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Clinical Risk Assessment Project Caitlyn Green & Heather Davis A/Prof Graeme Hart - ACACI

Clinical Risk Assessment Project Caitlyn Green & Heather Davis A/Prof Graeme Hart - ACACI. Funded by: Pharmatel Fresenius Kabi Pty. Ltd. Project Details. Project Commenced September 2006 Jointly Managed by: ACACI - Clinical Governance Dept of Gastroenterology - Nutrition and Dietetics

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Clinical Risk Assessment Project Caitlyn Green & Heather Davis A/Prof Graeme Hart - ACACI

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  1. Clinical Risk Assessment ProjectCaitlyn Green & Heather DavisA/Prof Graeme Hart - ACACI Funded by: Pharmatel Fresenius Kabi Pty. Ltd.

  2. 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

  3. 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

  4. 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

  5. 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

  6. eMUST Specifications (cont’d) • Writes to Sequel database • Dietitian communication via LAN page • Score  2 • Efficient, accurate audit data • Standard reports via crystal reports

  7. 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

  8. Admission process • Tape measures kept by bedside • Removed duplicate data entry on admission

  9. Nurses conduct screening on admission

  10. Ward infrastructure 2 additional PC’s supplied to ward – close to/near bedside

  11. 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

  12. Baseline data collection – general medicine

  13. Identification of practice gap • 80% High risk patients not referred to dietitian

  14. Data Analysis

  15. Risk Profile: Ward 7 East (Gen Med) N = 46 Slightly lower than international/national benchmarks

  16. Risk Profile: Pre-admission clinics N = 44

  17. % Admissions Screened: Ward 7 East Average = 75%

  18. % Admissions Screened: Pre-admission Pre Admission Liaison Nurse Debriefing Average = 37.5%

  19. Obese patient distribution • Total Screened • Obese

  20. 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)

  21. 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

  22. 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

  23. Pre-admission: High risk breakdown

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