Establishing an evidenced‐based dietetic model of care in haemodialysis using implementation science. Issue 2 (21st March 2019)

• Record Type: Journal Article
• Authors: Mackay, Hannah J.; Campbell, Katrina L.; van der Meij, Barbara S.; Wilkinson, Shelley A.
• Is Part Of: Nutrition & dietetics. Volume 76:Issue 2(2019)
• Page Start: 150
• Page End: 157
• Publication Date: 2019-03-21
• Subjects: clinical nutrition and dietetics -- evidence‐based practice -- malnutrition -- renal; Nutrition -- Periodicals; Dietetics -- Periodicals; 613.205
• DOI: 10.1111/1747-0080.12528
• Languages: English
• ISSNs: 1446-6368

Abstract

Abstract : Aim: To establish an evidence‐based dietetics service in an in‐centre haemodialysis unit utilising implementation science. Methods: The service was developed through the Knowledge‐to‐Action Framework. The steps of the Action Cycle were addressed through a literature review, identification of evidence‐based guidelines, benchmarking and local staff engagement. The theoretical domains framework (TDF) was used to identify barriers/enablers, and behaviour change wheel to determine appropriate interventions. To monitor, evaluate outcomes and assess sustained knowledge use we employed multidisciplinary team engagement and database use. Audit data were collected at baseline, 6 and 12 months on nutrition assessment (Patient‐Generated Subjective Global Assessment), intervention timeliness and alignment to dietetic workforce recommendations. Descriptive statistics, McNemar tests and a linear mixed model were applied. Results: Barriers existed in the knowledge, skills, environmental context and resources TDF domains. Suitable interventions were identified with training on nutritional management of haemodialysis patients delivered to 148 nurses, and nutrition management recommendations summarised into local procedural resources. A database to prompt and monitor outcome measures was created and indicated that over 18 months post‐service commencement, eligible patients received nutrition assessment at least 6‐monthly, aligning with recommendations. Prevalence of malnutrition was 28% (n = 9/32) at baseline, 23% (n = 5/22) at 6 months and 20% (n = 4/20) at 12 months ( P = 0.50). Conclusions: We demonstrated benefits to service development and implementation with implementation science providing a structured and methodical approach to translating guidelines into practice. Development of training, resources and prompts for outcome measures has supported the establishment of an evidence‐based dietetics service in a haemodialysis unit.