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Summary of Results

Health Topic:   Endocrine, nutritional and metabolic
Guidance:   Nutrition support in adults
Description:   The summary of the published clinical guideline on Nutrition support in adults. It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage

External literature

External literature Assessment Coverage

Hearnshaw, SA and Thompson NP (2007) Use of parenteral nutrition in hospitals in the North of England Journal of Human Nutrition and Dietetics 20: 14-23

Description: An audit of 193 patients across the Northern Nutrition Network. The authors report practice is generally in line with guidelines: 82% patients had appropriate indications for PN. However only 3 of 15 hospitals had nutrition support teams.

Practice appears to be in line with guidance Local

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2010) A Mixed Bag: An enquiry into the care of hospital patients receiving parenteral nutrition

Description: The primary aim of the study was to examine the process of care for patients receiving parenteral nutrition (PN) in hospital. 5527 patients from 218 hospitals were identified as meeting the inclusion criteria for the study. The prevalence of named -patient individually compounded or 'bespoke' bags was low at 22%. If this figure is truly representative it shows a poor standard of initial PN which goes against NICE guidance.

Practice appears not to be in line with guidance National

London Procurement Programme (2010) Appropriate community oral nutritional supplementation

Description: Audit data obtained from a number of London PCT's shows a lack Audit data obtained from a number of London PCT's shows a lack of dietetic capacity to provide effective care, as well as inappropriate prescribing of oral nutritional supplements (ONS). Audit data indicates that between 57% and 75% of prescriptions do not meet ACBS prescribing criteria and are therefore inappropriate. It is estimated between 28 and 37 million has been spent inappropriately based on these data.

Practice appears not to be in line with guidance Regional

Judges D et al (2012) Clinical guidelines and enteral nutrition support: a survey of dietetic practice in the United Kingdom European Journal of Clinical Nutrition (2012) 66, 130-135

Description: This study, conducted during February and March 2009, explored the influence of guidelines and clinical experience on enteral tube feeding practices in UK dieticians. In total 681 responses were received. Results found that 85% deemed 'clinical experience' to be of greatest influence when initiating tube feeding regimen; 70% of respondents were aware of a department feeding protocol; 67% of protocols used a start rate of 24-49 ml/h and 23% had mandatory implementation of NICE guidelines.

Doubts about or mixed impact in practice National

Wagstaff G (2011) Dietetic practice in refeeding syndrome. Journal of Human Nutrition and Dietetics. Volume 24, Issue 5, Pages 505-515, October 2011

Description: This study used an on-line survey to investigate current dietetic practice in refeeding syndrome. London NHS Trusts were asked to disseminate the survey to all dietitians working with adults. There was a 30.8% response rate. 89.8% of respondents had read the 2006 NICE guidance, and 66.9% had changed their practice regarding refeeding syndrome management as a result. 62% do not wait for biochemistry to normalise before commencing nutrition, and 75% continue to supplement electrolytes reactively.

Practice appears not to be in line with guidance Local

Omar, S.P. et al (2011) Adherence to the national institute of clinical excellence guidance on parenteral nutrition screening is not adequate to improve outcomes.

Description: The aim of this study was to assess outcome measures of parenteral nutrition (PN) administration when NICE guidance was adhered to at King?s College Hospital NHS Foundation Trust, London between 2008 and 2010. 262 adult patients were divided into two groups: guidance compliant (143) and guidance non-compliant (119). Results show no difference in duration of treatment, total number of PN bags used per patient and length of hospital stay between the groups.

Doubts about or mixed impact in practice Local

Kimpton, S.E. (2011) A clinical audit to determine adherence in the norfolk and norwich university hospital to the nice guidelines for nutritional support in adults in the prevention and treatment of refeeding syndrome. Proceedings of the Nutrition Society. Conference Publication: (var.pagings). 70 (pp E281), 2011. Date of Publication: 2011.

Description: This audit aimed to determine the current practice in the prevention and treatment of refeeding syndrome, adherence to NICE guidelines and the use of the Malnutrition Universal Screening Tool (MUST) at Norfolk and Norwich University Hospital. Data was collected for 7 days on 30 patients over 11 weeks. Results include: MUST score calculated in 50% of patients; in 85% Vitamin B was started prior to feeding; and there was no delay in starting feeding for 76.7% of patients.

