1. 20% Identified at Risk by Medical Staff (n=6/30)
The identification and classification of the risk resulting from an under-resourced dietetic service.
R. Hannon1, S.McMahon1, O. Smith1, M. O’Donoghue1, D. Walsh1, B. Moore1, E. Sweeney1, C. White1, K. McElligott1, E. Duignan1,
L. Masterson1, G. Marrinan1, M. Lyons1, M. Hannon1, N. Brosnan1, R. Clyne1, S. Cunneen1, C. O’Hanlon1
1Department of Nutrition & Dietetics, Beaumont Hospital, Dublin 9, Ireland
Introduction
Conclusion
Results
The prevalence of malnutrition on admission to hospital has been well documented. Data from the Nutrition Screening Survey has shown that in 2010–2011 between 27–32% of patients were at risk of malnutrition on admission to hospital in Ireland.
In 2016, our Nutrition and Dietetics Department experienced severe deficits in staffing. At its worst, the staffing deficit for the department was 22.6%, equivalent to 5.5 WTE. In an effort to control patient risk service was reduced to a minimum number of areas.
Inadequate dietetic staffing resulted in a moderate to extreme malnutrition risk for 75% of this patient cohort. Early identification of malnutrition using MUST is recommended by HIQA.
Malnutrition has been linked with an 85% higher risk of hospital admission and re-admission and a 30% longer length of hospital stay.
Refeeding syndrome is a potentially lethal condition for which the predominant risk factor is malnutrition. This condition is treatable and preventable in some cases (NICE, 2006)
Key Recommendations & Actions
Ensure sufficient Dietetic staffing and adequate backfill for vacant posts
Implementation of MUST hospital-wide for timely identification of patients who are malnourished or at risk of malnutrition 
Immediate & appropriate Dietetic referral for high risk patient (as per MUST)
Amend PIPE referral system in order to ensure appropriate Dietetic referrals
Offer appropriate Dietetic follow up to all patients who were placed on the waiting list.
As a result of the staffing deficit some key findings were identified.
A total of 137 patients were placed on a waiting list for the last quarter of Of these 49 received dietetic input pre-discharge and 17 day-case patients were excluded from the audit. Data was collected on the remaining 68 patients.
Initial MUST (Malnutrition Universal Screening Tool) screening completed on 31% (21/68) of inpatients
74% (n=50/68) were identified at moderate to extreme nutritional risk (based on the HSE risk assesment tool )
44% (n=30/68) retrospectively identified by Dietetics as being at risk of refeeding syndrome.
Of these 20% were identified by the medical teams as being at risk and 50% of these patients were treated correctly.
49% of patients (n=33/68) did not have a Nutrition Care Plan initiated
22% (n=15/68) of patients were readmitted to hospital during timeframe of this audit (October ‘16 –February ’17)
Aims & Objectives
Assess the nutritional risk to patients resulting from an under-resourced dietetic service and to facilitate future planning to minimise patient risk.
The referrals received from the areas with reduced service were initially screened and those who did not require enteral or parenteral nutrition support were placed on a waiting list. An audit tool was devised. Medical charts were retrospectively reviewed to analyse nutritional parameters and assess the level of risk to patients on the waiting list resulting from the absence of dietetic intervention. The HSE Risk Assessment Tool was completed on each patient as a means of risk analysis and categorisation.
Methods
20% Identified at Risk by Medical Staff (n=6/30)
References
1. Russell, C. A., and M. Elia. "Nutrition Screening Survey in the UK and Republic of Ireland in 2010." A report by BAPEN (2011).
2Allard JP, Keller H, Jeejeebhoy KN, et al. Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force. JPEN J Parenter Enteral Nutr. 2015
3. NICE National Institute for Health and Clinical Excellence. Nutrition Support in Adults. Clinical guideline 32, 2006.