Clinical Nutrition Impact of Dietetic input on patient nutritional outcomes in the falls pathway

Background: Many people on Home Enteral Feeding (HEF) require care home placement. An audit in 2018, of patient documentation for 82 patients receiving enteral feeding, identified that care standards were not being met (1) . Only 68% of patients had their Body Mass Index (BMI) calculated and percentage weight loss was recorded in just 10% of cases. Tube and stoma care were not always recorded. Effective nutritional monitoring and enteral feeding tube care is essential to reduce the incidence of complications and achieve positive nutritional and clinical outcomes (2,3) . The project aimed to evaluate the introduction of standardised documentation in 2019 compared to practice in 2018 and to assess nurse acceptance of the standardised documentation. Methods: A PDSA (Plan, Do, Study, Act) model for improvement was adopted. Standardised documentation was co-designed with stakeholders, including care home managers, care home nurses, dietitians and enteral feeding nurses (2) . This was piloted for one month with 23 patients on enteral feeding in three care homes. The care homes selected had larger numbers of patients on enteral feeding. Like in 2018, the completion of the new documentation was audited against local and national standards. These standards high-light the recommended care of enteral feeding tubes and effective nutritional monitoring practice (2,3) . 100% compliance represents the gold standard. A questionnaire was distrib-uted to permanent nurses, experienced in using both old and new documentation, exploring attitudes towards the standardised documentation. This included Background: Nutritional therapy is important in the management of inflammatory bowel disease (IBD) patients due to the prevalence of malnutrition and the role of exclusive enteral nutrition (EEN) in the induction of disease remis-sion. The UK IBD Standards (1) provide a benchmark for nutritional assessment and nutritional therapy for IBD. The aim of this study was to elucidate the dietary management strategies that are utilised in UK clinical practice for IBD patients and to assess whether the National IBD Standards are being met in relation to the provision of nutritional therapy. Methods: A cross- sectional observational study was under-taken using a questionnaire survey of NHS dietitians working with IBD patients. Participants were invited to take part via an email disseminated by the British Dietetic Association. Data collection was conducted between February- March 2020 using an electronic self- administered questionnaire in Qualtrics software. Frequency n (%) was used to report the results of categorical data. Pearson’s chi- squared or Fisher’s exact test was used to determine association with a p- value of 0.05 to determine statistical significance. Ethical approval was granted by Research Ethics Committee at King’s College London (MRA- 19/20- 17352). Results: Complete responses were obtained from 43 dietitians. Thirteen (30.2%) dietitians reported less than 1.0 whole time equivalent (WTE) gastroenterology dietitian for their Trust. Dietitians more frequently reported ‘always’ for inpatients (n = 14 (32.6%)) having an assessment of nutritional status than newly diagnosed IBD outpatients (n = 3 (7%)). Higher gastroenterology dietetic resourcing (≥1.0 WTE) was associated with a higher frequency of nutritional assessment for inpatients compared to <1.0