Development of a Nutrition Care Pathway to Improve Service Provision for Patients with an Upper Gastrointestinal Malignancy (#321)
Introduction: Malnutrition is a significant problem for patients with an Upper Gastrointestinal (GI) malignancy. Patients for surgical management were only referred to the dietitian post operatively. Upper GI patients managed in Chemotherapy Day Unit (CDU) were not routinely referred to the Dietitian and a high prevalence of malnutrition had previously been reported by Marshall and Loeliger (1). The aim of this project was to implement best practice guidelines for nutrition support in patients with an Upper GI malignancy and bridge identified service gaps.
Method: Phase 1 of the project focused on pre and post operative identification and care of patients undergoing major resections, with patients identified via the Upper GI and Oncology meetings and screening in pre-admission clinic. A database of patients who received pre-operative immunonutrition was established. Phase 2 focused on identification of upper GI patients in CDU, in which a point prevalence study using Patient Generated Subjective Global Assessment (PG-SGA) Malnutrition Screening tool was repeated. Malnutrition prevalence results were then compared with unit data from 2012.
Results: In the 12 months from July 2012, 29 patients (94%) of surgical Upper GI patients received oral immunonutrition support. Enteral feeding tubes were inserted in 40% of patients.100% of patients were followed up within 2-4 weeks of discharge. In CDU 60% of malnourished upper GI patients were referred to the dietitian compared to 0% in 2012. There were no statistically significant differences in age, weight or BMI between groups.
Conclusion: This project has provided a model for nutrition service delivery in line with best practice guidelines to address the needs of this complex patient group across the continuum of their health care. A standardized approach to nutrition care for upper GI patients has been established with a nutrition service algorithm developed to facilitate its implementation.