Utilizing technology for malnutrition screening and referrals to nutrition services.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 284-284
Author(s):  
Susan Franco ◽  
Corrine Hanson ◽  
Glenda Woscyna ◽  
Jana Wells ◽  
Meghan McLarney
Keyword(s):  
Nursing Staff ◽  
Screening Tool ◽  
Screening Tools ◽  
Cancer Center ◽  
Oncology Patients ◽  
Record System ◽  
Nutrition Screening ◽  
Nutrition Risk ◽  
Positive Screen ◽  
Nutrition Services

284 Background: The incidence of disease-related malnutrition in oncology patients ranges from 40-80%. This is the highest of all hospital patient groups. Malnutrition is associated with decreased quality of life, increased healthcare costs and intolerance to treatment. Screening for nutrition risk is often lacking in outpatient settings. Electronic health records could be utilized to improve the delivery of validated nutrition screening tools such as the Malnutrition Screening Tool (MST) in outpatient oncology settings. Methods: We designed a pilot project (Feb-July 2018) to administer the MST for outpatient oncology patients seen at the Fred and Pamela Buffett Cancer Center (FPBCC) using an electronic medical record system. “Best Practice Alerts” (BPAs) were used to notify the nursing staff of a patient with a screen that was positive for nutrition risk (MST score ≥3). The BPA recommended a referral to nutrition services; nursing staff could choose to “order” or “do not order" a Nutrition Consult. Results: A total of 2,672 patients received MST screening during the pilot. Out of these, 223 (8%) had a positive screen for nutrition risk; 197 of these were eligible for a nutrition services referral. A BPA “fired” 152 times out of 197 eligible patients (77%). Of the197 eligible patients, 58 (29%) were actually referred to nutrition services. Of these 58 referrals, 43 (74%) were triggered based on a BPA, while the remaining referrals were received outside of a BPA. BPAs failed to fire 45/197 times (23%). Conclusions: An EHR-based nutrition screening system to increase referrals in patients identified at nutrition risk in an outpatient oncology setting was effective for 29% of eligible patients. Barriers encountered included failures in technology as well as human factors. During the pilot it was discovered that the BPA was firing in a location in the chart where the nurse did not regularly work. There was not a consistent message as to the goals and outcomes during the pilot which resulted in lack of awareness by nurses to respond to the nutrition risk score. Utilizing an EHR-based nutrition screening tool is an effective way to identify patients at risk and refer them to appropriate resources in a timely and efficient way.

Optimizing the use of a nutrition screening tool for oncology patients.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 101-101
Author(s):  
Carol Parrales ◽  
Maritza Cardena Alencar ◽  
Jessica MacIntyre ◽  
Chinny Trivedi ◽  
Patricia Araujo
Keyword(s):  
Nurse Practitioners ◽  
Screening Tool ◽  
Quality Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Referral Process ◽  
Contributing Factors ◽  
Oncology Patients ◽  
Nutrition Screening ◽  
Nutrition Screening Tool

101 Background: Oncology infusion centers play a crucial role in detection of malnutrition. In one month, the Sylvester Comprehensive Cancer Center chemotherapy infusion center in Miami (SCCC CTU) treats over 400 oncology patients. Research shows that 40-80% of patients with a cancer diagnosis are malnourished (Isenring et al., 2006). In April, 1.89% of patients seen at the Miami CTU were referred to an oncology nutritionist. The goal was to increase the percentage of patients referred by 2% by June through adequate screening and referral. Methods: SCCC Miami CTU nursing staff’s knowledge on the use of the Malnutrition Screening Tool (MST) and the referral process were assessed through a survey. The survey also functioned as an educational instrument. Additionally, one-on-one discussions about the referral process were conducted with the SCCC CTU nurse practitioners. Results: The survey was available to CTU RNs with a 35% completion rate. Results portrayed that 82.35% were aware of the MST screening tool; however, 88.25% were unaware of the appropriate code to refer patients to nutritionist. Therefore, if nutritional consults were placed, it was unlikely that the nutritionist would receive the request. Identified obstacles included having to call a provider to initiate a consult, lack of time for proper assessment and the availability of a nutritionist. Conclusions: Although results did not yield a significant increase of referrals through the use of the appropriate code, there was a 1.22% increase on the overall referrals placed. Lack of training and knowledge on the MST, improper use of the referral code, and the intricacy of the workflow, were contributing factors to the inadequacy in screening and referral process. Participation of all staff in education initiatives and interventions should be a vital component in improving quality care of oncology patients. [Table: see text]

scholarly journals A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital

2010 ◽  
Vol 104 (5) ◽  
pp. 751-756 ◽  
Author(s):  
Konstantinos Gerasimidis ◽  
Orla Keane ◽  
Isobel Macleod ◽  
Diana M. Flynn ◽  
Charlotte M. Wright
Keyword(s):  
High Risk ◽  
General Hospital ◽  
Nursing Staff ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
District General Hospital ◽  
Screening Tools ◽  
Lower Sensitivity ◽  
Tertiary Referral Hospital ◽  
Rater Reliability

Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59 % of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47 % were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (κ = 0·46) and inter-rater reliability (κ = 0·53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.

