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Malnutrition and Patient Safety Healthcare Policy

The health care policy issue that presents the greatest interest to me is patient safety. I am convinced that all aspects of this issue should be the primary concern of all the professionals working in the field. Each hospital has to develop quality standards and assessment guidelines to be able to maintain the due level of service, equipment, and education of both the staff and patients on safety issues. It is highly important to identify risks and address them before they may threaten people’s well-being and life (Shekelle et al., 2013).

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When researchers speak about security issues in health care, they usually imply the safety of medications, the technology used for physiotherapy, hygiene, and high-quality nursing. However, there is one more factor that is none the less significant – this is nutrition safety. I particularly value its significance as I had a chance to witness a lot of incidents connected with malnutrition that aggravated the condition of the patients whose safety in this aspect was neglected (Correia et al., 2014). I believe that all the nursing personnel must be aware of the deplorable consequences of poor nutrition and address them alongside with other safety issues.

The specific problem surrounding nutrition safety consists of underestimation of its impact not only as a preventive measure but also as a part of the treatment. There are a lot of health care professionals who do not accept the responsibility for their patients’ healthy eating. The issue is specifically addressed only in cases of obesity, digestion disorders, terminal or severe diseases, and allergies in dangerous forms. Nevertheless, both doctors and nurses have to encounter the problem every day, even with patients whose condition is not related to digestive system disorders. There are now a lot of nutrition professionals qualified enough to help patients with the treatment of diabetes, obesity, bulimia, and other conditions. Their specialization is usually very broad. However, other health care specialists do not typically possess the necessary qualifications for dealing with nutrition safety concerns (Kris-Etherton et al., 2014).

As far as the existing regulations of nutrition are concerned, there now exist five possible scenarios, which allow a health care professional to implement nutrition tools in his/her practice (Correia et al., 2014):

  • you have a license as a nutrition specialist, whose academic preparation and practical experience meet all the legal standards accepted by the state laws;
  • you have a license in health care that gives you the right to regulate patients’ nutrition; in this case, you do not have to be a dietitian but your scope of practice presupposes that you are allowed to use and regulate the implementation of nutrition tools including the assessment of their safety;
  • you have a health care license that is exempt from the nutrition law; you possess a diploma that is accepted in your state and the nutrition law has an exemption for your specialization, which means that you can apply nutrition tools and modify nutrition of patients for the sake of providing maximum possible safety level;
  • you do not have a license in health care as you are exempt from it; your profession presupposes that you can use nutrition tools and no license is required in this case;
  • there is no law concerning nutrition in your state; it implies that being a health care professional you can introduce nutrition policies without having to align with the existing legislation.

The reality is that most health care providers have no right to regulate nutrition legally. This implies that modifications of the existing laws are essential for enabling specialists to interfere with the problem at the prevention stage.

If we analyze the context of the problem, the following key problematic points can be identified (Grol, Wensing, Eccles, & Davis, 2013):

  • dehydratioe to be transferred to care homes, no information is provided about their nutritional needs and dangers associated with the violation of these requirements.

There are a lot of options that can be suggested to deal with the problem. First and foremost, the creation of a nutrition safety team is required. The team would include a dietician, physician, nurse, and pharmacist. However, if we evaluate the efficiency of this decision, it becomes evident that this option does not solve the problem as it still does not allow health professionals who are not related to nutrition to regulate daily nutrition matters that inevitably arise during the hospital stay. It is also possible to address the issue at the higher level creating a special nutrition commission that would be responsible for regular assessment of hospitals in terms of food that they provide to their patients. This option is rather effective but still expensive to implement. Another option is to create a set of regulations concerning each condition that would identify what diet would be the safest possible option. Despite the seeming simplicity of this decision, it is still challenging and time-consuming to develop and implement. Thus, the following recommendations could be valuable (Mahan & Raymond, 2016):

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  • preventing malnutrition and treating patients who already suffer from it; a nutrition safety team can help recognize the cases of undermined nutrition safety; it can identify which patients need special attention in terms of nutrition and how their condition can be improved with the help of diet;
  • addressing metabolic complications and side effects in case artificial nutrition is unavoidable; acute conditions should be prevented or treated immediately as they present a real danger to patients’ life;
  • paying more attention to other disturbances that do not seem to be any danger but often signalize the presence of more serious problems (e.g. diarrhea, sickness, aspiration, etc.)
  • reducing complications that may arise from the implementation of artificial nutrition mechanisms (e.g. catheters, tubes, etc.); this could be achieved through standardization of artificial feeding procedures;
  • developing guidelines concerning the nutrition of all patients including those who do not show any signs of digestive problems;
  • creating a database of different cases associated with nutrition safety violations that could be used as precedents when it is necessary to decide how to deal with this or that case;
  • developing nutritional programs of both parenteral and enteral nutrition;
  • launching educational programs that would be aimed at educating all the personnel to recognize and prevent nutrition safety violations and change the nutrition plan following the patient’s conditions.

Moreover, it would be rather helpful to create a web resource that would reflect nutrition safety status and updates of each health care organization as there is currently no organization that would perform the role of the information provider. The point is that general information about the state of the problem across the country is not enough as the issue is specific for each hospital. This means that despite the obvious involvement of federal authorities, the immediate target is still local legislation. It is important to solve the particular problems of the city hospitals as the nationally imposed guidelines may be non-applicable for some specific cases. That is one the first body I would contact would be the mayor of the city as he/she possesses sufficient power to regulate the safety issues and at the same time is not detached from the particular local problems. Perhaps, it would not help develop national standards but it would still improve the safety conditions of each particular hospital (Shekelle et al., 2013).

Thus, the conclusion can be made that patient safety is a highly complex issue that has a lot of aspects. It is necessary to address not only such evident factors as technological or medication security but also the quality and safety of food. In many cases, it may aggravate the condition of the patient. The amount of specific cases requiring particular consideration implies that the measures must be taken at the local level.


Correia, M. I. T., Hegazi, R. A., Higashiguchi, T., Michel, J. P., Reddy, B. R., Tappenden, K. A.,… & Muscaritoli, M. (2014). Evidence-based recommendations for addressing malnutrition in health care: An updated strategy from the feed M. E. Global Study Group. Journal of the American Medical Directors Association, 15(8), 544-550.

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: The implementation of change in health care. Hoboken, NJ: John Wiley & Sons.

Kris-Etherton, P. M., Akabas, S. R., Bales, C. W., Bistrian, B., Braun, L., Edwards, M. S.,… & Pratt, C. A. (2014). The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. The American Journal of Clinical Nutrition, 99(5), 1153S-1166S.

Mahan, L. K., & Raymond, J. L. (2016). Krause’s food & the nutrition care process. New York, NY: Elsevier Health Sciences.

Shekelle, P. G., Wachter, R. M., Pronovost, P. J., Schoelles, K., McDonald, K. M., Dy, S. M.,… & Larkin, J. W. (2013). Making health care safer II: An updated critical analysis of the evidence for patient safety practices. Evidence Report/Technology Assessment, 11(2), 1-94.

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