Clinical audit on adherence to using Malnutrition Screening Tool and dietitian referral in the Oncology Outpatient Clinic, National Cancer Institute, Malaysia
- Author:
Ng Wai Han
1
;
Norshariza Jamhuri
;
Zuwariah Abdul Rahman
;
Betti Sharina Mohd Haniff Lai
;
Siti Nuraini Mohd Samwil
Author Information
1. Department of Dietetics and Food Services, National Cancer Institute (NCI), Putrajaya Malaysia
- Publication Type:Journal Article
- Keywords:
Malnutrition Screening Tool (MST);
cancer patients;
clinical audit;
dietitian referral
- From:
Malaysian Journal of Nutrition
2018;24(4):627-635
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Malnutrition is a frequent complication in cancer patients and can negatively affect treatment outcome. Preliminary audit conducted at the Oncology Clinic, National Cancer Institute (NCI), found that only 5.8% of outpatients underwent nutrition screening using the Malnutrition Screening Tool (MST), and only 2.6% of dietitian referrals were recorded. This audit aims to determine the rate of adherence to nutritional screening, and to implement remedial measures for improved patient care.
Methods: This was a cross-sectional audit comprising three phases, namely initial audit, remedial measures and re-audit. Criteria audited include screening rate using MST and dietitian referral based on MST scores. Standards were set at 100% for both criteria. Data collected for initial audit were patients’ MST scores records and total dietitian referral forms retrieved from Electronic Medical Records. After initial audit, self-administered questionnaires for nurses and physicians were developed to identify barriers. Measures implemented for change included patientadministered MST to shorten screening time, and procedure flowchart to facilitate referral. After 6 months, a re-audit was conducted.
Results: Total subjects for initial audit and re-audit were 349 and 390, respectively. Initial audit and re-audit showed screening rate using MST increased significantly from 6.3% to 79.5%, but there was no significant change for the dietitian referral rate.
Conclusion: This clinical audit has led to a change in the policy in NCI outpatient clinics whereby nurses directly schedule dietitian referrals without going through physicians for patients with MST scores ≥2. Continuous audit and monitoring are necessary to facilitate improvement in MST implementation for better outpatient care.
- Full text:4.2018my0429.pdf
