Clinical Dietitian Atrium Health/Levine Children's Cancer and Blood Disorders Levine Children's Hospital Charlotte, North Carolina, United States
Background: Children with cancer are at increased risk of malnutrition. Per a screening survey, ~30% of our solid tumor and leukemia/lymphoma patients are at nutritional risk. Given the cyclic nature of cancer therapy, malnutrition can be easily missed leading to increased risk of morbidity and mortality. Barriers to identification are the need for education, standardized language, and lack of a nutrition algorithm for management. As part of a larger quality improvement (QI) project, Nutrition Best Practice Guidelines (NBPGs) were developed as a reference for diagnostic criteria and as a nutrition algorithm to guide treatment decisions including standardization of the dietitian consult.
Objective: Data collection spans July 2019 to December 2020. One measured goal for this project is to increase the percent of patients with a new diagnosis who receive a nutrition consult within 30 days of diagnosis to 80%.
Design/Methods: A multidisciplinary QI team (RDs, NP, RN, MD) used the Model for Improvement QI framework with aim statement, key driver diagram, and process flow map. Evidence-based NBPGs were created to provide diagnostic criteria, as a nutrition algorithm to guide malnutrition treatment decision-making, and to standardize care by developing a dietitian referral process to streamline transition from inpatient to outpatient settings. NBPGs were refined via multiple PDSA cycles. Dietitians searched current literature for existing guidelines. Preliminary NBPGs were presented to the QI committee, with changes over many iterations. The draft NBPGs then went to the Best Practice Committee (BPC) who proposed clarifications. BPC reviewed the changes and referred the proposed NBPGs to the provider team for review. After more changes, the NBPGs were approved for use. Initiation of a standardized nutrition consultation and documentation of nutrition status were created and implemented through this process. Annotated run charts evaluated improvement.
Results: The process measure was defined via completion of a dietitian consult for newly diagnosed patients within 30 days of diagnosis with a goal of 80% receiving. A run chart shows non-random variation with a median shift from 39% to 100% and indicating sustained process improvement above goal. Conclusion(s): Standardization of care and language around malnutrition has increased understanding and awareness of this complex topic in pediatric oncology and led to improvement in intervention times and overall decreased malnutrition incidence.
Nutrtion Best Practice Guidelines Page 1 of 2
Nutrtion Best Practice Guidelines Page 2 of 2
Authors/Institutions: Holly Hirsch, Levine Children's Hospital, Charlotte, North Carolina, United States; Courtney Huddle, Levine Children's Hospital, Charlotte, North Carolina, United States; Mehgan Beverley, Levine Children's Hospital, Charlotte, North Carolina, United States; Chandler Kasay, Levine Children's Hospital, Charlotte, North Carolina, United States; Emita Clark, Levine Children's Hospital, Charlotte, North Carolina, United States; Jamie R. Mochel, Levine Children's Hospital, Charlotte, North Carolina, United States; Joel Kaplan, Levine Children's Hospital, Charlotte, North Carolina, United States
