Key findings from the two interventions, nutrition champion and dietetic team, are presented below. There were 3 evaluation wards for each intervention, all developed action plans to enhance oral nutrition support in the clinical area. Staff perspectives on the use and effectiveness of MUST in identifying patients at risk of malnutrition, the usefulness of a local care guideline are also included.
Knowledge and attitudes of staff towards oral nutrition support
- Baseline data showed that most staff felt nutrition was given high a priority in their clinical areas and they had access to specialist advice.
- The need for further training, better access to evidence based guidelines and improved communication between the multi-disciplinary team (MDT)were identified by a high proportion of staff as a means of improving oral nutrition support.
- Ward based nutrition champions were considered a successful method for improving nutrition at ward level.
- With the support of the ward manager they were able to identify relevant nutritional interventions that could be improved. They then worked with staff to implement the changes required.
- The benefit that champions provided was most evident when they were supported by being given time to provide appropriate training and implement improvements in practice.
- Some champions linked with their ward based dietitians and gained additional support for their action plans.
- The model of using a team of dietitians to support the evaluation wards was a success from the perspective of the dietitians involved.
- Having a Agenda for Change Band 3 dietetic assistant to provide support for the ward based Band 5 dietitian meant that her time could be spent developing relationships, supporting ward staff and the MDT.
- The Band 7 in a supervisory role was able to speak to the senior management team to ensure a shared understanding and approach to nutrition on the ward and the implementation of their action plan.
- The dietetic assistant extended her expected role, in particular working with the ward kitchen assistants.
- The way staff were trained impacted on improvements in documentation of nutrition assessment/care management and observations of nutrition activities.
- The use of a Training Needs Analysis demonstrated that training plans instigated by ward nutrition champions were the most successful approach to ensuring all staff had an understanding of scoring MUST, the need for weekly reassessment and use of the local care guideline.
- Results from regularly auditing patient notes showed that most wards improved their documentation of MUST on admission and weekly reassessment.
Staff perspective on MUST
- Staff felt the MUST screening tool provided a clear, standardised evidence base for all grades of staff to assess patients at risk of malnutrition.
- It encouraged MDT communication on nutrition although this was not always consistent.
- There were issues with assessing patients who were frail and/or extremely ill and difficult to weigh.
Project and change management
- A combination of top down and bottom up action planning worked well.
- Providing education on change management and action planning was welcomed by all levels of staff especially those in the nutrition champion role.
- Interviews with staff highlighted the importance of leadership to improve oral nutrition support.
- Project overload was a challenge when implementing evidence based changes in practice, it can be difficult for wards to prioritise due to the number of top down initiatives.
The project finished in June 2012 and the findings are being written up for publication. Please contact Professor Kate Gerrish firstname.lastname@example.org