An Audit of nutrition in patients admitted to the Auckland City Hospital Acute Stroke Unit

Abstract

Stroke is a leading cause of death and disability worldwide. Malnutrition is frequently observed in patients with stroke; and dysphagia, a common consequence of stroke, also contributes to malnutrition risk. Despite these findings, the provision of nutrition care and the monitoring of nutritional status are often overlooked in the treatment and management of patients with acute stroke. In 2010, the New Zealand Stroke Foundation outlined a number of evidence-based recommendations for the management of nutrition and hydration in patients with stroke. Local standards of care also exist for the provision of nutrition and hydration on the Auckland City Hospital Stroke Unit. To our knowledge, no studies of New Zealand stroke units have reported on nutrition outcomes. The purpose this study was to conduct an audit on the current level of nutrition care and the nutritional status of patients admitted to a stroke unit, compared to national and local guidelines. Consecutive patients admitted to the Auckland City Hospital Stroke Unit were recruited into the audit between May and July 2015. Data were collected on nutritional status (Malnutrition Screening Tool [MST]), nutrition prescriptions, nutrition intake and clinical outcomes. The audit was performed on 95 participants (51% males, mean age 72.6 years [SD 15.8]). Only 40% of patients receiving oral nutrition and 69% of patients receiving enteral nutrition (EN) met their recommended energy requirements on the stroke unit during the first 5 days of hospital stay. One quarter (25%) of all participants were made NBM and one in seven (14%) received EN at some stage while on the stroke unit. Results from this audit confirmed that current levels of nutritional screening, and nutritional intakes of patients admitted to the Auckland City Hospital Stroke Unit are lower than recommendations. This audit provides a starting point for further more in-depth research regarding nutrition in New Zealand stroke units. We recommend a key performance indicator (KPI) for stroke units to report to the Ministry of Health: 75% of patients admitted to stroke units should have MST documented in clinical records within 48 hours of admission. This KPI will enable a standardised measurement of the efficiency of nutrition services across New Zealand stroke units.