Oral Presentation Victorian Integrated Cancer Service Conference 2015

St Vincent's Cancer Centre: pilot model of care involving a nutrition assistant for malnutrition screening and early nutrition intervention (#29)

Jing Hui (Jillian) Chin 1 , Natalie Simmance 1
  1. Nutrition Department, St Vincent's Hospital, Melbourne, Victoria, Australia

Malnutrition is common in cancer patients and is associated with reduced treatment tolerance, increased morbidity and mortality and higher healthcare costs. Results of the 2012 Phase I Malnutrition in Victorian Cancer Services study identified 35% of patients receiving chemotherapy at the St Vincent’s Cancer Centre were malnourished compared with the state average of 25%1.

Aims
To improve the identification of intravenous (IV) chemotherapy patients with/at risk of malnutrition, measure nutrition service activity and increase malnutrition awareness of staff and patients.

Methods
Key stakeholders were engaged in the development, piloting and evaluation of a nutrition service model adapted from Peter MacCallum Cancer Centre2. A part-time (0.5 EFT) nutrition assistant (NA) role was developed and piloted for 3 months. Their role involved malnutrition screening using the Malnutrition Screening Tool (MST), early intervention (including use of weight card) and triaging high risk patients for Dietitian assessment. Patient characteristics, nutrition service activity and staff/patient satisfaction were measured at baseline (December 2013 – March 2014) and pilot (March 2014 – June 2014).

Results
Participants included cancer patients receiving IV chemotherapy (baseline n=156; pilot n=153). Malnutrition screening of new patients improved from 60% (baseline) to 80% (pilot). Re-screening of existing patients also improved from 0% to 85%. Patients were weighed more regularly (3 patients not weighed at pilot vs 31 patients at baseline). Dietitian activity reduced from 0.3 to 0.1 EFT as NA activity increased. Early intervention was provided to 38 patients by the NA. 90% of Cancer Centre staff (n=11) agreed that the NA adds value to the patients’ treatment experience and outcomes. Patient satisfaction was similarly positive.

Conclusions
The Nutrition Assistant was successful in improving malnutrition identification and undertaking substitution of low-risk nutrition care from the Dietitian. Patients and staff were receptive to use of weight card however its impact needs to be further evaluated. Overall, the model of care was successful in meeting best practice guidelines for the timely screening, identification and management of malnutrition in the Oncology ambulatory setting.

  1. Marshall L, Loeliger J 2012, Investigating Practices Relating to Malnutrition in Victorian Cancer Services – summary report, Department of Health, State Government of Victoria, Melbourne.
  2. Loeliger J (Project Manager) 2011 Developing a novel nutrition support program to improve nutritional outcomes for ambulatory patients in the Chemotherapy Day Unit (CDU). Western and Central Melbourne Integrated Cancer Services and Peter MacCallum Cancer Centre. Final Report.