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Table 1 Intervention strategies

From: Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation

Strategy

Delivered by

Delivered to

Intended outcome

Additional information

Organisational level (EOF pathway)

 Free fluids prescribed on POD0

Doctor

Patient

Decrease times to first diet and solid diet prescription and improve energy and protein intakes.

EOF pathway was flexible and individualized, encouraging HCPs to exercise their clinical judgment and refer nutritionally ‘at risk’ patients to a dietitian.

Prescription of ONS twice daily for the first three days after surgery was a strategy identified early on by knowledge users, who indicated it was acceptable and feasible. Due to conflicting perspectives from staff members, this strategy was removed from the formal EOF pathway, although surgeons adopted and implemented this strategy as they acknowledged the strength of the evidence supporting this practice.

 Free fluids and ONS delivered POD0

Nurse

Patient

 HEHP diet prescribed POD1

Doctor

Patient

 ONS prescribed TDS

Doctor

Patient

Health care professional level

 Awareness and education sessions

CF and lead author

Registered and enrolled nurses

Increase staff awareness around importance of timely and adequate nutrition after surgery; and familiarize staff with intervention strategies being implemented.

Reduce times to first nutrition delivery and diet upgrades.a

Sessions delivered to nurses were formal (a 30–45 min PowerPoint presentation was utilized to share evidence for EOF and findings from previous study phases, six weeks prior to starting data collection) or informal (a 5–10 min overview of the information presented in the formal sessions was conducted during scrum meetings and ad hoc, at times convenient to staff, over 2-week period prior to data collection).

Study flyers and an email containing information on the intervention and EOF pathway were disseminated to nursing staff one week prior to data collection.

 Awareness and education sessions

Colorectal fellow

Interns, residents, registrars

 Ward orientation (nutrition)

Ward dietitian

Interns, residents

Patient level

 Meal ordering awareness

Treating nurse or AIN

Patient

Inform patients about timely and adequate nutrition; and support them to participate in their nutrition care.

Delivery and content of nutrition-related messages were done at each HCP’s discretion.

The handout was piloted among lay members of the public (n = 3) to assess readability, resulting in minor changes to wording, structure and design.

 Nutrition-related messages

Doctor

Patient

Increase patient awareness of nutrition after surgery and encourage oral intake.

 Preoperative nutrition handout

Preadmission clinic nurse

Patient

Facilitate patient-centered care and increase oral intake by encouraging patients to select foods that they prefer/can manage.

  1. AIN Assistant in Nursing, CF Clinical Facilitator (nursing), EOF early oral feeding, HEHP high Energy, high protein, ONS oral nutrition supplement/s, POD postoperative day, TDS three times daily
  2. aNursing staff were responsible for sourcing foods on the ward; and medical staff were responsible for prescribing diets after surgery