title: The accuracy of food intake charts completed by nursing staff as part of usual care when no additional training in completing intake tools is provided.
abstract: OBJECTIVE
  Dietary intake tools that require ongoing training may not be valid and useful in a busy acute care setting. We compared nutrient intakes of inpatients using weighed food records (WFR) with food charts completed by nursing staff who hadn't received recent intake tool training.
  
  
  METHODS
  The weight of individual foods remaining on patients' main meal trays was deducted from a reference tray weight. Mid-meal consumption was determined by patient report. WFR and food charts were converted to nutrients using suppliers' information. Food charts were also converted using a ready reckoner. Agreement between methods was tested using t-tests, cross-classification, correlations and Bland-Altman plots.
  
  
  RESULTS
  Forty-three intake days were compared (n = 15 inpatients, 77 ± 8 yrs, 60%M). Most (93%) food intake charts were incomplete. Energy and protein intakes across meals were similar between food charts and WFR (754 ± 442 kCal, 29.9 ± 19.7 g protein; p > 0.05). Significant correlations were observed at breakfast between WFR and food chart ready reckoner (energy: r = 0.793; protein: r = 0.588; p < 0.01), and breakfast, morning tea and lunch using the food chart supplier's information (energy: r = 0.767-0.898, p < 0.05; protein: r = 0.786-0.912, p < 0.05). Cross-classification was unacceptable (11-33% gross misclassification), and mealtime limits of agreement were wide (-497-+552 kCal, -27-+36 g protein).
  
  
  CONCLUSIONS
  The poor agreement between intake methods suggests that food charts completed by nursing staff as part of usual care with no additional intake tool training may not accurately measure inpatient intake. Given that nursing staff may require ongoing training on completion of intake tools, alternative efficient and accurate means of measuring inpatient intake may be needed.
authors.affiliation: Queensland Health, Logan Hospital, Meadowbrook, QLD, 4131, Australia. Electronic address: michelle.palmer@health.qld.gov.au.
authors.forename: Michelle
authors.initials: M
authors.lastname: Palmer
authors.affiliation: Griffith University, Gold Coast, QLD, 4215, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Miller
authors.affiliation: Queensland Health, Logan Hospital, Meadowbrook, QLD, 4131, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Noble
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015930:Diet Records; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D062407:Meals; D009740:Nursing Staff / Q000193:education*
chemical_list: D004044:Dietary Proteins
keywords: Energy; Food intake chart; Hospital; Protein; Validation