Nutrition and hydration management among stroke patients in inpatient rehabilitation: a best practice implementation project

Abstract

Introduction: In 2012 in Australia, stroke was the cause of 11 791 deaths and affected the lives of over 420 000 survivors. Survivors experience significant physical and cognitive deficits; and accumulate a 43% risk of subsequent stroke. Effective evidence-based management of stroke is essential. The Stroke Foundation released Clinical Guidelines for Stroke Management in 2017. Within these guidelines, nutrition and hydration are recognized as important aspects of poststroke management. Audit criteria drawn from the guidelines focussed on the role of multidisciplinary screening, assessment, monitoring and treatment of dehydration and malnutrition; as well as provision of nutrition education and counselling relating to secondary prevention of stroke. The implementation team included dietetics, medical and nursing staff. The project was completed in the stroke unit at Hampstead Rehabilitation Centre (Adelaide, South Australia). Objectives: To determine current compliance with Australian Clinical Guidelines of Stroke Management 2017, specifically those relating to nutrition, hydration and secondary prevention. To engage a multidisciplinary team to develop and implement strategies promoting best practice care for stroke survivors. Methods: The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System audit tool for baseline and follow-up audit, and the Getting Research into Practice feedback tool to facilitate practice change. Results: Postimplementation audit results demonstrated improvement in four criteria: Criterion 3 – Nondysphagic stroke patients with confirmed malnutrition or at risk for malnutrition are offered oral nutrition supplements, Criterion 4 – Stroke patients who are malnourished or at risk of malnutrition are referred to a Dietitian for individualized medical nutrition therapy, Criterion 5 – The hydration status of stroke patients is assessed, monitored and managed throughout their hospital admission, Criterion 6 – Stroke survivors are referred to a Dietitian for the provision of individualized dietary advice which incorporates secondary prevention strategies. Criterion 7 (A collaborative goal setting approach which includes the stroke survivor, their families and carers and the rehabilitation care team is implemented) remained consistent at 100% compliance. Although Criteria 5 and 6 improved during the project, they remained below 75% compliance therefore, offer ongoing opportunity for development. Criterion 1 (Stroke patients are screened for malnutrition upon admission using a validated malnutrition screening tool) and Criterion 2 (Stroke patients are rescreened for malnutrition weekly using a validated malnutrition screening tool) were affected by a change from written to electronic medical records therefore, the results did not accurately reflect the intervention. Conclusion: The current project successfully increased knowledge of nutrition and hydration management for stroke survivors and more closely aligned inpatient management with best practice guidelines to improve health outcomes. It highlighted areas of focus moving forward and has prompted ongoing work for sustaining evidence-based practice change.

Nurses’ roles in changing practice through implementing best practices: A systematic review

“…Studies were from a variety of healthcare or clinical contexts, with the majority ( n = 20) from a hospital setting. Of these, n = 14 were conducted in specialised hospital-based settings, including: medical and surgical wards ( n = 2) (Siegel 2020 ; Travers et al 2018 ), paediatric settings ( n = 2) (Rosenberg et al 2016 ; Yu et al 2017 ), postnatal ward ( n = 1) (Anderson & Kynoch 2017 ), neonatal intensive care unit ( n = 1) (Ceballos et al 2013 ), surgical ward ( n = 1) (Hu et al 2019 ), haemodialysis centre ( n = 1) (Jia et al 2016 ), haematology–oncology ( n = 1) (Naseer et al 2017 ), orthopaedic ward ( n = 1) (Ong et al 2017 ), medical ward ( n = 1) (Ullrich, McCutcheon & Parker 2015 ), intensive care unit ( n = 1) (Chiwaula et al 2021 ), in-patient rehabilitation ( n = 1) (Mullins 2021 ) and a neurology department (Sheng et al 2020 ).…”

“…Leadership played a role in almost all studies ( n = 21). This could be individuals, for example, a clinical champion (Allen et al 2018 ; Becker et al 2020 ), a (clinical) team leader (Anderson & Kynoch 2017 ; Chong et al 2013 ), a project leader (Hu et al 2019 ; Mullins 2021 ; Yu et al 2017 ) or nurse leader (Ceballos et al 2013 ), a nurse clinician (Nazeer et al 2017; Ong et al 2017 ), a knowledge broker (Bayly et al 2018 ), a practice facilitator (Shade et al 2020 ), Facilitator CogChamps (Travers et al 2018 ), a programme or project coordinator (Fleiszer et al 2015 , 2016 ; Monkong et al 2020 ) or an audit team leader (Jia et al 2016 ). In some studies, the leader was the researcher (Mitchell 2017 ) or part of the research team (Kilpatrick et al 2020 ; Rosenberg et al 2016 ; Williams et al 2019 ).…”

“…managing the project, process control and promotion and keeping timelines (Monkong et al 2020 ; Mullins 2021 ; Yu et al 2017 )…”

Nutritional Supplements and Neuroprotective Diets and Their Potential Clinical Significance in Post-Stroke Rehabilitation

“…Malnutrition is common in patients with neurological conditions, including stroke. The causes of this abnormality are directly related to neurological diseases, such as cognitive functions and disorder of consciousness, neurogenic vomiting, neurogenic dysphagia, depression, motor deficit and gastrointestinal dysfunction [ 8 , 9 , 10 ].…”

The Role of Supplementation with Natural Compounds in Post-Stroke Patients

“…People with neurological diseases, including poststroke patients, are particularly prone to malnutrition. That malnutrition is caused by ailments associated with neurological diseases, such as impaired consciousness and cognitive functions, neurogenic dysphagia, neurogenic vomiting, gastrointestinal dysfunction, motor deficits or depression [ 1 , 2 , 3 ]. According to ESPEN (European Society for Clinical Nutrition and Metabolism), malnutrition is defined as “a condition resulting from the lack of intake or absorption of nutrients, leading to a change in body composition, physical and intellectual impairment of the body’s physical and intellectual function, and adversely affecting the treatment of the underlying disease” [ 4 ].…”