A STANDARDISED ASSESSMENT PROCESS TO IMPROVE NUTRITIONAL ASSESSMENT AND MANAGEMENT IN HAEMODIALYSIS PATIENTS

J STOCKINGS 1

1Hunter New England Health, Charlestown, Australia

Background: The prevalence of malnutrition in patients receiving Haemodialysis is between 28-54%, and is strongly associated with mortality. The KDOQI Clinical Practice Guideline recommends the regular use of the 7-point Subjective Global Assessment (SGA) tool to assess nutritional status in patients with Chronic Kidney Disease. An audit of our clinical service demonstrated that an SGA was administered in only 25% of patients. This was documented in a digital medical record that was not accessed by the multi-disciplinary team. We also found that some patients were not being referred despite being malnourished on assessment.

Aim: To improve the identification and management of malnutrition in patients receiving haemodialysis

Methods: A standardised dietetic assessment form was developed and implemented. This form comprised of a 7 point SGA and other key components of nutritional assessment including medical and social history, medications, anthropometry, biochemistry,nutrition related symptoms and dietary intake. The form was completed and filed in the dialysis medical file.

Results: Eighteen months post implementation of the standardised form, 89% of patients had a 7 point SGA completed.  Subsequently, the prevalence of malnutrition in our patient cohort had decreased to 11% (from 15%). Referrals increased by 50% and patient review wait time reduced.  This result was likely due to routine assessment by Dietitians and an increase in awareness of the nutritional intervention and issues due to enhanced communication with the multidisciplinary team. .

Conclusion: The use of a standardised form was effective in improving the identification of malnutrition, reducing referral wait time and improving staff referrals to the dietetic service.

 


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