Background: Care pathways help to standardise management, translate evidence-based guidelines into local protocols and improve patient care. Evidence shows head and neck cancer patients undergoing surgery have been identified to be at high nutritional risk and therefore are likely to benefit from a nutrition care pathway.

Aim: 1. To investigate current nutrition guidelines for surgical head and neck patients 2. To Audit current practice 3. To Develop and implement of an evidence based care pathway for surgical head and neck patients.

Methods: A literature review was conducted regarding current best practice nutritional guidelines. A retrospective audit of 45 patients was completed during a 3 month period in 2012. Current practice was examined including; patient screening, timing of first dietetic contact, timing of dietetics review, time to start oral/ enteral intake. A surgical care pathway was then developed in line with best practice guidelines and implemented within the multi-disciplinary team.

Results: Thirty percent of patients were screened before surgery. Automatic referrals were seen by the dietitian within 24 hours of surgery in 83% of patients, 90% of patients were reviewed 3 times per week and 100% reviewed every 2 weeks after. Only 23 patients had a completed Patient-Generated Subjective Global Assessments (PG-SGA) on admission. Patients considered low risk were not at risk according to Malnutrition Screening tool (MST). Oral or enteral intake was started within 1 day for all patients.

Conclusions: The results showed that current nutrition practice is predominantly in line with best practice guidelines however an evidence based pathway is indicated to streamline current practice.