Clinical risk assessment project caitlyn green heather davis a prof graeme hart acaci
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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 l.jpg

Clinical Risk Assessment ProjectCaitlyn Green & Heather DavisA/Prof Graeme Hart - ACACI

Funded by: Pharmatel Fresenius Kabi Pty. Ltd.


Project details l.jpg
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 (cont’d)

  • 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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Ward infrastructure

2 additional PC’s 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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Identification of practice gap

  • 80% High risk patients not referred to dietitian



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Risk Profile: Ward 7 East (Gen Med)

N = 46

Slightly lower than international/national benchmarks




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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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