The aim of this observational study was to review nutritional practice within an acute stroke unit (ASU) and compare practice against National Institute for Health and Clinical Excellence (NICE) guidance, National Patient Safety Agency (NPSA) guidelines, and the National Stroke Agenda. 'Observations of Care', a well recognized approach and part of the Royal College of Nursing clinical leadership programme, was undertaken along with a traditional audit to review nutritional care in the ASU. Usually undertaken by persons outside of the team to prevent bias, in this situation the bias was minimized as the auditor was new to the team. Current practice was evaluated and it was important for the team to have ownership of the assessment process. This article also reviews the prevalence of malnutrition in hospitals and the importance of nutritional assessment, the use of screening tools and types of diet that best maintain optimum outcomes. Patients who have experienced a stroke can face a range of problems that influence dietary intake. On admission, 16-31% are already malnourished.