Nutrition Support Teams: An Evidence-Based Practice

With the development of specialized nutrition support, an interdisciplinary approach was essential to translating this medical breakthrough from the laboratory to the bedside. As this new innovation was adopted, interdisciplinary nutrition support teams were created to optimize the effectiveness and safety of this therapy. The impact of standardization and the use of an interdisciplinary team to provide specialized nutrition support have been shown to improve outcomes and safety and to have a positive financial impact on healthcare institutions. Yet many hospitals do not have nutrition support teams, and the numbers that do may have decreased. To be effective, nutrition support teams need to practice at an evidence-based level and measure their performance. Nutrition support teams include many of the components of the healthcare delivery system that are advocated for the future, and nutrition support teams should be encouraged as the preferred system of providing specialized nutrition support.

Nursing management of post-stroke dysphagia in a tertiary hospital: a best practice implementation project

BACKGROUND

Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological conditions such as stroke. Nurses, who are available to patients 24 hours a day in hospital are in an ideal position to identify individuals with swallowing difficulties and initiate interventions that may prevent further complications until a formal assessment can be undertaken.

OBJECTIVES

The aim of this evidence implementation project was to improve nursing management of dysphagia in acute stroke patients and prevent the occurrence of aspiration in patients admitted to the neurology ward of Huashan Hospital, Fudan University, Shanghai.

METHODS

This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools. The same six audit criteria were used for the baseline and the follow-up clinical audits. The baseline audit was followed by the implementation of strategies targeted to address the identified barriers and the follow-up audit evaluated changes in practice. The same sample size (20 nurses and 30 patients) was used for both audits.

RESULTS

Improvements in practice were observed for all six audit criteria. The result of the post-implementation audit showed 100% compliance for the following recommendations: use of a validated tool, nurse-initiated dysphagia screening, appropriate referral to Speech and Language Therapy and education for nurses on dysphagia screening. The lowest compliance rate was for criterion 4 (patient education before discharge), which was 80%. The compliance rate for criterion 3 (screening within 24 hours from admission) was 93%.

CONCLUSION

This project has demonstrated significant improvements in nursing practice related to dysphagia screening and management. The project was successful not only in increasing the knowledge and skills of nurses but also in implementing a formalized process for dysphagia screening and referral. Strategies to sustain practice change should be developed, and regular audit cycles need to be carried out to monitor the process and evaluate outcomes.

Organizational aspects of starting and running an effective nutritional support service

Setting up and running a Clinical Nutritional Support Team can be challenging and is time consuming. Team members have to be motivated, committed and persistent. High quality working relationships are fundamentally important within the team, between teams and with other healthcare professionals. Good communication, careful planning, sensitive implementation and robust monitoring are the cornerstones of a successful service. Looking forward as well as back will help the team to maintain and improve its position in an ever-changing environment. While nutritional support is everyone's business, an effective multiprofessional Clinical Nutritional Support Team is the best way to ensure that patients receive appropriate and timely treatment. It is also wise to remember that a successful Clinical Nutritional Support Team will be as committed to its own development as it is to the care of the patients referred to it.

Restoring pleasure: nutritional management of dysphagia

Dysphagia is associated with many different conditions and although widespread it is frequently not recognized. People with dysphagia are at risk of developing serious complications such at malnutrition, dehydration and aspiration. Texture modification, food fortification and dietary supplements are important elements in effective nutritional management of dysphagia and can also help bring back some of the pleasure to mealtimes. The ideal approach to the management of dysphagia involves a multidisciplinary team.