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Implementation Adherence of Malnutrition Screening on Head and Neck Oncology Patients

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2024-05
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DNP Project
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Problem & Purpose: Lack of a standardized nutritional assessment process for patients with head and neck cancer receiving radiotherapy alone (HNC-R) may lead to undiagnosed malnutrition, interrupted radiotherapy, and increased complications. At a northeastern US academic medical center radiation oncology clinic, usual practice includes arranging dietician team referrals for all patients with HNC who receive chemoradiotherapy. In contrast, audits revealed that only two patients with HNC-R received dietician team referrals in FY 2022. This project aimed to promote early detection of malnutrition for all patients with HNC-R by implementing a standardized nutritional assessment process into the clinic's daily workflow. Methods: Before initiation of this 15-week project, the project lead (PL) educated clinic staff (providers/nurses) on administering a nutritional assessment tool, the Patient- Generated Subjective Global Assessment (PG-SGA) to patients with HNC-R. Staff administered PG-SGA during radiation consults at weeks one, four, and final week of radiotherapy. PG-SGA score > 4 initiated a dietician referral. Clerical staff entered data into the electronic medical record (EMR); PL audited EMR and entered data based on EMR audit on a HIPAA-compliant database server, REDCap®. Results: Staff screened 100% (17/17) of patients. Due to lost data on three patients, EMR documentation of PG-SGA scores occurred for 82% (14/17); 64% (9/14) of patients with HNC-R received dietician referrals. Conclusions: Clinic staff adhered to the new workflow process which increased nutritional assessments and dietician referrals for the target subpopulation within this radiation-oncology clinic.

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