Epworth healthcare malnutrition prevalence audit.

Abstract

Background: Malnutrition is associated with an increased length of stay, adverse clinical outcomes, increased treatment costs and financial shortfalls for the organisation. Hence, timely screening and the provision of dietetic intervention is vital to optimise patient care. Studies have identified malnutrition prevalence rates ranging from 6-53% in Australian hospitals, however the prevalence of malnutrition risk and incidence at Epworth Healthcare has not been accurately quantified to date. Methods: Snapshot audit completed by dietetics staff from May to October 2017. 616 patients were audited across Epworth Richmond and Epworth Rehabilitation (Richmond, Hawthorn, Brighton and Camberwell). Researchers examined the compliance with the Epworth weight protocol and interviewed patients to determine whether weight and height had been physically measured on admission and weekly. Compliance and accuracy of Malnutrition Screening Tool (MST) completion was examined and all patients were screened for malnutrition. Those patients deemed to be at risk of malnutrition (MST≥2) then underwent assessment using the Subjective Global Assessment Tool and any patients diagnosed with malnutrition were provided nutrition intervention. Audit findings were also compared with the results of the 2017 Point Prevalence Study (PPS). Results: The audit revealed poor compliance with the Epworth Weighing the Patient Protocol. 28% of audited patients were found to not have a weight recorded in their medical history. 43% of patients were not physically measured for weight and 76% were not physically measured for height. It was also discovered that 41% of patients who qualify for weekly weight measurements were not being re-weighed.

The audit illustrated poor compliance with Malnutrition Screening for risk management with only 59% MST completion on admission, of which only 41% were correctly completed by nursing staff. Only 36% of patients with LOS > 7 days were being screened weekly.

The audit found that 26% of patients were at risk of malnutrition group wide and 16% were diagnosed with either mild-moderate malnutrition or severe malnutrition. 62% of at risk patients and 50% of patients diagnosed with malnutrition had not been referred to dietetics The 2017 PPS found a 9.8% incidence of malnutrition risk group-wide, which is indicative of a significant under estimate of actual prevalence. The audit also highlighted several short fallings in the ability of the PPS to thoroughly or accurately examine compliance with patient weight monitoring and screening tool completion. Conclusions: The completion of weight monitoring and malnutrition screening at Epworth Healthcare does not meet the 100% compliance target. This has potential consequences for patient outcomes and safety and significant financial implications for the organisation. It is felt that both group-wide and local approaches should be taken to address the short fallings identified in compliance with protocols and several suggestions have been proposed.