Reshaping Nutrition Intervention

Mrs Anika Howard1

1NSW Health, Lismore, Australia

As a published research author, and with 10 years of clinical experience, Anika readily advocates for person centred care through quality improvement initiatives. Challenged by the limitations of operating within a volume based care mode, Anika recently completed the NSW Health Clinical Excellence Commission Foundational Clinical Leadership Program. Her project examined existing nutrition service delivery in response to patients identified at risk of malnutrition, and considered opportunities for workforce development to transition towards a value based model of patient care.

Recreationally, Anika enjoys an active coastal life with her husband and two young daughters. As a lover of food, she enjoys that all foods that she eats are inherently ‘Dietitian Approved’.

Malnutrition is a significant issue within Australian Hospitals, with a national prevalence of 35-43% amongst inpatients. The NSW Health Nutrition Care Policy provides a framework for a strategic and coordinated approach to nutrition care. However, within a regional hospital with a volume based care model and finite 1.6 FTE general dietetic staffing, the monthly 130-198 patients identified at risk of malnutrition do not receive timely nutrition intervention.

Using Improvement Science methodology, this project examines the existing nutrition service model and investigates opportunities for workforce development. Key change ideas include:

  1. Ascertaining referral data quality by conducting plate wastage audits, patient meal time audits, and re-screening of malnutrition risk using validated tools
  2. Remodelling the Diet Aide role to engage in delegated clinical tasks through completion of the Cert IV Allied Health Assistant (Nutrition & Dietetics) and in house training
  3. Reviewing and developing more efficient clinical documentation processes

More than 50% of malnutrition risk referrals received by the Dietetics department were found to be generated erroneously. By implementing a local minimum intake benchmark (<4000kJ/day) within Nutrition Analytic software, sensitivity of patient food consumption data to indicate malnutrition risk was improved by 30%.

This project is in the implementation phase. The change ideas addressed have been foundational to the project aim and have positioned the Diet Aide workforce to reflect the NSW Health Allied Health Assistant model. Further staged Plan, Do, Study, Act cycles are planned, with outcomes estimated to be reached by the end of 2021.


Anika Howard is a senior dietitian and champion for change at her hometown regional hospital in northern New South Wales.

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