- Email: [email protected]
Audit of appropriate use of oral nutritional supplements in care homes in North Hampshire
e192
Abstracts / Clinical Nutrition ESPEN 10 (2015) e174ee212
Conclusion: Children on HPN have better dental health when compared to national statistics on children and adults on HPN. Reference 1. Intestinal failure and home parenteral nutrition: Implications for oral health and dental care. Lee AM, Gabe SM, Nightingale JM, Burke M. Clin Nutr. 2012 Jun 22. 2. Oral health, dental prophylaxis and catheter related bloodstream infections in home parenteral nutrition patients: results of a UK survey and cohort study. Lee AM, Gabe SM, Nightingale JM, Burke M. Br Dent J. 2012 Jan 27;212(2):E4. 3. Children's dental health in England 2003 4. The influence of micronutrients on oral and general health B Willer€rsch, I Willershausen, Ph Mohaupt, A Callaway Eur J shausen, A Ross, M Fo Med Res. 2011; 16(11): 514e518. Published online 2011 November 10. doi: 10.1186/2047 783X-16-11-514 OC34. A PILOT STUDY EVALUATING THE USE OF THE STAMP© NUTRITION SCREENING TOOL IN HOSPITALISED INFANTS A. Carey, H. McCarthy, A. Thompson, H. McNulty. Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, UK General estimates suggest 9-47% of hospitalised children may be at risk of malnutrition1 and subsequently many organisations recommend formal nutrition screening of all children on admission to hospital2,3,4. The Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) was recently developed to identify nutrition risk in hospitalised children aged 2-16 years5. The aim of this pilot study was to evaluate the use of STAMP© in infants under 2 years of age. Infants, aged 2 weeks to 2 years, were recruited from February to May 2012 on admission to participating infant wards in two tertiary children’s hospitals in Dublin. STAMP© was completed by the admitting nurse or project assistant. A subset of patients underwent a full nutrition assessment by a registered dietitian, utilising an adapted version of the Subjective Global Nutritional Assessment (SGNA) tool6. The validity, sensitivity and specificity of STAMP© were assessed by comparing nutrition risk as identified by the tool against the classification of nutrition risk as determined by the full nutritional assessment. In total, 59 infants were recruited to undergo a full nutritional assessment following STAMP© nutrition risk screening. Evaluation of STAMP© demonstrated moderate reliability in predicting nutrition risk compared to that determined by the full nutritional assessment (¼ 0.808; 95% CI 0.317, 0.633). Strong inter-rater reliability (¼0.658) was observed when STAMP© was completed by both a dietitian and nurse/project assistant. Table 1 Calculation of the statistic, sensitivity, specificity, positive and negative predictive values for malnutrition risk agreement between a full nutrition assessment and STAMP©. STAMP© nutrition screening tool risk
Full nutrition assessment
Low risk High risk Total Sensitivity (%) Specificity (%) PPV (%) NPV (%) Statisticz
Low risk*
High risk
34 0 34 100 87 (0.785, 0.955)y 79 (0.687, 0.893)y 100 0.808 (0.317, 0.633)
5 19 24
y
4 5 6
Agostoni C, et al. (2005) McCarthy H. et al. (2012) Secker D. & Jeejeebhoy K. (2012)
OC35. A SYSTEMATIC REVIEW OF DIETARY ADVICE WITH OR WITHOUT ORAL NUTRITIONAL SUPPLEMENTS IN PATIENTS WITH CHANGES IN BODY COMPOSITION AND METABOLIC MARKERS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART). E. Spyreli. King’s College London, Stamford Street, London SE1 9NH, UK HIV patients that receive highly active antiretroviral treatment can develop excessive muscle loss (wasting), lipoatrophy or lipohypertrophy, lipid abnormalities and insulin resistance (lipodystrophy)(1). Extreme weight loss predicts negative prognosis for patient’s survival while HIV lipodystrophy increases the risk of developing cardiovascular disease, metabolic syndrome, impairs quality of life and increases mortality (2). This systematic review identified randomised controlled trials (RCTs) investigating the effects of dietary counselling on HIV positive patients with wasting and lipodystrophy syndrome receiving HAART and determine their effects on body composition markers, lipid profile and glucose metabolism. A systematic review of the literature was conducted using two electronic databases (MEDLINE & CENTRAL) as well was the reference list of selected articles. Only RCTs comparing dietary advice against no advice in HIV patients receiving HAART were included. Their quality was assessed according to the “Cochrane Collaboration’s tool for assessing risk of bias”. A meta-analysis was eventually performed to summarise their findings on body composition indices and biochemical profile. Six RCTs met the inclusion criteria with overall 739 participants and a mean duration of 6.5 months. They were classified under three categories; interventions focusing on the prevention of HIV-associated lipodystrophy, on the treatment of lipodystrophy and interventions for HIV-wasting syndrome. Four of them were included in one final meta-analysis. Dietary advice with supplements if required compared to no advice led to a significant increase in HDL cholesterol levels (2.74 mg/ dL, CI: 1.04 e 4.43 mg/ dL, P ¼ 0.002). Slight, non-significant decreases were seen for BMI (-1.2 Kg/ m2, CI: -3.15 e 0.75 Kg/m2, P ¼ 0.23), waist circumference (-1.92 cm, CI: -5.64 e 1.81 cm, P ¼ 0.31) and LDL cholesterol levels (-6.97 mg/dL, CI: -15.53 e 1.58 mg/dL, P value ¼ 0.11). No association was found between dietary advice and total cholesterol, fasting triglyceride and fasting glucose levels. Cochrane Collaboration tool for assessing bias showed that the studies are prone to selection, performance and detection bias. There is uncertainty around the potential benefits that dietary advice has on measures of body composition and lipid parameters in HIV patients on HAART. Further large-scale studies are needed, including populations of HIV infected individuals that are homogenous for co-morbidities and reporting details for the duration and the content of the dietary interventions. 1. Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm D J & Cooper D A. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998; 12: F51-8. 2. Palenicek J P, Graham N M, He Y D, Hoover D A, Oishi J S, Kingsley L & Saah A J. Weight loss prior to clinical AIDS as a predictor of survival. Multicenter AIDS Cohort Study Investigators. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 10: 366-73. OC36. AUDIT OF APPROPRIATE USE OF ORAL NUTRITIONAL SUPPLEMENTS IN CARE HOMES IN NORTH HAMPSHIRE K. Malcolmson. Hampshire Hospitals Foundation Trust, UK
The results of this pilot study suggest that STAMP© would be a valid nutrition screening tool for identifying malnutrition risk in a general inpatient population aged 2 weeks to 2 years. 1 Puntis J. (2010) 2 Royal College of Nursing (2006) 3 Brotherton A., et al. (2010)
Malnutrition, in terms of under-nourishment, is both a cause and consequence of disease. It is common and affects between 30-50% of care home residents1. Malnutrition was found to cost the NHS £13 billion in 20062. Oral nutritional Supplements (ONS) have been shown to effectively treat malnutrition when used appropriately. Studies have shown improved
Abstracts / Clinical Nutrition ESPEN 10 (2015) e174ee212
nutritional care can reduce emergency admissions, infection risk, improve wound care and reduce their associated costs2. Better nutritional care for individuals at risk can result in substantial cost savings to the NHS and even a saving of 1% of the annual health care cost of malnutrition, would amount to £130 million annually3. Aims 1)To establish the proportion of residents inappropriately prescribed ONS 2) To determine cost savings from inappropriate supplements prescribed 3) To establish the levels of use of Malnutrition Universal Screening Tool (MUST)2 in nursing homes 4) To establish the levels of food fortification in nursing homes 5) To establish the levels of nutritional training in nursing homes Method: 29 nursing homes with more than 15 beds were visited in the North Hampshire CCG. Homes were asked about nutritional care plans, assessment and training. All patients that were on ONS were assessed for their appropriateness of supplements. Based upon clinical judgement, a recommendation was made as to whether supplements should be either: Continued, stopped or changed to reach therapeutic dose. The homes consisted of a total of 1,117 occupied beds of which was given) 104 patients were on supplements (9%). 1) 45% of residents’ supplements were stopped as these were found to be inappropriate 2) Cost savings were calculated as a daily saving from the reduction in nutritional supplements, this was then extrapolated to a year
