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Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results)
Dominique Glatt1, Caoimhe Hughes1, Orlaith McCarthy1
1Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, EH21 6UU, UK.
Insights
This audit assessed nutritional practices in pediatric cancer care, revealing gaps in anthropometry, screening, and biochemistry. Improvements are needed to optimize patient outcomes and nutritional support.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Healthcare Auditing
Background:
- The Royal Hospital for Sick Children (RHSC) in Edinburgh established specific nutritional standards for pediatric cancer patients.
- A clinical audit was initiated to evaluate current nutritional practices against these developed standards.
Purpose of the Study:
- To audit anthropometry, nutritional biochemistry, and malnutrition screening practices in pediatric cancer patients.
- To identify areas for improvement in nutritional practices and enhance nutrition-related clinical outcomes.
Main Methods:
- A clinical audit was conducted over 20 weeks between 2015 and 2017 at RHSC.
- Data from 185 pediatric cancer patient records (inpatient, day-care, outpatient) were analyzed.
- Practices were assessed for anthropometry, malnutrition screening, and nutritional biochemistry, with results stratified by adherence to standards.
Main Results:
- Significant deviations from standards were found, particularly in height/weight documentation, head circumference, arm anthropometry, and malnutrition screening.
- Initial and re-screening for malnutrition and assessment of vitamin D, A, E, B12, and parathyroid hormone levels showed deficiencies (<70% adherence).
- Specific deficits were noted across inpatient, day-care, and outpatient settings.
Conclusions:
- Baseline nutritional practices were established, highlighting key areas for improvement within the RHSC Pediatric Oncology and Haematology Department.
- The findings will inform the next steps of the audit to optimize patient care and nutritional support.
Background:
The department of Haematology and Oncology at the Royal Hospital for Sick Children (RHSC) in Edinburgh have developed their own nutritional standards specific to paediatric cancer. We aimed to audit the current nutritional practice in anthropometry, nutritional biochemistry and malnutrition screening for paediatric cancer patients against nutritional standards to identify areas for nutritional-practice improvement and progress nutrition-related clinical outcomes.
Methods:
A Clinical audit was conducted >20 weeks between 2015 and 2017 in three data collection locations (inpatient (IP), day-care (DC), or outpatient (OP)) at RHSC. We included patients aged 0-18 years and undergoing treatment for diagnosed malignant childhood cancer (ICCC-3 or Langerhans Cell Histiocytosis). Data were collected by analysing documentation and observing clinical practice for frequency and mode of administration of anthropometry, malnutrition screening, nutritional biochemistry and resulting documentation completion. Results were presented as descriptive statistics and stratified by percentage of standard met (100%, 99-70%, <70%).
Results:
185 audited patient records (22 IP, 54 DC and 109 OP) were analysed. The areas which were <70% of the standard were: height and weight documentation for DC; head-circumference for IP; arm anthropometry assessment for all locations; initial PYMS screening and re-screening in IP; malnutrition screening in DC and OP; and initial assessment and re-assessment for serum vitamins D, A, E, B12 and parathyroid hormone levels.
Conclusion:
Baseline nutritional practice was successfully established, identifying areas for practice improvement in the RHSC Paediatric Oncology and Haematology Department; this will be implemented in the next step of the audit to optimise patient care.
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