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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

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

Funded by: Pharmatel Fresenius Kabi Pty. Ltd.

project details
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
background
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
progress to date
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
emust specifications
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
emust specifications cont d
eMUST Specifications (cont’d)
  • Writes to Sequel database
  • Dietitian communication via LAN page
    • Score  2
  • Efficient, accurate audit data
  • Standard reports via crystal reports
nutrition screening process
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
admission process
Admission process
  • Tape measures kept by bedside
  • Removed duplicate data entry on admission
ward infrastructure
Ward infrastructure

2 additional PC’s supplied to ward – close to/near bedside

emust demonstration
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
identification of practice gap
Identification of practice gap
  • 80% High risk patients not referred to dietitian
risk profile ward 7 east gen med
Risk Profile: Ward 7 East (Gen Med)

N = 46

Slightly lower than international/national benchmarks

admissions screened pre admission
% Admissions Screened: Pre-admission

Pre Admission Liaison Nurse Debriefing

Average = 37.5%

obese patient distribution
Obese patient distribution
  • Total Screened
  • Obese
key outcomes
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)
future directions
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
breakdown of obese patients
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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