Total daily cost of ONS before audit
Total daily cost of ONS after audit
Potential saving per day
Potential saving per year
£250.30
£126.32
£123.98 (49.6%)
£45,253
3) 75% of homes were using MUST however only 27% of these were consistently correct 4) 38% of homes had systematic food fortification in place 5) 10% of homes had regular malnutrition training This audit shows that when patients are reviewed by a registered Dietitian, supplement usage in the community could be greatly reduced due to the inappropriate prescribing of ONS. From this audit 45% of patients had ONS stopped and a potential of £45,253 could be saved each year. This potential saving could be reinvested to easily cover the cost of one full time band 6 Dietitian (49hrs a week), who could provide dietetic review of patients in the community and nutritional training. Nutritional training was only conducted in 10% homes and this will clearly affect patient’s nutritional status and care, potentially creating a positive impact on the wider cost of malnutrition to the NHS. 1. Malnutrition Advisory Group (MAG). THE ‘MUST’ REPORT Nutritional screening of adults: A multidisciplinary responsibility. (Accessed January 2012 www.bapen.org.uk) 2. BAPEN Commissioning Nutritional Care. (Accessed January 2012 www. bapen.org.uk) 3. Elia M, Russell CA (eds). Combating malnutrition; Recommendations for Action. A report from the Advisory Group on Malnutrition, led by BAPEN. Redditch: BAPEN, 2009. 4. British Association Parenteral and Enteral Nutrition (BAPEN) Malnutrition Universal Screening Tool (MUST). (Accessed January 2012 www. bapen.org.uk) OC37. RETROSPECTIVE AUDIT OF PARENTERAL NUTRITION USE IN A TERTIARY ONCOLOGY AND HAEMATOLOGY CENTRE PRIOR TO THE LAUNCH OF THE MULTIDISCIPLINARY NUTRITION TEAM L.K. Wells 1, W.I. Ali 2, W.Y. Lim 2, M.A. Butt 2. 1Department of Nutrition and Dietetics, The Queens Centre for Oncology and Haematology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK; 2Department of Oncology, The Queens Centre for Oncology and Haematology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
e193
The provision of parenteral nutrition (PN) should occur under the supervision of a multidisciplinary nutrition team after enteral nutrition has been considered, and excluded (1). Prior to the launch of a multidisciplinary nutrition team at the Hull and East Yorkshire hospitals NHS Trust, a retrospective audit of patient records was carried out to provide baseline data on PN use at the Queen’s centre for Oncology and Haematology (QCOH), from the date the centre opened up until the launch date of the nutrition team (August 2008-November 2011). The indication for PN, clinical diagnosis, weight (kg), height (m), body mass index (kg/m2), access route for PN, duration of PN (days) and level of refeeding syndrome (RFS) risk (2) were recorded. Data from all the 32 patients (16 female, 16 male) prescribed PN during this period was included in the audit. Weights ranged from 41-101 kg (n¼31), mean 67.4 kg. Height 1.54-1.93 m, (n¼29) mean 1.67m. Weight loss ranged from 0-26% (n¼22) mean 12%. Body mass index (kg/m2) ranged from 15-42 kg/m2 (n¼29), mean 24 kg/m2. PN was prescribed to patients with a diagnosis of oesophageal/gastro-oesophageal junction cancer 22% (n¼7), lymphoma 19% (n¼6), bowel cancer 16 % (n¼5), pancreatic cancer 13 % (n¼4), gynaecological cancer 9% (n¼3), head and neck cancer 9% (n¼3), lung cancer 3% (n¼1) and breast cancer 3% (n¼1). PN was indicated in 44% of patients (n¼14) due to an obstruction of the gastrointestinal tract, 19% (n ¼6) due to failed enteral feeding, 13 % (n¼4) due to mucositis, 9%, (n¼3) due to ileus, 9% (n¼3) due to gastrointestinal perforation, 3% (n¼1) due to a failed oesophageal stent and 3% (n¼1) due to a grade 4 Cetuximab skin rash to the face (3). PN was administered centrally to 86% (n¼28) of patients via a femoral, Hickman, PICC or central line to and to 14% (n¼4) via a peripheral cannula. The duration of PN administration ranged from 3-60 days (n¼30), mean 14 days. The Dietitian documented 81% of patients (n¼23) to be at a high risk of RFS 63% (n¼32). In conclusion, PN has been administered appropriately and with authentic indication at the QCOH. An obstruction of the gastrointestinal tract and failed enteral feeding were the main indications for PN most frequently to patients with oesophageal cancer, lymphoma and bowel cancer in tertiary oncology centre. 