NUTRITIONAL EPIDEMIOLOGY, COMMUNICATION s95

4.2% of AA (5.9% males, 3.1% females). These values tended to be higher than national figures for obesity (7.6%) when AA are considered, and lower for malnutrition (10.5%) in the case of CC. Conclusions: 1) Obesity tended to occur more often than expected, whereas undernutrition was mxginally less prevalent ; 2) Males seemed to display more aberrations than females, although this finding was not statistically confilmed; 3) A program for nutritional guidance and assistance in pr imxy schools is being implemented;

neither consultants rated any of the interventions as unsafe. Forty percent of interventions were classifed as ‘safe’ decisions, 53% were “of significant clinical benefit” and 7% wex “vely significant”. Changes in potassium and sodium content of the TPN regimen and changing from TPN to enteral feeding were regxded as “very significant” by both consultants. Conclusions: A dietitian and a phunacist can competently manage TPN for a cohort of surgical patients. This may be a clinically and cost effective use of personnel to improve patient care.

354-P. NURSING STUDENTS AND THEIR ATTITUDES 356-P. A NEW METHOD FOR IMPLEMENTATION OF TOWARDS THE USE OF ALTERNATIVE MEDICINE NUTRITIONAL THERAPY IN HOSPITALS

S. Pettersen’, mBveZ lFaculty of Vocational Teacher Education, Akershus University College, Bekkestua, ‘The Palliative Care Unit, Department of Oncology, Ulleval University Hospital, Oslo, Norway

Rationale: The telm complementary or alternative medicine (CAM) in- cludes a vast collection of treatment regimens and products. Norwegian studies have shown that about 20% of the cancer patients use CAM, and vitamins and diets xe among the most popular methods. The use of CAM poses many challenges in clinical oncology. In this study we explored nurs- ing students’ attitudes towards CAM. Results were discussed in a health literacy perspective, since nurses’ attitudes might affect their critical ability to inform cancer patients of the use of CAM. Method: The sulliey samples were drawn from the 2001 Norwegian pop- ulation of 3rd year nursing students. 1266 questionnaires were sent out. Attitudes towards 15 specific CAM practises were measured on a 5-point Likea scale (1 ‘very negative’ to 5 ‘very positive’). For simplifying and vi- sualizing results, responses 1 and 2 were combined into one single response category (“negative”), and 4 and 5 into one category (“positive”). Results: 317 students answered the questionnaire (response rate of 25%). Most respondents (63 - 90%) were positive towards acupuncture, zone ther- apy, therapeutic touch, aromatherapy, and homeopathic herbal medicine. Fifty-nine percent expressed positive attitudes towxds herbal medicine, 27% towards hyhotherapy of colon but only 12% were positive towxds megavitamin therapy. Conclusions: The nursing students were generally positive to a wide range of CAM practices. Nursing educators should emphasis epistemology dis- cussions as well as critical evaluation of published health claims. In order to inform cancer patients of possible benefits and risks of CAM, attainment of health literacy and critical thinking skills is of utter importance for graduate nurses.

355-P. MANAGEMENT OF TPN, DOES IT REQUIRE A MEDICAL PRACTITIONER?

K.M. Fxrer, L.J. Harper, J.L G.L. Cxlson

Shaffer, I.D. Anderson, N.A. Scott,

Intestinal Failure Unit, Hope Hospital, Manchester; United Kingdom

Rationale: A pilot study to determine the competencies of a dietitian and a phamacist to prescribe and alter total parentera nutrition (TPN) was initiated as part of the “Changing The Workforce Programme” in surgical patients. Method: The dietitian and phamacist received additional training from the surgeons and each other prior to the initiation of the pilot. When all con- sultants were satified with the individuals’ clinical knowledge patients were lefexed for management of their TPN regimen. This involved changes to electrolytes, volume and the requesting of appropriate biochemical monitor- ing. Decisions to stop TPN, change the regimen and commence enteral feed- ing were made by the dietitian and phamacist. Detailed reports were written to outline the rationale for clinical decisions. A previously validated scoring sytem was used to determine the clinical impact of any decisions made by the team. All interventions were independently and sepxately assessed by a consultant surgeon and consultant gastrcenterlogist, blinded to the nature of the discrepancy between the medical staff and dietitian/phamacist. Results: Twenty two consecutive patients completed the study and the team made a total of 181 interventions. Despite minor differences in opinion,

H.H. Rasmussen’, .I. Kon&up’, M. Staun3, K. Ladefoged4, H. Kristensen t , A. Wengler3 ‘Medical Gastroenterology, Aalborg Hospital, Aalborg, 2Nutrition Unit, 3Medical Gastroenterology, Rigshospitalet, Copenhagen, 41nternal Medicine, K@ge Hospital, K@ge, Denmark

Rationale: Many bxrieres make implementation of nutritional therapy dif- ficult in hospitals. In this study we investigated whether, a targeted plan made by the staff in different depxtments, improved nutritional therapy within selected checkpoints. Method: Four different specialities participated in the study with a multi- disciplinary nutrition team. The study had fom elements: 1) A PC-based multidisciplinary identification of bxrieres. 2) Point prevalence prior and after the study period, estimating the use of screening of nutritional risk (NRS 2002), whether a nutrition plan was made, and monitoring was doc- umented in the records. 3) A plan made by the staff regarding nutritional therapy. 4) The implementation procedure. Results: Barrieres concerning nutrition included low priority, the lack of focus, routine or established procedures, and insufficient knowledge. The staff introduced individually targeted procedures including: assigning of responsibility, a nutrition record, electronic calculator of energy intake, upgrading of the dietitians and specie1 diets, communication, education of the staff, and patient education. Point prevalence prior vs after the study period showed the following: BMI was measured in 0% vs 69%. Documentation of weight loss within the last week was found in 4% vs 25% of the records. About 75% had a food intake less than normal within the last week, documented in 30% vs 61%. Newly one third wele at a severe nutritional risk, documented in the records in 25% vs 67%, and of these 15% vs 47% had a nutrition plan and a plan for monitoring in 20% vs 87%. Conclusions: The introduction of a new method for implementation of nutritional therapy based on plans txgeted to individual depxtments may improve nutritional therapy in hospitals. Sponsor: Fresenius-Kabi A/S

357-P. HOW TO INITIATE A MULTIDISCIPLINARY NUTRITION PROJECT IN A HOSPITAL WARD?

M. Holst t , H. Kristensen’, A. Wengle? ‘Medical Gastroenterology, Aalborg Hospital, Aalborg, ’ Gastroenterology, Rigshospitalet, Copenhagen, Denmark

Rationale: Initiation of a multidiciplinary project regxding the implemen- tation process is described with nursing as centre of rotation. Method: Using a PC-based multidisciplinary hearing, identification of pos- sible barrieres was made among the staff in a dept. of medical gastroenterol- ogy. Before and after implementation a measurement of proces indicators was made including screening of nutritional risk (NSR 2002), nutrition planning, and monitoring (JCAHO). A therapy- and nursing plan within nutrition was made based on identification of barrieres in the staff, and txgeted for individual patients. Results: Pre-measurements showed that assessment of nutritional risk was only recorded in 7% of the patients at low nutritional risk, and in 15% of the patients at a high nutritional risk. Information about the food intake of the patients, was only recorded in 60% of the jounals. Forty percent of the patients lost weight during hospitalisation, but the weight loss was not men- tioned in the records. Re-measurement after implementation showed, that