Enhancing the quality of oral nutrition support for hospitalised patients: a mixed-methods knowledge translation study. (The EQONS study)

Aim - To report a multi-faceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. Background - Malnutrition among hospitalised patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. Design - A mixed-method integrated knowledge translation study. Methods - The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. Findings - Statistically significant differences (Chi Square) were observed in self-reported confidence of nurses a) to assess patients using the Malnutrition Universal Screening Tool, b) to teach colleagues how to use the Malnutrition Universal Screening Tool and c) to ensure that patients were assessed within 24 hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organisation) and macro (healthcare system) levels acted as barriers and enablers for change. Conclusion - Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition.