Documented but Not Demonstrably Performed: A Retrospective Audit of Routine NRS-2002 Screening Records in Hospitalized Adults with Diabetes

Background/Objectives: Nutritional-risk screening at admission is mandatory in many hospitals but is rarely audited. We audited routine Nutritional-Risk Screening 2002 (NRS-2002) records entered by nurses with mandatory training and credentialed access in hospitalized adults with diabetes.

Methods

Retrospective, records-based audit of all eligible admissions (2020-2025) at a Saudi tertiary center. Routine items were extracted verbatim, and dietitians re-scored each admission from the same record using a common written procedure.

Results

Of 650 admissions assessed, 131 were excluded (46 with no form opened; 85 with incomplete clinical data). Of 519 analyzed forms, 446 (85.9%) carried zero on every item and 22 (4.2%) contained any substantive item; of 73 non-zero totals, 41 comprised the age item alone and 11 could not be derived from their items. Among 83 admissions in which a charted body-mass index below 20.5 kg/m2 made the full screen mandatory, 79 (95.2%) had no substantive item. Any entry was present in 70.8% of patients aged ≥70 years versus 5.9% of younger patients, although indications for the full screen were less frequent in older patients. Re-scoring classified 124 admissions (23.9%, 95% CI 20.4-27.7) at NRS-2002-defined risk versus one routinely; 123 (99.2%) were unrecognized. Scoring diabetes itself as disease severity 1 left this unchanged; an extreme lower-bound rule gave 57 (11.0%), none recognized.