1. A Mixed Bag: An enquiry into the care of hospital patients receiving parenteral nutrition. A report by the National Confidential Enquiry into Patient Outcome and Death. 2010. Available from: http://www.ncepod.org. uk/2010pn.htm 2. Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition [Internet]. National Collaborating Centre for Acute Care (UK). 2006. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/21309138 3. Common terminology criteria for adverse events v3. 0 (CTCAE) [Internet]. Cancer Therapy Evaluation Program. National Cancer Institute Bethesda, Md; 2006. Available from: http://scholar.google.com/scholar? cluster¼14562828772555817497&hl¼en&as_sdt¼0,22. Last accessed 27/ 4/13 14.00pm OC38. AN AUDIT TO ESTABLISH THE INCIDENCE OF MALNUTRITION IN AN ACUTE HOSPITAL M. Patel, E. Korc, J. Pietkiewicz, S. Chow, R. Youngman, L. Hyam, J. Moore, K.Stewart, M. Taylor, S. McKay. Nutrition and Dietetic Department, The North Middlesex University Hospital NHS Trust, Sterling Way, Enfield, London, N18 1QX, UK Increasing numbers of patients with malnutrition are admitted and discharged from hospitals (2). The Malnutrition Universal Screening Tool (MUST) is the recommended screening tool for malnutrition in the United Kingdom (UK) (1). There are reported inconsistencies in use of the MUST (2). The aim of this audit was to establish the nutritional status of inpatients and the use of MUST. All inpatients were assessed. The BMI and MUST completed by nursing staff within 24 hours of admission were recorded. The accuracy was reassessed by dietitians, to measure the incidence of malnutrition. The need for dietetic input and the rate of referrals were examined. A comparison was made of the overall results between previous and present MUST audits.
Abstracts / Clinical Nutrition ESPEN 10 (2015) e174ee212
Conclusion: Children on HPN have better dental health when compared to national statistics on children and adults on HPN. Reference 1. Intestinal failure and home parenteral nutrition: Implications for oral health and dental care. Lee AM, Gabe SM, Nightingale JM, Burke M. Clin Nutr. 2012 Jun 22. 2. Oral health, dental prophylaxis and catheter related bloodstream infections in home parenteral nutrition patients: results of a UK survey and cohort study. Lee AM, Gabe SM, Nightingale JM, Burke M. Br Dent J. 2012 Jan 27;212(2):E4. 3. Children's dental health in England 2003 4. The influence of micronutrients on oral and general health B Willer€rsch, I Willershausen, Ph Mohaupt, A Callaway Eur J shausen, A Ross, M Fo Med Res. 2011; 16(11): 514e518. Published online 2011 November 10. doi: 10.1186/2047 783X-16-11-514 OC34. A PILOT STUDY EVALUATING THE USE OF THE STAMP© NUTRITION SCREENING TOOL IN HOSPITALISED INFANTS A. Carey, H. McCarthy, A. Thompson, H. McNulty. Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, UK General estimates suggest 9-47% of hospitalised children may be at risk of malnutrition1 and subsequently many organisations recommend formal nutrition screening of all children on admission to hospital2,3,4. The Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) was recently developed to identify nutrition risk in hospitalised children aged 2-16 years5. The aim of this pilot study was to evaluate the use of STAMP© in infants under 2 years of age. Infants, aged 2 weeks to 2 years, were recruited from February to May 2012 on admission to participating infant wards in two tertiary children’s hospitals in Dublin. STAMP© was completed by the admitting nurse or project assistant. A subset of patients underwent a full nutrition assessment by a registered dietitian, utilising an adapted version of the Subjective Global Nutritional Assessment (SGNA) tool6. The validity, sensitivity and specificity of STAMP© were assessed by comparing nutrition risk as identified by the tool against