Evaluation of adherence to a nutrition-screening programme over a 5-year period.

BACKGROUND: Nutrition screening using the Malnutrition Universal Screening Tool (MUST) was implemented for adult patients in 2006. The aim of this study was to assess adherence to the screening programme over a 5-year period after a targeted approach to training ward staff. SUBJECTS/METHODS: Following the implementation of MUST on 32 wards, regular audits were carried out. Data on completion rates at ward level were collected by nutrition link nurses and submitted electronically for collation. RESULTS: Data on MUST were collected on a total of 17 876 patients during this period. Mean percentage of patients screened with a moderate or high risk of malnutrition was 19% in those screened within 24 h after admission and 28% in those screened at 7 days. Twenty percent of patients had an uncompleted MUST score at 24 h after admission and 15% were uncompleted after 7 inpatient days. After implementation, half the hospital population were being screened on admission. However, a number of wards were neither reporting the data nor completing the screening process. Following targeted training on wards, screening rates improved in 2009 and the number of patients screened improved as ward engagement increased. CONCLUSION: Audit has been fundamental in the implementation of MUST and has allowed training, additional time and educational resources to be allocated to specific wards to facilitate improvements in screening. Lead nurse support and monitoring has improved adherence rates and facilitated an increase in the identification of patients at moderate and high risk of malnutrition.

Improving adherence to a care plan generated from the Malnutrition Universal Screening Tool.

BACKGROUND/OBJECTIVES: Recommendations state that all hospital patients should be screened for malnutrition and for each level of risk, a suitable care plan should be available. This study investigates current practice at ward level regarding adherence to a care plan generated from a nutrition screening tool, and then aims to improve basic nutritional support actions by modifying a care plan and finally evaluates change in practice. SUBJECTS/METHODS: Pro formas were completed on nutrition care plans of 100 patients. Subsequently, 7 focus groups were conducted, which included 30 ward staff and 6 dietitians. Care plans were re-designed using information from focus groups, followed by a second set of pro formas on the care plans of 103 patients. RESULTS: Themes regarding barriers and facilitators for completion of care plans were derived from the focus groups including: 'duplication', 'time pressures', 'leadership support', 'operational issues', 'document style' and 'training'. Pro formas before and after re-design showed that nutritional support actions increased from 13 (9%) to 98 (52%) for patients at moderate or severe risk of malnutrition (P=0.033). CONCLUSIONS: Focus groups allowed engagement with ward staff to explore how care plans were used, which assisted in re-designing the care plan, while the pro formas identified limitations of initial procedures and then evaluated change. Subsequently, basic nutritional support actions that resulted from screening improved. The suitability of care plans to facilitate basic nutritional support and documentation was enhanced. However, improvements are still required, emphasising the necessity for continued training and a strategic approach to the delivery of basic nutritional care.