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The aim of this project was to evaluate the current practice and implement best practice related to Enhanced Recovery After Surgery (ERAS) nutrition care protocols amongst elective colorectal surgery patients at Calvary North Adelaide Hospital. A second aim was to improve outcomes regarding length of hospital stay and rate of unplanned readmissions within 28-days in patients undergoing elective colorectal surgery.The rate of postoperative morbidity remains high after elective colorectal surgery. Enhanced Recovery After Surgery is an evidence-based program incorporating multimodal interventions (including nutrition interventions) in the perioperative period to reduce postoperative morbidity and expedite recovery.This evidence implementation project used the JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool. This project was conducted across the preadmission clinic, intensive care unit and surgical wards of a 153-bed, private, acute care hospital in Australia, along with five private surgical clinics. The sample size included 20 patients undergoing elective colorectal surgery and five colorectal surgeons. Seven audit criteria based on the ERAS Society nutrition care protocols for elective colorectal surgery were used, and patient outcomes were length of stay and rate of unplanned readmission within 28 days. A pre-implementation audit was conducted, which informed the development of an implementation plan for ERAS nutrition care protocols using the GRiP analysis. A follow-up audit was conducted to measure change in practice and patient outcomes.Improvement in compliance was observed in four audit criteria: preoperative fasting is minimized (from 0% to 15%), early feeding is implemented postoperatively (from 10% to 65%), preoperative carbohydrate drinks are given (from 20% to 25%) and oral supplements are given postoperatively (from 0% to 20%). Compliance for one audit criterion remained constant: patients are screened for malnutrition risk in preadmission clinic (100% for both audits). Two audit criteria saw a drop in compliance: nutrition support is provided preoperatively to malnourished patients (from 60% to 15%) and nutrition education is provided preoperatively (from 60% to 20%). There was a 2.5-day reduction in length of stay (average 10.8 days length of stay pre-implementation versus 8.3 days post-implementation) and an increase from 0% to 20% in the rate of unplanned readmissions within 28 days post-implementation; however, these were not statistically significant (p = 0.7 and p = 0.11, respectively).Changes in patient outcomes could not be attributed to the implementation of ERAS nutrition care protocols, given the mixed compliance with audit criteria in the post-implementation audit. This project has, however, raised awareness of the importance of having operational definitions for audit criteria, systems to ensure adherence to protocols, and audits of calendar year data for reliability and validity of results. It has also increased knowledge of ERAS nutrition care protocols amongst those involved in the care of patients undergoing elective colorectal surgery and strengthened relationships within the multidisciplinary team. This project represents the first step toward the development of an effective ERAS nutrition care program for patients underoing elective colorectal surgery at Calvary North Adelaide Hospital and informs future audits and feedback cycles.

A previous pilot test on an online nutrition care algorithm for patients on hemodialysis showed that the algorithm was able to track nutrition changes over time; however, use of the algorithm took time beyond usual care. This study piloted methodology to compare outcomes between patients who receive

Childhood and adolescent obesity increases the risk of developing comorbidities, including much of the high cholesterol and hypertension, seen in adults. In this article, we consider the recently released Integrated Guidelines for Cardiovascular Health Risk Reduction in Children and Adolescents in our nutrition intervention for 2 cases. Patientand family-centered counseling for weight management, in addition to risk reduction through nutrition care plans, is conducted using the 5 A’s frameworkVassess, advise, agree, assist, and arrange. Practitioners will build on foundation knowledge and learn practical applications of evidence-based guidelines/strategies to best support their obese patients and families. Nutr Today. 2012;47(5):229Y242

Objectives To investigate the intention of fitness businesses to promote the provision of nutrition care from personal trainers. Study design Cross-sectional evaluation of webpage content. Methods Fitness businesses within two Australian federal electorates were identified using the Fitness Australia list of registered fitness businesses. Inductive content analysis of these fitness business websites and associated social media sites was undertaken to compare website content to the Fitness Australia Position Statement outlining the Roles and Responsibilities of Registered Fitness Professionals. Fitness businesses were classified as ‘within scope of practice’ if they referred to national nutrition guidelines or dietetic services. ‘At risk of being beyond scope’ included websites which did not include enough information to definitively state within or beyond scope. Fitness businesses were classified as ‘definitely beyond scope of practice’ if they advertised nutrition care which clearly extended beyond translation of the national dietary guidelines. Results Of the businesses reviewed, 15% were within scope despite none referring to a dietitian; 34% were at risk of being beyond scope; and 51% were beyond scope as they advertised nutrition care such as personalized diets without indicating dietetic input. Conclusions A considerable portion of fitness businesses reviewed advertised their personal trainers as able to provide nutrition care outside the recommended scope of practice. Strategies that help fitness businesses and personal trainers to support clients to have healthy dietary behaviours without extending outside the scope of practice are warranted.

The purpose of this study was to assess nursing assistants' perceptions of barriers to feeding nursing home residents. A 38-item questionnaire was developed from data obtained during four different focus groups. Results suggest that workload and supervision constraints, poor nurse-nursing assistant interactions, inadequate food quality and quantity, and staff educational needs may all negatively influence resident food intake.