Nutritional risk management for stroke survivors with dysphagia in a rehabilitation department: a best practice implementation project

ABSTRACT Introduction: Stroke survivors with dysphagia face a greater risk of malnutrition and life-threatening complications, yet evidence-based nutritional management in this population remains underutilized in clinical practice. Objective: This project aimed to implement and evaluate an evidence-based standardized nutritional risk management program for stroke survivors with dysphagia in a rehabilitation department in a hospital in China. Methods: This evidence implementation project was conducted using the JBI Evidence Implementation Framework, which is grounded in an audit and feedback process, along with a structured approach to identifying barriers to best practice recommendations. The audits included 28 health care professionals. Patient participation was 41 at baseline, 45 at first follow-up, and 46 at second follow-up. Compliance with 27 evidence-based audit criteria was evaluated, and four key barriers were identified, with corresponding change strategies implemented to address them. Data were analyzed using descriptive statistics, ANOVA, and χ 2 tests. Results: The majority of audit criteria showed significant improvement in compliance: 13 reached 100%, while the remaining 14 achieved a compliance rate exceeding 84%. Health care professionals’ knowledge scores of nutritional management demonstrated a significant increase across the three audit cycles, rising from 12.21 ± 3.201 at baseline to 19.18 ± 2.611 in the second follow-up audit ( F = 48.102, p < 0.001). Similarly, patients’/caregivers’ knowledge scores increased significantly from 9.00 ± 2.674 to 16.48 ± 2.987 ( F = 78.835, p < 0.001). Analysis across all audits revealed a significant reduction in both the incidence of hypoalbuminemia (from 17.1% to 2.2%; p = 0.048, Fisher's exact test) and complication rates (from 48.8% to 10.9%; χ 2 = 17.476, p < 0.001). Conclusions: The project successfully integrated evidence-based nutritional risk management into clinical practice, demonstrating that multidisciplinary team collaboration, systematic training, and protocol standardization can significantly enhance evidence-based practice and may improve patient outcomes. To ensure sustainability, ongoing education, regular audits, and expansion to other clinical units are recommended. Spanish abstract: https://links.lww.com/IJEBH/A676