| Description |
Background: Malnutrition is prevalent among cancer patients and impacts patient outcomes and quality of life. The Malnutrition Screening Tool (MST) is a valid and efficient method for screening patients for increased risk of malnutrition. Currently, the MST is embedded in a regional cancer hospital's electronic health record (EHR) system. Local Problem: Despite its availability, the utilization of the MST has been suboptimal, resulting in potentially missed nutritional interventional opportunities for patients at risk of malnutrition. This quality improvement project aimed to identify the barriers to utilizing the MST and facilitate its utilization in a regional GI outpatient oncology clinic by implementing a toolkit. Methods: The project consists of assessing the staff's current usage of MST, developing and implementing a toolkit, and evaluating the usage of the MST toolkit pre- and postimplementation. The assessment included in-person observations and pre- and post-intervention surveys. The toolkit is an online training module that provides background about malnutrition's impact on patients with cancer, a step-by-step guide to using the MST, and knowledge quizzes. Data on MST usage, flagged patients, completed screenings, and subsequent referrals were collected and analyzed over a pre- and post-implementation period, 90 days vs. 45 days, respectively. Results: During the pre-intervention phase, 15% of flagged patients were screened via the MST, leading to a referral rate of 0.89 per 100 visits. Post-intervention, screening rates increased to 20%, and the referral rate rose to 1.21 per 100 visits. The pre- and post-intervention survey responses identified primary barriers, including forgetfulness, workflow time constraints, and lack of training for MST utilization. Survey responders suggested including MST training during employment and orientation in the unit. Conclusion: Implementing a toolkit improved MST utilization and referral rates in a 45-day, post-implementation period. A significant finding is that about 10% of screened patients were consistently referred to the dietitian consultation in both pre- and post-intervention phases, suggesting the critical importance of the MST screening to identify patients at risk of malnutrition. Identified barriers should be addressed, including improving staff engagement, workflow efficiency, and appropriate training. The clinic's leadership and support from the interdisciplinary team in overcoming the barriers are essential in facilitating the MST use and expanding it hospital-wide, ultimately impacting patient outcomes. |
