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Evid Based Nurs 6:68-71 doi:10.1136/ebn.6.3.68
  • Implementation forum

Implementing evidence-based guidelines for nutrition support in acute stroke

Table 3

Meal observations, guideline compliance, and patient outcomes in patients with stroke before and after guideline implementation

Outcomes Before n (%) Aftern (%) Significance*
*Calculated using chi square test unless otherwise indicated; NS = not significant
† Mann-Whitney U-test
‡Calculated from numbers of patients with specific impairments that affect eating and treated with occupational therapy and physical therapy.
Meal observations (n=120, 42 stroke patients)
Eat independently 39 (32) 13 (31)
Need assistance to eat 48 (40) 17 (40)
Need feeding 18 (15) 9 (21)
Tube fed 8 (7) 3 (7) NS†
Assisted to eat by relatives 5 (4)* 2 (5)*
Fed by relatives 8 (7)* 1 (2)* NS†
Guideline compliance(n=200 before, n=200 after, all stroke patients)
Swallowing function screened within 24 hours 106 (53) 123 (62) <0.001
Screened for dysphagia using validated tool 0 64 (32) <0.001
Screened for nutritional risk within 24 hours 3 (1) 36 (18) <0.001
Use of validated nutrition risk tool for screening 6 (3) 53 (26) <0.001
Use of validated nutrition risk tool for monitoring 35 (17) 74 (37) <0.001
Referrals to physiotherapy‡ 61–63% 91–92% p<0.001
Referrals to occupational therapy‡ 58–70% 82–84% p<0.001
Nutritional support decision making deferred beyond day 5 35 (17) 12 (6) <0.001
Tube fed 33 (16) 27 (13) NS
Tube feeding implemented and established (>50% prescription delivered) 17/33 (51) 22/27 (81) <0.016
Referral to SLT 74 (37) 80 (40) NS
Weighed within first 5 days 58 (29) 66 (33) NS
Patient outcomes
Chest infection, aspiration pneumonia, or sepsis 33 (16) 13 (6) <0.003

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