Observational study of the relationship between nurse staffing levels and compliance with mandatory nutritional assessments in hospital.

Abstract

BACKGROUND\nIn the UK, it is recommended that hospital patients have their nutritional status assessed within 24\xa0h of admission using the Malnutrition Universal Screening Tool (MUST). The present study aimed to examine the association between nurse staffing levels and missed nutritional status assessments.\n\n\nMETHODS\nA single-centre, retrospective, observational study was employed using routinely collected MUST assessments from 32 general adult hospital wards over 2\xa0years, matched to ward nurse staffing levels. We used mixed-effects logistic regression to control for ward characteristics and patient factors.\n\n\nRESULTS\nOf 43\xa0451 instances where staffing levels could be linked to a patient for whom an assessment was due, 21.4% had no MUST score recorded within 24\xa0h of admission. Missed assessments varied between wards (8-100%). There was no overall association between registered nurse staffing levels and missed assessments; although higher admissions per registered nurse were associated with more missed assessments [odds ratio (OR)\xa0=\xa01.09, P\xa0=\xa00.005]. Higher healthcare assistant staffing was associated with lower rates of missed assessments (OR\xa0=\xa00.80, P\xa0<\xa00.001). There was a significant interaction between registered nurses and healthcare assistants staffing levels (OR\xa0=\xa00.97, P\xa0=\xa00.011).\n\n\nCONCLUSIONS\nDespite a written hospital policy requiring a nutritional assessment within 24\xa0h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24\xa0h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.