the classification of nutrition risk as determined by the full nutritional assessment. In total, 59 infants were recruited to undergo a full nutritional assessment following STAMP© nutrition risk screening. Evaluation of STAMP© demonstrated moderate reliability in predicting nutrition risk compared to that determined by the full nutritional assessment (¼ 0.808; 95% CI 0.317, 0.633). Strong inter-rater reliability (¼0.658) was observed when STAMP© was completed by both a dietitian and nurse/project assistant. Table 1 Calculation of the statistic, sensitivity, specificity, positive and negative predictive values for malnutrition risk agreement between a full nutrition assessment and STAMP©. STAMP© nutrition screening tool risk
Full nutrition assessment
Low risk High risk Total Sensitivity (%) Specificity (%) PPV (%) NPV (%) Statisticz
Low risk*
High risk
34 0 34 100 87 (0.785, 0.955)y 79 (0.687, 0.893)y 100 0.808 (0.317, 0.633)
5 19 24
y
4 5 6
Agostoni C, et al. (2005) McCarthy H. et al. (2012) Secker D. & Jeejeebhoy K. (2012)
OC35. A SYSTEMATIC REVIEW OF DIETARY ADVICE WITH OR WITHOUT ORAL NUTRITIONAL SUPPLEMENTS IN PATIENTS WITH CHANGES IN BODY COMPOSITION AND METABOLIC MARKERS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART). E. Spyreli. King’s College London, Stamford Street, London SE1 9NH, UK HIV patients that receive highly active antiretroviral treatment can develop excessive muscle loss (wasting), lipoatrophy or lipohypertrophy, lipid abnormalities and insulin resistance (lipodystrophy)(1). Extreme weight loss predicts negative prognosis for patient’s survival while HIV lipodystrophy increases the risk of developing cardiovascular disease, metabolic syndrome, impairs quality of life and increases mortality (2). This systematic review identified randomised controlled trials (RCTs) investigating the effects of dietary counselling on HIV positive patients with wasting and lipodystrophy syndrome receiving HAART and determine their effects on body composition markers, lipid profile and glucose metabolism. A systematic review of the literature was conducted using two electronic databases (MEDLINE & CENTRAL) as well was the reference list of selected articles. Only RCTs comparing dietary advice against no advice in HIV patients receiving HAART were included. Their quality was assessed according to the “Cochrane Collaboration’s tool for assessing risk of bias”. A meta-analysis was eventually performed to summarise their findings on body composition indices and biochemical profile. Six RCTs met the inclusion criteria with overall 739 participants and a mean duration of 6.5 months. They were classified under three categories; interventions focusing on the prevention of HIV-associated lipodystrophy, on the treatment of lipodystrophy and interventions for HIV-wasting syndrome. Four of them were included in one final meta-analysis. Dietary advice with supplements if required compared to no advice led to a significant increase in HDL cholesterol levels (2.74 mg/ dL, CI: 1.04 e 4.43 mg/ dL, P ¼ 0.002). Slight, non-significant decreases were seen for BMI (-1.2 Kg/ m2, CI: -3.15 e 0.75 Kg/m2, P ¼ 0.23), waist circumference (-1.92 cm, CI: -5.64 e 1.81 cm, P ¼ 0.31) and LDL cholesterol levels (-6.97 mg/dL, CI: -15.53 e 1.58 mg/dL, P value ¼ 0.11). No association was found between dietary advice and total cholesterol, fasting triglyceride and fasting glucose levels. Cochrane Collaboration tool for assessing bias showed that the studies are prone to selection, performance and detection bias. There is uncertainty around the potential benefits that dietary advice has on measures of body composition and lipid parameters in HIV patients on HAART. Further large-scale studies are needed, including populations of HIV infected individuals that are homogenous for co-morbidities and reporting details for the duration and the content of the dietary interventions. 1. Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm D J & Cooper D A. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998; 12: F51-8. 2. Palenicek J P, Graham N M, He Y D, Hoover D A, Oishi J S, Kingsley L & Saah A J. Weight loss prior to clinical AIDS as a predictor of survival. Multicenter AIDS Cohort Study Investigators. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 10: 366-73. OC36. AUDIT OF APPROPRIATE USE OF ORAL NUTRITIONAL SUPPLEMENTS IN CARE HOMES IN NORTH HAMPSHIRE K. Malcolmson. Hampshire Hospitals Foundation Trust, UK
