Nutritional assessments in COPD: the respiratory nurse perspective on current practice across the UK.

Low body mass index (BMI) and weight loss are associated with a poorer prognosis for patients with COPD but are potentially reversible. Nutritional assessments should be key part of patient management and respiratory nurses are in a good position to undertake these. Guidelines recommend referral to a dietician for those patients with an abnormal BMI (<20 or >25) and those with a low BMI given nutritional supplements. Methodology An electronic survey using closed ended questions was emailed to 533 respiratory nurses in the UK. 177 responses (33%) were returned from across primary, secondary and community sectors. Those nurses not managing COPD patients were asked not to respond. Results 88% reported using weight and BMI to assess patients, with 85% undertaking an assessment at least once or twice year. Only 32% used any further screening tool. 94% of nurses have access to a dietician and 85% of nurses are able to refer directly, but highlight long waiting times. Despite this, 54% refer less than half of patients they identify with an ongoing nutritional problem. 16% are unable to get nutritional supplements for their patients but, where available, 96% had access to a range of supplements. Reasons cited were the need for a dietician referral first and GPs reluctance to prescribe supplements. 65% reported not having any specific criteria for referral to a dietician and 87% felt a specific simple practical tool would help manage this group of patients. 42% felt overall that malnourished patients were managed poorly in their area (see Abstract P39 table 1). Discussion Respiratory nurses conduct nutritional assessments with COPD patients and the majority appear to have access to a dietician. Yet, despite this, referral to specialist dietetic services is low. This may be due to perceived lack of dietician services or long waiting times. Improved awareness, education and training among respiratory nurses regarding nutritional assessment together with improved access to dietetic services would seem to be priorities for the future in order to meet current recommendations.