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European Journal of Clinical Nutrition

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. 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. 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). 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.

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