P019 OPTIMIZING NUTRITION RISK SCREENING AND FOLLOW-UP NUTRITION COUNSELING IN AN OUTPATIENT INFLAMMATORY BOWEL DISEASE POPULATION

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Therezia AlChoufete ◽  
Siobhan Proksell ◽  
Marc Schwartz ◽  
Cassie Myers ◽  
Emily Weaver ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Screening Tool ◽  
Disease Risk ◽  
Nutrition Status ◽  
Risk Scores ◽  
Nutrition Screening ◽  
Nutrition Risk ◽  
Inflammatory Bowel

Abstract Background As management of Inflammatory Bowel Disease (IBD) advances, the outpatient (OP) population is shifting its fears from risks of malnutrition to those associated with over-nutrition and under-nutrition, lack of diet education, access to resources, mental health implications, and socioeconomic status. Failure to identify a patient at nutrition risk could lead to increased costs of care which can be avoided by proper nutrition screening and counseling with a Registered Dietitian (RD). The integration of nutrition counseling into the interdisciplinary care model for patients with IBD needs to be optimized to identify a broader range of risks to nutrition status in an efficient and objective format that can be applied universally in the OP IBD setting. Aims This study 1) explores a novel approach to nutrition risk screening within the OP IBD setting using an interdisciplinary team approach; and 2) evaluates correlations between an objective scoring method for biological and psychosocial risk with nutrition risk scores reported by an RD. Methods Two objective nutrition risk scoring methods were developed to capture biological (NUTR-OBJ) and lifestyle (NUTR-WELL) nutrition factors on a 0–6 scale (low-severe risk). Scores were determined using review of the electronic health record and a screening tool provided to patients. These scores were compared to the previously established IBD Biopsychosocial Complexity Grid, a tool which organizes this health information into biological and psychological domains and serves as the basis for algorithm-driven treatment plans within an IBD Medical Home. Results Data from 44 patients (mean age:35.2 years;47.7% female;56.8% Crohn’s Disease) were included in this study. BMI ranged from 18.08 to 37.92 kg/m2. BIO-C-PRO (mean=1.95,SD 1.86) and BIO-C-OBJ (mean 1.59, SD 1.76) indicate mild overall disease risk within our sample. NUTR-OBJ scores (mean=2.39, SD 1.28) showed no significant correlations with biological (BIO-C-PRO/OBJ) or psychosocial (PSY-C/H;SOC-SES;MI-C) scores. NUTR-WELL (mean=1.98,SD 1.36) showed strong positive correlations with PSY-C (r=.326, p<.05), PSY-H (r=.386,p<.01), SOC-SES (r=.306,p<.05), and MI-C (r=.473,p<.01). Discussion This study indicates a significant correlation between NUTR-WELL scores and psychosocial scores, suggesting validity for this nutrition screening tool to determine behaviors that may increase nutrition risk. Poor correlations between NUTR-OBJ and biological scores suggests that the need for nutrition intervention may not always be indicated by disease severity. This scoring system can potentially serve as a guide to maximize efficiency of follow-up appointments with an RD and avoid complications of care related to poor nutrition status that may be unidentified by disease risk alone. Further research is needed to confirm findings and extend to a larger sample.

Malnutrition screening: A screening tool for outpatient oncology patients, leveraging EMR data.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 275-275
Author(s):  
Jeannine B. Mills ◽  
Alice C. Shapiro ◽  
Colleen Spees ◽  
Elaine Trujillo ◽  
Elise Cushman ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Oncology ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Clinic Visit ◽  
Nutritional Risk ◽  
Oncology Patients ◽  
Nutrition Risk ◽  
Cancer Centers ◽  
Staffing Patterns

275 Background: The provision of adequate nutritional care in outpatient cancer centers was the focus of a 2016 NAS Workshop, “Assessing Nutrition Care in Outpatient Oncology.” Here we report our internal project evaluating ongoing documentation of a malnutrition screening tool (MST) at 3 national cancer centers (CC). Methods: Screening scores from a validated 2 question MST scale were entered into the EMR. Questions probe for: 1) unintentional weight loss; and 2) eating poorly because of a decreased appetite. A score of ≥ 2 indicated nutrition risk. De-identified oncology clinic visit data were examined monthly to assess MST utilization and scores for radiation and medical oncology patients across the CC’s. Results: Approximately two-thirds (67%) of unique medical oncology patients that visited the CC’s had documented MST data with 9% (n = 144,129) scoring at nutritional risk. MST completion rates were higher in radiation oncology clinics secondary to staff education. Of those that had a valid MST score in radiation clinics, 13% (n = 23,202) of MST scores indicated nutritional risk. Conclusions: The MST is a valid malnutrition screening tool for outpatient oncology patients, yet this tool is not uniformly being utilized nationally. Consistent use of the MST in the electronic medical record and leveraging data on utilization are needed to inform staff compliance, consistency in care, future dietitian staffing patterns, cost/benefit analysis, and health outcomes for oncology patients. [Table: see text][Table: see text]

scholarly journals A Dispatch Screening Tool to Identify Patients at High Risk for COVID-19 in the Prehospital Setting