The results of this pilot study suggest that STAMP© would be a valid nutrition screening tool for identifying malnutrition risk in a general inpatient population aged 2 weeks to 2 years. 1 Puntis J. (2010) 2 Royal College of Nursing (2006) 3 Brotherton A., et al. (2010)
Malnutrition, in terms of under-nourishment, is both a cause and consequence of disease. It is common and affects between 30-50% of care home residents1. Malnutrition was found to cost the NHS £13 billion in 20062. Oral nutritional Supplements (ONS) have been shown to effectively treat malnutrition when used appropriately. Studies have shown improved
Abstracts / Clinical Nutrition ESPEN 10 (2015) e174ee212
nutritional care can reduce emergency admissions, infection risk, improve wound care and reduce their associated costs2. Better nutritional care for individuals at risk can result in substantial cost savings to the NHS and even a saving of 1% of the annual health care cost of malnutrition, would amount to £130 million annually3. Aims 1)To establish the proportion of residents inappropriately prescribed ONS 2) To determine cost savings from inappropriate supplements prescribed 3) To establish the levels of use of Malnutrition Universal Screening Tool (MUST)2 in nursing homes 4) To establish the levels of food fortification in nursing homes 5) To establish the levels of nutritional training in nursing homes Method: 29 nursing homes with more than 15 beds were visited in the North Hampshire CCG. Homes were asked about nutritional care plans, assessment and training. All patients that were on ONS were assessed for their appropriateness of supplements. Based upon clinical judgement, a recommendation was made as to whether supplements should be either: Continued, stopped or changed to reach therapeutic dose. The homes consisted of a total of 1,117 occupied beds of which was given) 104 patients were on supplements (9%). 1) 45% of residents’ supplements were stopped as these were found to be inappropriate 2) Cost savings were calculated as a daily saving from the reduction in nutritional supplements, this was then extrapolated to a year
Total daily cost of ONS before audit
Total daily cost of ONS after audit
Potential saving per day
Potential saving per year
£250.30
£126.32
£123.98 (49.6%)
£45,253
3) 75% of homes were using MUST however only 27% of these were consistently correct 4) 38% of homes had systematic food fortification in place 5) 10% of homes had regular malnutrition training This audit shows that when patients are reviewed by a registered Dietitian, supplement usage in the community could be greatly reduced due to the inappropriate prescribing of ONS. From this audit 45% of patients had ONS stopped and a potential of £45,253 could be saved each year. This potential saving could be reinvested to easily cover the cost of one full time band 6 Dietitian (49hrs a week), who could provide dietetic review of patients in the community and nutritional training. Nutritional training was only conducted in 10% homes and this will clearly affect patient’s nutritional status and care, potentially creating a positive impact on the wider cost of malnutrition to the NHS. 1. Malnutrition Advisory Group (MAG). THE ‘MUST’ REPORT Nutritional screening of adults: A multidisciplinary responsibility. (Accessed January 2012 www.bapen.org.uk) 2. BAPEN Commissioning Nutritional Care. (Accessed January 2012 www. bapen.org.uk) 3. Elia M, Russell CA (eds). Combating malnutrition; Recommendations for Action. A report from the Advisory Group on Malnutrition, led by BAPEN. Redditch: BAPEN, 2009. 4. British Association Parenteral and Enteral Nutrition (BAPEN) Malnutrition Universal Screening Tool (MUST). (Accessed January 2012 www. bapen.org.uk) OC37. RETROSPECTIVE AUDIT OF PARENTERAL NUTRITION USE IN A TERTIARY ONCOLOGY AND HAEMATOLOGY CENTRE PRIOR TO THE LAUNCH OF THE MULTIDISCIPLINARY NUTRITION TEAM L.K. Wells 1, W.I. Ali 2, W.Y. Lim 2, M.A. Butt 2. 1Department of Nutrition and Dietetics, The Queens Centre for Oncology and Haematology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK; 2Department of Oncology, The Queens Centre for Oncology and Haematology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
