Implementing evidence-based guidelines for nutrition support in acute stroke
- 1Mayday Healthcare NHS Trust and Faculty of Health and Social Care Sciences, Kingston University / St George’s Hospital Medical School, Kingston upon Thames, UK
- 2Faculty of Health and Social Care Sciences, Kingston University / St George’s Hospital Medical School, Kingston upon Thames, UK
This work forms part of the South Thames Evidence-Based Practice (STEP) Project funded in 1996 by what was then South Thames Research and Development Directorate of the UK Department of Health. STEP was a major multidisciplinary initiative supported by collaborative partnerships between university departments and National Health Service (NHS) Trusts with the aim of evaluating implementation of research evidence in a variety of settings. External evaluation was done by King’s College.
A range of topics was identified with substantial evidence bases. South London Trusts were invited to participate where topics matched their service priorities. 9 projects were sited in 8 Trust locations and focused on leg ulcer management, pressure area care, continence, breast feeding, family centred care in schizophrenia, discharge planning, nutrition (2 projects), and rehabilitation management in stroke. Each project reported separately, and separate academic teams provided internal and external overview evaluation reports.1–2 The following is a description of one of these projects, which focused on nutrition for patients with acute stroke.
Nutrition in acute stroke
Stroke is a major cause of mortality, morbidity, and enduring disability in industrialised countries, producing a range of problems that influence eating and dietary intake.3–4 Nutrition in hospital affects progress and response to treatment, morbidity, mortality, and unplanned readmission.5 On admission, 16–31% of patients with stroke have indices of malnutrition,6–7 and the rate increases thereafter. Almost 50% of patients admitted to rehabilitation units are affected,8–9 with multiple nutritional risk factors conferring increased vulnerability. Malnutrition has been linked with increased risk of death and dependency after stroke.9–10 To address these concerns, the STEP Project for nutrition support in acute stroke aimed to develop, implement, and evaluate evidence-based multiprofessional guidelines.
The guidelines and their underpinning evidence
The academic and clinical managers at the institution of the project agreed on the outline project remit, which …