nutritional plan’s macro-micronutrient intake.
To further support the proper function of the NSTs in Greece, GrESPEN in collaboration with HDA and PASINOD will host relevant courses for all potential members of an NST on how to establish one and become a competitive member.
The new legislation highlights that the National and International Guidelines on Nutritional Support have to be followed. Given the economic situation in Greece, it becomes even more important that the NST focuses on the implementation of the simplest, safest, and most cost-effective means for nutritional support acceptable to the patient.
Tsagari Amalia, PhD, Clinical dietitian
ICDA Representative of Hellenic Dietetic Association
Bathrelou Eirini, PhD