Background In response to the Care Quality Commission and NHS contract requirements, a validated screening tool; the Malnutrition Universal Screening Tool ‘MUST’ was introduced into our hospice setting in 2012. Subsequent research amongst nursing staff confirmed lack of confidence in ‘MUST’ in identifying and guiding decisions for appropriate nutritional care. A project team was established to investigate how we might achieve appropriate nutritional care taking into account the changing and complex needs of patients and carers in the hospice setting.

Aims To identify nutritional issues experienced and develop a nutrition assessment tool to sensitively determine and deliver nutritional care to meet the needs of patients and carers.

Methods A practice development approach was utilised engaging all stakeholders. The approach included:

• questionnaires to staff

• discussion forums involving members of the healthcare team, patients, carers and catering.

• qualitative interviews with patients/carers.

Findings were used to initiate change and refine and validate a nutrition assessment tool.

Results Results from the questionnaires and forums identified issues affecting the delivery of optimal nutritional care. Solutions were identified and tested, patient and carer participation was a key component. A new approach to menu planning, including 13-day cycles, menu choices and portion size was developed. A new nutrition assessment tool – the ‘Patient Led Assessment for Nutritional Care’ (PLANC) was developed, tested, refined and validated to identify nutritional issues and determine care taking into account the stage of disease. Nutrition and hydration were integrated into the shared patient record. New pathways and resources were created to address common nutritional problems with triggers for escalation management to a specialist dietitian and dietetic assistant when required.

Conclusion The practice development process for change fitted well with the ethos of the organisation and resulted in practice improvements to enhance care. The ‘PLANC’ tool for nutrition assessment has been integrated into care across the settings.