surgical unit between 24 th May 2016 and the 22 nd June 2016 were eligible for inclusion in this study. All patients were assessed by a member of the study team within 48 hours of the patients being admitted. A prospective review of the patient's medical and nursing records was undertaken to obtain the data outcomes required. Results: 500 patients (female 236:264 male; mean age 59 years (range 17-100years)) were recruited during the study period. In total 450 patients were from general surgery and 50 patients were from general medicine. Age, cancer diagnosis, emergency admission and female gender were all factors positively linked to increasing incidence of malnutrition. Three hundred and six patients (61%) had presenting symptoms which deleteriously impacted on nutritional status. These included nausea and vomiting (n¼138; 27.6%), diarrhoea or constipation (n¼23; 4.6%), pain (n¼92; 18.4%). Poor appetite and anorexia was reported in 175 patients (34%). Poor tissue viability was reported in 21 patients (4.2%). 130 patients (25%) were nil by mouth at the time of initial assessment by the study team in view of pending surgery. Patients who had a planned admission to hospital had a lower risk of undernutrition using the MUST screening tool when compared to patients admitted as an emergency admission, 25 patients (14.3%) versus 74 patients (22.8%). Our locally used validated nutritional risk screening tool reported 77 planned admission patients (44%) versus 158 emergency patients (48%) were either malnourished or at high risk for malnutrition. Conclusion: Many factors contribute to altered nutritional status. This reinforces the need for robust nutritional screening on admission to hospital and subsequent timely nutritional assessment by trained professionals followed by remedial nutritional treatment. Reference [1] BAPEN.org.uk.

was significantly greater for nurses on medical wards (p¼0.02) and those with previous training in NG position checks (p¼0.01). A pH was assigned in all 72 observations of the pH 7 solution with a range of answers given: pH 3.5 (n¼1), pH 5.5 (n¼2), pH 6 (n¼47) and pH >6 (n¼22). Substantial intra-rater reliability was demonstrated (kappa¼0.77) with 84% exact agreement and 94% exact and adjacent agreement. There were no significant factors influencing intra-rater reliability. Overall intra-rater reliability is good, however there are issues with accuracy of pH readings. As bronchial secretions have a minimum pH of 6, exact agreement is required at this level. Underestimation , which occurred in 15% of readings (pH 1.6 and pH 4 solutions), may result in harm. Although this may be addressed by training, which improved accuracy in this study, other strategies may need to be adopted as only half of this cohort had been formally trained despite widespread teaching programmes across the trust. Further consideration should be given to the use of pH meters or lowering the pH threshold for feeding without x-ray, but this poses other issues including radiation exposure, delays in feeding whilst awaiting imaging and difficulties with x-ray interpretation.

was significantly greater for nurses on medical wards (p¼0.02) and those with previous training in NG position checks (p¼0.01). A pH was assigned in all 72 observations of the pH 7 solution with a range of answers given: pH 3.5 (n¼1), pH 5.5 (n¼2), pH 6 (n¼47) and pH >6 (n¼22). Substantial intra-rater reliability was demonstrated (kappa¼0.77) with 84% exact agreement and 94% exact and adjacent agreement. There were no significant factors influencing intra-rater reliability. Overall intra-rater reliability is good, however there are issues with accuracy of pH readings. As bronchial secretions have a minimum pH of 6, exact agreement is required at this level. Underestimation , which occurred in 15% of readings (pH 1.6 and pH 4 solutions), may result in harm. Although this may be addressed by training, which improved accuracy in this study, other strategies may need to be adopted as only half of this cohort had been formally trained despite widespread teaching programmes across the trust. Further consideration should be given to the use of pH meters or lowering the pH threshold for feeding without x-ray, but this poses other issues including radiation exposure, delays in feeding whilst awaiting imaging and difficulties with x-ray interpretation.

was significantly greater for nurses on medical wards (p¼0.02) and those with previous training in NG position checks (p¼0.01). A pH was assigned in all 72 observations of the pH 7 solution with a range of answers given: pH 3.5 (n¼1), pH 5.5 (n¼2), pH 6 (n¼47) and pH >6 (n¼22). Substantial intra-rater reliability was demonstrated (kappa¼0.77) with 84% exact agreement and 94% exact and adjacent agreement. There were no significant factors influencing intra-rater reliability. Overall intra-rater reliability is good, however there are issues with accuracy of pH readings. As bronchial secretions have a minimum pH of 6, exact agreement is required at this level. Underestimation , which occurred in 15% of readings (pH 1.6 and pH 4 solutions), may result in harm. Although this may be addressed by training, which improved accuracy in this study, other strategies may need to be adopted as only half of this cohort had been formally trained despite widespread teaching programmes across the trust. Further consideration should be given to the use of pH meters or lowering the pH threshold for feeding without x-ray, but this poses other issues including radiation exposure, delays in feeding whilst awaiting imaging and difficulties with x-ray interpretation.

No abstract

The impact of Clostridium Difficile (C Diff) is widespread; ultimately impairing recovery and increasing length of hospital stay (1) . The incidence of C Diff in Wales's averages 17 patients/1000 admissions; which is similar for Scotland and England. Risk factors for the development of C Diff are increasing age, poor general health, immuno-compromise and patients undergoing major surgery (1) . The incidence in surgical patients equates to 9.6/1000 admissions (1) . The risk of malnutrition both pre/post surgery is well documented (2) . However, the link between malnutrition and the subsequent development of C Diff in surgical patients is not widely published. It seems logical that the deleterious effects of malnutrition, both on immunological and gastrointestinal function (2) may predispose patients to increasing risk of contracting C Diff. One of the recommendations of the recently published 'Clostridium Difficile Infection -How to deal with the problem' is that a Dietitian should form part of the multidisciplinary team reviewing all patients with C Diff.The aim of this study was to review the current level of dietetic input to surgical patients who developed C Diff. Data were collected retrospectively on confirmed cases of C Diff for 2008. The following data were collected, age, diagnosis, severity and duration of C diff, nutritional status (BMI, % weight loss and nutritional risk score), inflammatory markers, number of patients who were referred to the Dietitian, number of patients who received nutritional support and methods of delivering nutritional support and the duration and length of hospital stay.During the study period 65 patients were confirmed with C Diff. The majority of patients were not referred to the Dietitian. The percentage weight loss on admission suggests that the cohort were malnourished. Of the patients referred to the Dietitian 61 % required artificial nutritional support and 39 % required sip feeds. This review has concluded that patients confirmed with C Diff are often malnourished and the majority are not referred to the Dietitian. Further analysis of this dataset will be available late summer 2009.