e193
The provision of parenteral nutrition (PN) should occur under the supervision of a multidisciplinary nutrition team after enteral nutrition has been considered, and excluded (1). Prior to the launch of a multidisciplinary nutrition team at the Hull and East Yorkshire hospitals NHS Trust, a retrospective audit of patient records was carried out to provide baseline data on PN use at the Queen’s centre for Oncology and Haematology (QCOH), from the date the centre opened up until the launch date of the nutrition team (August 2008-November 2011). The indication for PN, clinical diagnosis, weight (kg), height (m), body mass index (kg/m2), access route for PN, duration of PN (days) and level of refeeding syndrome (RFS) risk (2) were recorded. Data from all the 32 patients (16 female, 16 male) prescribed PN during this period was included in the audit. Weights ranged from 41-101 kg (n¼31), mean 67.4 kg. Height 1.54-1.93 m, (n¼29) mean 1.67m. Weight loss ranged from 0-26% (n¼22) mean 12%. Body mass index (kg/m2) ranged from 15-42 kg/m2 (n¼29), mean 24 kg/m2. PN was prescribed to patients with a diagnosis of oesophageal/gastro-oesophageal junction cancer 22% (n¼7), lymphoma 19% (n¼6), bowel cancer 16 % (n¼5), pancreatic cancer 13 % (n¼4), gynaecological cancer 9% (n¼3), head and neck cancer 9% (n¼3), lung cancer 3% (n¼1) and breast cancer 3% (n¼1). PN was indicated in 44% of patients (n¼14) due to an obstruction of the gastrointestinal tract, 19% (n ¼6) due to failed enteral feeding, 13 % (n¼4) due to mucositis, 9%, (n¼3) due to ileus, 9% (n¼3) due to gastrointestinal perforation, 3% (n¼1) due to a failed oesophageal stent and 3% (n¼1) due to a grade 4 Cetuximab skin rash to the face (3). PN was administered centrally to 86% (n¼28) of patients via a femoral, Hickman, PICC or central line to and to 14% (n¼4) via a peripheral cannula. The duration of PN administration ranged from 3-60 days (n¼30), mean 14 days. The Dietitian documented 81% of patients (n¼23) to be at a high risk of RFS 63% (n¼32). In conclusion, PN has been administered appropriately and with authentic indication at the QCOH. An obstruction of the gastrointestinal tract and failed enteral feeding were the main indications for PN most frequently to patients with oesophageal cancer, lymphoma and bowel cancer in tertiary oncology centre. 1. A Mixed Bag: An enquiry into the care of hospital patients receiving parenteral nutrition. A report by the National Confidential Enquiry into Patient Outcome and Death. 2010. Available from: http://www.ncepod.org. uk/2010pn.htm 2. Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition [Internet]. National Collaborating Centre for Acute Care (UK). 2006. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/21309138 3. Common terminology criteria for adverse events v3. 0 (CTCAE) [Internet]. Cancer Therapy Evaluation Program. National Cancer Institute Bethesda, Md; 2006. Available from: http://scholar.google.com/scholar? cluster¼14562828772555817497&hl¼en&as_sdt¼0,22. Last accessed 27/ 4/13 14.00pm OC38. AN AUDIT TO ESTABLISH THE INCIDENCE OF MALNUTRITION IN AN ACUTE HOSPITAL M. Patel, E. Korc, J. Pietkiewicz, S. Chow, R. Youngman, L. Hyam, J. Moore, K.Stewart, M. Taylor, S. McKay. Nutrition and Dietetic Department, The North Middlesex University Hospital NHS Trust, Sterling Way, Enfield, London, N18 1QX, UK Increasing numbers of patients with malnutrition are admitted and discharged from hospitals (2). The Malnutrition Universal Screening Tool (MUST) is the recommended screening tool for malnutrition in the United Kingdom (UK) (1). There are reported inconsistencies in use of the MUST (2). The aim of this audit was to establish the nutritional status of inpatients and the use of MUST. All inpatients were assessed. The BMI and MUST completed by nursing staff within 24 hours of admission were recorded. The accuracy was reassessed by dietitians, to measure the incidence of malnutrition. The need for dietetic input and the rate of referrals were examined. A comparison was made of the overall results between previous and present MUST audits.