title: Improving adherence to a care plan generated from the Malnutrition Universal Screening Tool.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Nutrition and Dietetics, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: E R
authors.initials: ER
authors.lastname: Brierley
authors.forename: S T
authors.initials: ST
authors.lastname: Burden
mesh_terms: D017144:Focus Groups; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis / Q000178:diet therapy* / Q000517:prevention & control; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support / Q000592:standards*; D058996:Quality Improvement; D012306:Risk