Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

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

European Journal of Clinical Nutrition volume 67, pages 174–179 (2013)Cite this article

Subjects

Abstract

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Council of Europe. Food and Nutritional Care in Hospitals: How to Prevent Undernutrition Nutrition Programmes in Hospitals Group for the Committee of Experts on Nutrition, Food & Safety and Consumer Health. Strasbourg: Council of Europe 2003.

  2. National Collaborating Centre for Acute Care. Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. NICE Clinical Guideline 32: London, 2006.

  3. Department of Health Essence of Care Benchmarking for Food and Drink. Her Majesty’s Stationery Office, United Kingdom 2010.

  4. National Patient Safety Agency Patient Environment Action Team Assessment. National Patient Safety Agency, London 2010.

  5. Westergren A, Wann-Hansson C, Bergh Börgdal E, Sjölander J, Strömblad R, Klevsgård R et al. Malnutrition prevalence and precision in nutritional care differed in relation to hospital volume – a cross-sectional survey. Nutr J 2009; 8: 1–8.

    Article  Google Scholar 

  6. Russell C, Elia M Nutrition Screening Survey in the UK in 2008. British Association of Enteral and Parenteral Nutrition 2008.

  7. Stratton RJ, Green CJ, Elia M Disease-Related Malnutrition: An Evidence-Based Approach to Treatment. CAB International: Wallingford, 2003.

    Book  Google Scholar 

  8. British Association for Parenteral and Enteral Nutrition. Hospital Food as Treatment. British Association for Parenteral and Enteral Nutrition: Maidenhead, Berks, 1999.

  9. Weekes CE, Spiro A, Baldwin C, Whelan K, Thomas JE, Parkin D et al. A review of the evidence for the impact of improving nutritional care on nutritional and clinical outcomes and cost. J Hum Nutr Diet 2009; 22: 324–335.

    Article  CAS  Google Scholar 

  10. Department of Health Equity and Excellence. Liberating the NHS: 2010 The Stationery Office, United Kingdom http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf Accessed 24 June 2011.

  11. Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA . Effectiveness and cost effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 2005; 82: 1082–1089.

    Article  CAS  Google Scholar 

  12. Kondrup J, Johansen N, Plum LM, Bak L, Larsen IH, Martinsen A et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 2002; 21: 461–468.

    Article  CAS  Google Scholar 

  13. Brugler LJ, DiPrinzio MJ, Bernstein L . The five-year evolution of a malnutrition treatment program in a community hospital. Jt Comm J Qual Improv 1999; 25: 191–206.

    CAS  PubMed  Google Scholar 

  14. Rypkema S, Adang G, Dicke E, Naber H, de Swart T, Disselhorst B et al. Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition. J Nutr Health Aging 2003; 8: 122–127.

    Google Scholar 

  15. O’Flynn J, Peake H, Hickson M, Foster D, Frost G . The prevalence of malnutrition in hospitals can be reduced: results from three consecutive cross-sectional studies. Clin Nutr 2005; 24: 1078–1088.

    Article  Google Scholar 

  16. Miles M, Huberman M Qualitative Data Analysis: A Source Book for New Methods. Sage Publications: Thousand Oaks, CA, 1994.

    Google Scholar 

  17. Thomas JM, Isenring E, Kellett E . Nutritional status and length of stay in patients admitted to an Acute Assessment Unit. J Hum Nutr Diet 2007; 20: 320–328.

    Article  CAS  Google Scholar 

  18. Ruxton CH, Gordon J, Kirkwood L, McMillan B, Ryan E . Risk of malnutrition in a sample of acute and long-stay NHS Fife in-patients: an audit. J Hum Nutr Diet 2008; 21: 81–90.

    Article  CAS  Google Scholar 

  19. Edington J, Boorman J, Durrant ER, Perkins A, Giffin CV, James R et al. Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. Clin Nutr 2000; 19: 191–195.

    Article  CAS  Google Scholar 

  20. Smoliner C, Norman K, Wagner K, Hartig W, Lochs H, Pirlich M . Malnutrition and depression in the institutionalised elderly. Br J Nutr 2009; 102: 1663–1667.

    Article  CAS  Google Scholar 

  21. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘Malnutrition Universal Screening Tool (MUST)’. Brit J Nutr 2004; 92: 799–808.

    Article  CAS  Google Scholar 

  22. Jefferies D, Johnson M, Ravens J . Nurturing and nourishing: the nurses’ role in nutritional care. J Clin Nurs 2011; 20: 317–330.

    Article  Google Scholar 

  23. Nursing and Midwifery Council The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives 2008 Nursing and Midwifery Council London.

  24. British Dietetic Association Code of Professional Conduct. The British Dietetic Association Birmingham 2008.

  25. O’Cathain A, Murphy E, Nicoll J . Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods approach Health Service Research. BMC Health Serv Res 2007; 7: 85.

    Article  Google Scholar 

Download references

Acknowledgements

We thank E Rowlands for assistance with some of the data collection, and nurses, patients and dietitians who participated and gave their valuable comments regarding this evaluation process. This research was fully funded by the Chairman’s Research Prize Scholarship. CC undertook data collection, analysis of qualitative work from the transcriptions and assisted with the manuscript. EB assisted with data collection and assisted with the manuscript; SB designed the study and undertook data analysis on quantitative data, and prepared the manuscript. All authors critically reviewed the manuscript and approved the final version. This work was undertaken at the Manchester Biomedical Research Centre (http://www.manchesterbrc.org/).

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK

    C Cooper & S T Burden

  2. Central Manchester University Hospital NHS Foundation Trust, Manchester, UK

    E R Brierley

  3. School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

    S T Burden

Authors
  1. C Cooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E R Brierley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S T Burden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S T Burden.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cooper, C., Brierley, E. & Burden, S. Improving adherence to a care plan generated from the Malnutrition Universal Screening Tool. Eur J Clin Nutr 67, 174–179 (2013). https://doi.org/10.1038/ejcn.2012.196

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2012.196

Keywords

This article is cited by

Search

Advanced search

Quick links