Pilot process and outcome evaluation of the introduction of a clinical nutrition pathway in the care of in-hospital renal patients.

OBJECTIVE: Our objective was to investigate the effect of in-service education and the use of a clinical decision-making pathway on nurses' knowledge related to nutritional needs of renal patients and referrals to a dietitian. DESIGN: This was a before-and-after evaluation study of the effect of the implementation of a clinical nutrition pathway on nurses' knowledge and dietitian referrals. SETTING: The setting was a renal in-patient unit in southeast Queensland, Australia. PARTICIPANTS: There were two groups of participants. Part 1 consisted of 53 registered nurses working in the renal unit of a regional general hospital, and Part 2 consisted of the medical records of two cohorts of more than 100 patients admitted to the renal unit. INTERVENTION: A clinical nutrition pathway and a resource package were developed to support nurses' decision-making related to the nutritional care of renal patients. Thirty-minute in-service education sessions were conducted to explain the use of the pathway, and to develop nurses' confidence in dietary decision-making for renal patients. MAIN OUTCOME MEASURES: The main outcome measures consisted of the nurses' knowledge of nutritional interventions with renal patients and the frequency of dietitian referrals. RESULTS: The nurses' knowledge increased, and referrals to dietitians remained constant. CONCLUSIONS: In-service education and access to unit-based resources, including a decision-support clinical nutrition pathway, improved nurses' knowledge of nutritional care for renal patients. Nurses continued to refer patients for dietitian consultation after the intervention.