Clinical Risk Assessment Project Caitlyn Green

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Clinical Risk Assessment Project Caitlyn Green
Heather DavisA/Prof Graeme Hart - ACACI

• Funded by Pharmatel Fresenius Kabi Pty. Ltd.

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Project Details

• Project Commenced September 2006
• Jointly Managed by
• ACACI - Clinical Governance
• Dept of Gastroenterology - Nutrition and
  Dietetics
• Project Aim
• To improve patient care by
• Identifying patients at high risk of malnutrition
  using electronic medium
• Facilitating objective timely referral to
  dietitians

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Background

• Incidence of malnutrition 20 - 40 inpatients
  (international data)
• Impact of malnutrition on our patients
• Impaired recovery (immunity, muscle function,
  wound healing)
• Increased LOS
• Reduced QOL
• Impact of malnutrition on the Bottom Line
• UK 7.3 billion/year (BAPEN Health Economic
  Report)
• 14 higher for malnourished patients versus well
  nourished (NICE 2006)
• Malnutrition risk screening mandated for
  accreditation in UK USA

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Progress to date

• Completed development of eMUST (Electronic
  Malnutrition Universal Screening Tool)
• Integrated eMUST into nursing admission practice
  in
• Acute medical ward
• Pre-admission clinics
• 1,000 patients screened
• 100 of high malnutrition risk patients referred
  to dietitian
• Commenced writing publications

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eMUST Specifications

• Programming funded by Austin Health
• Austin Health Programmers
• Over 3 month period
• Based on MUST tool (BAPEN)
• Calculation of BMI, weight loss, total risk
  score
• Incorporates alternative measurement methods
• Separate system - interfaces with Medtrak
• User access via Medtrak
• Developed in dot net environment web based

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eMUST Specifications (contd)

• Writes to Sequel database
• Dietitian communication via LAN page
• Score ? 2
• Efficient, accurate audit data
• Standard reports via crystal reports

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Nutrition Screening Process

• Performed by nurses
• At point of entry for every patient
• Pre-admission clinic for elective surgery
• Upon admission/transfer to ward - within 24 hours
  of admission
• Steps
• Assess patient weight and height
• Determine previous weight/weight loss
• Check acute disease from list
• Automatic calculations
• LAN page to dietitian if appropriate

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Admission process

• Tape measures kept by bedside
• Removed duplicate data entry on admission

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Nurses conduct screening on admission
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Ward infrastructure
2 additional PCs supplied to ward close
to/near bedside
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eMUST demonstration

• http//server53s/trakcare/test_web/
• System capabilities
• Straightforward data entry (weight height)
• Alternative measurements (weight height)
• Adjustments for amputees
• Subjective criteria for weight loss

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Baseline data collection general medicine
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Identification of practice gap

• 80 High risk patients not referred to dietitian

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Data Analysis
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Risk Profile Ward 7 East (Gen Med)
N 46
Slightly lower than international/national
benchmarks
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Risk Profile Pre-admission clinics
N 44
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Admissions Screened Ward 7 East
Average 75
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Admissions Screened Pre-admission
Pre Admission Liaison Nurse Debriefing
Average 37.5
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Obese patient distribution

• Total Screened
• Obese

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Key Outcomes

• Improved patient care 100 identified high risk
  patients referred to dietitian
• Successful development of eMUST
• 1st of its kind in Australia!!
• Successful integration of nutrition screening
  into acute ward
• Nutrition risk/obesity prevalence documented in
  pilot areas
• Research/publications written and presented
  (MedInfo)

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Future directions

• Development of integrated nutrition management
  system (Phase 2)
• Ongoing data analysis
• Continued evaluation and investigation of
  sustainability
• Potential internal collaborations
• Continued publication and presentation of results

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Breakdown of obese patients

• Gen Surg 1/HPB 11 (Lap Chole)
• Cardiac Surgery 10
• Gen Surg 3 9 (Lap Banding)
• Vascular 9
• Thoracic Surg 7

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Pre-admission High risk breakdown