The effect of a dietetic/speech and language therapy assistant practitioner on compliance with nutrition screening targets on an acute stroke unit

Abstract

Background: Dietetic support on the acute stroke unit (ASU) at Southampton General Hospital (SGH) includes a dietetic/speech & language therapy assistant practitioner (AP). This post offers dedicated time to enable nutrition screening and subsequent care planning. National Institute of Health & Clinical Excellence (NICE) guidance (2006) and Trust policy states that all patients admitted to hospital should be assessed for risk of malnutrition using a validated tool such as the the Malnutrition Universal Screening Tool (MUST). The ASU was not achieving the standard of 100% compliance and intervention was needed to improve performance. The aims of the project were to develop a programme of intervention to improve compliance and to demonstrate any change by pre- and post-intervention audit. Methods: An audit tool was developed and a monthly audit programme commenced. Nursing staff were kept informed of results through posters displayed on the ward. Formal, ward-level teaching sessions were introduced; however, there was limited uptake and so the AP sought a high level of visible presence on the ward and started a programme of 1 : 1 teaching. Ward staff responded well to this more individualised, practical approach: they welcomed the support of the AP and availability for demonstrations when screening patients. This improved screening frequency and referrals to the Dietetic service for ‘high-risk’ patients were actioned quickly. This helped to ensure early nutritional intervention and the positive impact of screening could be seen by ward staff. This fostered an improved attitude to the use of the MUST. Results: Table 1 shows a steady, upwards trend over the 18 month period. Initially, only 11% of patients were being screened for malnutrition. At 6 months, this had risen, and over 60% of patients were being weighed and screened using the MUST. At 9 months, 100% of patients were both weighed and screened. Compliance remained high over the next 6 months. When the project began, compliance was low and nursing staff had not had recent education on nutrition screening. During the last 10 months of data collection, compliance fell below 90% only three times. This was explained by ward closures for infection control reasons and because of the hoist weighing scales being out of order. ‘Appropriate’ patients only were included in the results: those excluded were those who had been on the ward for <24 h, had not been assessed by the physiotherapists and could therefore not be mobilised and those deemed too acutely unwell by the Doctors for Therapist intervention. As a result of this project, discussions around the MUST have increased on the ASU and the MUST now has a place in the initial admission pack. Table 1. Percentage of patients being weighed and assessed with MUST over 18 months Month % Patients weighed % Patients screened August 2009 36 11 February 2010 64 61 May 2010 100 100 June 2010 70 65 July 2010 95 95 August 2010 100 100 September 2010 68 58 October 2010 95 89 November 2010 100 95 Conclusions: The role of the AP on the ASU is a unique one. It allows a practical and individual focus that has improved MUST-related awareness and skills amongst ward staff and supported a significant improvement in compliance with national and local standards of good clinical practice on the ASU. Reference: NICE (2006) Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (Clinical Guideline 32). http://www.nice.org.uk.