Have Renal Dietitians Successfully Implemented Evidence-Based Guidelines Into Practice? A Survey of Dietitians Across Australia and New Zealand

Objective: Successful implementation of evidence-basedpractice (EBP) guidelines has been shown to improve the nutrition status ofdialysis patients. This study aimed to establish use of EBP guidelines andimplementation of key recommendations for nutrition assessment of dialysispatients, as well as to identify barriers and enablers associated with EBPguideline adherence.

Design: A survey of nutrition assessment practicesand barriers to implementation of EBP guidelines was developed and piloted. Thesurvey measured implementation of guidelines regarding frequency of nutritionassessment and use of the subjective global assessment (SGA) to diagnosemalnutrition. Barriers to guideline implementation were measured usingagreement with statements rated on a Likert scale. Data were summarized ascounts and percentages and analyzed using chi-squared tests of association,with P < .05 indicating statistical significance.

Setting: The survey targeted specialist renaldietitians across Australian and New Zealand.

Participants: Sixty-five renal dietitians from Australiaand New Zealand responded to the survey. Most were females (89%, n = 58 of 65),aged <35 years (72%, n = 47 of 65), with one-third (n = 22 of 65) working inrenal dietetics for longer than 4 years.

Results: Nearly all participants (n = 62 of 65)reported routinely using EBP guidelines; however, only 55% and 66% indicatedthey had successfully implemented the guidelines regarding minimum 6-monthlynutrition assessment of dialysis patients (n = 36 of 65) and use of the SGA (n= 43 of 65), respectively. Barriers related to time, skills/self-efficacy, andan inefficient referral system were related to lower rates of guidelineimplementation.

Conclusion: These findings indicate an evidence–practicegap in the nutritional management of dialysis patients. A standardized approachto EBP guideline implementation including structured 6-monthly nutritionassessment of dialysis patients and group training for use of the SGA tool mayassist in closing this evidence–practice gap.