The 2011; state wide project titled “Investigating Practices relating to Malnutrition in Victorian Cancer Services.” found that 48% of (BHS) patients in BHS CDU were at risk of malnutrition. However only 14% of these patients had been referred to the dietitian compared to the state wide average of 48%. There was no dietetic service dedicated to the CDU at BHS at this time and malnutrition screening was not in place.
BHS had moved all it’s oncology services together into a new facility 8 months before and CDU was now operating from a new computerised patient record system- “e-record” alongside the other arms of the oncology service..
Method: This study is an observational study of management of nutrition risk in CDU patients. Two detailed audits.of 50 randomly selected patient medical histories were undertaken prior to and post implementation of staff education and management strategies to improve nutrition risk assessment and referral.
Results: This study indicates that the current systems employed within the medical oncology outpatient setting at BHS do not allow for easy identification for the cumulative effect of nutrition impact symptoms (NIS) to be identified and acted on. Screening information was siloed in the “e-record” and identification of NIS was not clearly recorded and sometimes prevented from being recorded by the structure of the “e-record”. The “e-progress notes” were not reflective of all the discourse around the patient’s journey. This lack of clarity did not facilitate timely referral.
The intervention resulted in a significant improvement in the completion of the Malnutrition Screening Tool (32% to 52%) and in the referral rate to the dietitian (20% to 40%) . In addition the discussion of NIS at multidisciplinary team meetings, and facilitating systematic changes to the way referrals are made to the dietitian, has greatly contributed to the increase in referral rate.