Implementation of a Pediatric Oncology Nutritional Algorithm on an Inpatient Unit

Abstract

Problem: The rate of malnutrition in pediatric oncology patients receiving chemotherapy is as high as 50% without nutritional support. The consequences of malnutrition are severe and can include reduced survival rates. The Children’s Oncology Group recommends these children receive nutrition screening at diagnosis and throughout treatment. Nutritional management and support for oncology patients in an academic, tertiary care pediatric unit was inconsistent and lacked a standardized policy. Purpose: The purpose of this quality improvement project was to implement a nutritional management algorithm for pediatric oncology patients admitted to an inpatient unit to improve early recognition of malnutrition and early nutritional interventions. Methods: The Mobilize Assess Plan Implementation Track framework was used to develop and implement a novel nutritional management algorithm over a 14-week period. Multifaceted education strategies were used and project leader attended multidisciplinary rounds. Patients were assessed daily for changes in weight/BMI or weight for length. Patients experiencing a loss of 1 z-score in BMI/weight for length or ≥5% weight loss from diagnosis, prompted referencing an algorithm for nutritional interventions. Chart audits were conducted to track outcome measures. Run charts were used to track compliance. Baseline comparison data were patients admitted 14-weeks prior to implementation. Results: Twenty-one patients with over 50 admissions met eligibility criteria. Compliance in daily weights improved from 72% to 88%. 96% of patients received a nutrition consult compared to 32% pre-implementation. 100% of patients had a nutrition consult during their diagnosis admission vs. 56% pre-implementation. 100% of patients had weight/BMI/weight for length tracked during every admission. Conclusion: Implementation of a nutrition management algorithm can improve early recognitionof malnutrition and early nutritional interventions in hospitalized pediatric oncology patients. Standardizing the nutrition assessment with electronic prompts for calculation and evaluation of anthropometric indices improved overall staff compliance. This project may have future application to the outpatient nutritional management of pediatric oncology patients undergoing chemotherapy treatment.