Doubts about or mixed impact in practice Local

Tahim, A.S. et al (2011) Appropriate monitoring of oral nutritional supplementation: An audit within a large GP practice. Proceedings of the Nutrition Society. Conference Publication: (var.pagings). 70 (pp E271), 2011. Date of Publication: 2011.

Description: This audit was conducted to assess whether there was appropriate documentation prior to starting and stopping oral nutritional supplementation, and whether BMI was measured within 3 months of starting treatment at Park Medical Centre, London. Electronic records on 39 patients were analysed. Results show 64.1% of all treatments were initiated at the practice. Of these, the reason for treatment was documented in 68% of cases. BMI was monitored within 3 months of treatment starting in 10% of cases.

Doubts about or mixed impact in practice Local

Speirs, C.A. (2011) 6 month prospective audit of parenteral nutrition in a general hospital. Proceedings of the Nutrition Society. Conference Publication: (var.pagings). 70 (pp E284), 2011. Date of Publication: 2011.

Description: A prospective audit of in-patients on Parenteral Nutrition (PN) was carried out over a six month period from August 2009, to compare the Royal Bolton Hospital NHS Foundation Trust's PN practices with NICE guidance. Findings include that all 34 identified patients had appropriate clinical indication(s) for PN, and that 32 had their nutritional requirements assessed by the dietician within 1 working day, the remaining 2 having died before the dietician could assess them.

Practice appears to be in line with guidance Local

British Association for Parenteral and Enteral Nutrition (BAPEN) (2013) Nutrition Screening Survey in the UK and Republic of Ireland in 2011.

Description: This report summarises the fourth nutrition screening survey undertaken in the UK. The survey was carried out from 5th -7th April 2011 and 171 hospitals, 78 care homes and 67 mental health units participated. The majority (86%) of hospitals stated that they knew what proportion of their patients were screened on admission and of those, 78% screened 76-100% patients. The ?Malnutrition Universal Screening Tool? (?MUST?) was used in 85% hospitals, 92% care homes and 75% mental health units.

Practice appears to be in line with guidance National

Baker, S. et al (2012) Initiating artificial nutrition support: a clinical judgement analysis. Journal of Human Nutrition & Dietetics. 25(5):427-34, 2012 Oct.

Description: Findings are presented from a clinical judgement analysis with 27 clinicians using two judgement tasks, carried out to measure variations in the practice of artificial nutrition including concordance with NICE guidelines. Clinicians were found to have only moderate agreement with NICE recommendations and overestimated the need for artificial nutrition support. Over 49 scenarios, clinicians decided to feed in 693 cases (vs. the guidelines 270) and not to feed in 684 (vs. the guidelines 1053).

Doubts about or mixed impact in practice Local

Guidelines and Audit Implementation Network (GAIN) (2012) Get Your 10 A Day Audit

Description: The aim of this audit was to examine current practice, identify aspects of good practice and areas for improvement in the management of nutrition for people in hospital settings. Data was collected between 4 July and 10 October 2011 across each of the five Health and Social Care trusts in Northern Ireland. Results included that 83% (651/783) audited had their Pre-MUST screening carried out within 24 hour of admission. This ranged across each trust from 45% to 100%.

Practice appears to be in line with guidance National

Dingwal, S. et al (2012) Adult nutritional status assessment in a hospital: Cross sectional study in a UK hospital Gut July 2012 Vol 61 Suppl 2

Description: This cross sectional study assessed completion of Malnutrition Universal Screening Tool (MUST) assessments; nutrition care plans, and food charts across ten wards at Luton and Dunstable Hospital. Ten patients were randomly selected from each ward, of these 100 patients 45% did not have a ?MUST? score. Two of the 10 wards had more than 50% completion of ?MUST? assessments. No wards had 100% completion.

Doubts about or mixed impact in practice Local

Adam, J.H. et al (2013) The development and evolution of nutrition service provision in the North East: 2003-2012 Gut. 2013 Conference (var.pagings) PAGES June-

Description: This study analysed the provision of nutrition services in hospitals across the North East of England between 2003 and 2012. Questionnaires were completed by a dietician from each acute hospital in the North East. The response rate was 100% . In 2012, 42% (2003: 19%) of hospitals had Nutrition Support Teams and all of acute trusts had a Nutrition Steering Committee (2003:31%). The use of standardised inpatient screening tools increased to 100% in 2012 from 31% in 2003.

Practice appears to be in line with guidance Regional

This page was last updated: 01 June 2013

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.