2021 ◽  
Vol 22 (6) ◽  
pp. 1253-1256
Author(s):  
Amy Albright ◽  
Karen Gross ◽  
Michael Hunter ◽  
Laurel O'Connor
Keyword(s):  
High Risk ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Tool ◽  
Screening Tools ◽  
High Risk Population ◽  
Common Symptom ◽  
Risk Population ◽  
Positive Screen ◽  
The Impact

Introduction: Emergency medical services (EMS) dispatchers have made efforts to determine whether patients are high risk for coronavirus disease 2019 (COVID-19) so that appropriate personal protective equipment (PPE) can be donned. A screening tool is valuable as the healthcare community balances protection of medical personnel and conservation of PPE. There is little existing literature on the efficacy of prehospital COVID-19 screening tools. The objective of this study was to determine the positive and negative predictive value of an emergency infectious disease surveillance tool for detecting COVID-19 patients and the impact of positive screening on PPE usage. Methods: This study was a retrospective chart review of prehospital care reports and hospital electronic health records. We abstracted records for all 911 calls to an urban EMS from March 1–July 31, 2020 that had a documented positive screen for COVID-19 and/or had a positive COVID-19 test. The dispatch screen solicited information regarding travel, sick contacts, and high-risk symptoms. We reviewed charts to determine dispatch-screening results, the outcome of patients’ COVID-19 testing, and documentation of crew fidelity to PPE guidelines. Results: The sample size was 263. The rate of positive COVID-19 tests for all-comers in the state of Massachusetts was 2.0%. The dispatch screen had a sensitivity of 74.9% (confidence interval [CI], 69.21-80.03) and a specificity of 67.7% (CI, 66.91-68.50). The positive predictive value was 4.5% (CI, 4.17-4.80), and the negative predictive value was 99.3% (CI, 99.09-99.40). The most common symptom that triggered a positive screen was shortness of breath (51.5% of calls). The most common high-risk population identified was skilled nursing facility patients (19.5%), but most positive tests did not belong to a high-risk population (58.1%). The EMS personnel were documented as wearing full PPE for the patient in 55.7% of encounters, not wearing PPE in 8.0% of encounters, and not documented in 27.9% of encounters. Conclusion: This dispatch-screening questionnaire has a high negative predictive value but moderate sensitivity and therefore should be used with some caution to guide EMS crews in their PPE usage. Clinical judgment is still essential and may supersede screening status.

Distress screening through PROMIS at an academic cancer center and network site: Implementation of a hybrid model.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2021-2021
Author(s):  
Mohana Roy ◽  
Joel W. Neal ◽  
Kelly Bugos ◽  
Christopher Sharp ◽  
Patricia Falconer ◽  
...  
Keyword(s):  
Supportive Care ◽  
Screening Tool ◽  
Cancer Center ◽  
Patient Portal ◽  
Supportive Services ◽  
Distress Screening ◽  
Positive Screen ◽  
Network Site ◽  
Care Services ◽  
Patient Reported

2021 Background: The NCCN guidelines recommend routine distress screening of patients with cancer, but the implementation of such programs is inconsistent. Up to one in three such patients experience distress, however fewer than half of them are identified and referred for supportive services. Methods: We implemented a hybrid (electronic and paper) distress screening tool, using a modified version of the PROMIS-Global Health questionnaire. Patients received either an electronic or in-clinic paper questionnaire to assess overall health and distress at the Stanford Cancer Center and its associated integrated network site. Iterative changes were made including integration with the electronic health record (EHR) to trigger questionnaires for appointments every 60 days. A consensus “positive screen” threshold was defined, with data collected on responses and subsequent referrals placed to a supportive care services platform. Results: Between June 2015 and December 2017, 53,954 unique questionnaires representing 12,744 distinct patients were collected, with an average completion rate of 58%. Approximately 30% of the questionnaires were completed prior to the visit electronically through a patient portal. The number of patients meeting the positive screen threshold remained ~ 40% throughout this period. Following assessment by the clinical team, there were 3763 referrals to cancer supportive services. Among the six most common referral categories, those with a positive screen were more likely to have a referral placed (OR 6.4, 95% CI 5.8-6.9 p- < 0.0001), with a sensitivity of 80% and a specificity of 61%. However, 89% of responses with a positive screen did not have a referral to supportive care services. Conclusions: The hybrid electronic and paper use of a commonly available patient reported outcome tool, as a high throughput distress screening tool, is feasible at a multi-site academic cancer center. Our positive screen rate for referrals was sensitive and consistent, but with a low positive predictive value. This screening also resulted in variable clinical response and overall increased clinical burden. Future directions for our group have included refining the threshold for a positive screen and implementation of a real-time response system, especially to address acute concerns.

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