Opportunity for delegation and interdisciplinary nutrition care in acute stroke units

Margot Leeson-smith1, Claire Archer2, Grace Carson3, Juliette  Mahero4, Liliana Botero Zapata1, Adrienne Young1

1Nutrition and Dietetics, Royal Brisbane And Women’s Hospital, Herston, Australia, 2Nutrition and Dietetics, Caboolture Hospital, Caboolture, Australia, 3Nutrition and Dietetics, Redcliffe Hospital, Redcliffe, Australia, 4Nutrition and Dietetics, The Prince Charles Hospital, Chermside, Australia

After stroke, nutritional risk related to dysphagia, fatigue, difficulty self-feeding and reduced appetite is common. International stroke guidelines recommend malnutrition screening and regular nutrition monitoring throughout the acute stroke admission. With increasing demands on allied health services, it is important to explore options for delegation and interdisciplinary care models. This study aims to describe nutrition care practices across acute stroke units in four Queensland hospitals, with the purpose of identifying opportunities for delegation and interdisciplinary care. Data were collected on consecutive patients admitted with acute stroke (August – November 2018): nutrition risk (defined as Malnutrition Screening Tool score ≥2, dysphagia requiring a texture modified diet and/or requiring feeding assistance), nutrition care initiated (diet code, food intake monitoring) and by who (dietitian, dietetic assistant, nursing, other), and indication for dietetic input (malnutrition diagnosis, enteral tube feeding need). Descriptive statistics (%, counts; mean, SD) were used to analyse data. Audits included 97 patients (average age 70 years, 52.5% male); five patients excluded due to palliation. Almost all patients were placed on oral diet (95%, n=92/97); of these, 48% (n=44/92) were identified as nutrition risk. Sixty-six percent (n=29/44) of at-risk patients received an appropriate high protein/energy diet, initiated mostly by dietitians (59%; dietetic assistants: 24%, nursing: 15%, speech pathology: 2%); less than half received food intake monitoring (39%, n=17/44), initiated mostly by the dietitian (56%; dietetic assistants: 24%, nursing: 20%).  Despite half of patients being at nutrition risk, only 7% (n=7/97) were malnourished and 5% (n=5/97) required enteral tube feeding. This study highlights opportunities for delegation and interdisciplinary care models in acute stroke, due to the high number of at-risk patients requiring monitoring and support but only a small number needing expert dietetic input. Implementation and evaluation of a systematised, interdisciplinary and delegation model is currently underway.

This study was supported with a grant from the Allied Health Professions Office of Queensland.


Margot Leeson-Smith is a Dietitian at the Royal Brisbane and Women’s Hospital / Central West Hospital and Health Service

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