PROGRAM RESEARCH EXCHANGE Thurs, May 28, 2020 2:00 4:00PM LAND - - PowerPoint PPT Presentation

UBC DIETETICS PROGRAM RESEARCH EXCHANGE

Thurs, May 28, 2020

2:00 – 4:00PM

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LAND ACKNOWLEDGEMENT

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HOST/MODERATOR

Heather Vass, RD, CDE

• Dietetics Education Coordinator

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MODERATOR

Tamara Cohen, PhD, RD

• Director of Dietetics, Assistant

Professor

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MODERATOR

Ali Browes, RD, MHA

• Dietetics Education Coordinator

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SCHEDULE

2:00 pm Welcome & Opening Remarks 2:10 pm Group A: Student 3-Minute Presentations 2:40 pm Group A: Moderated Panel Discussion 3:00 pm Break 3:10 pm Group B: Student 3-Minute Presentations 3:35 pm Group B: Moderated Panel Discussion 3:55 pm Wrap Up & Concluding Remarks

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HOUSEKEEPING

• Questions: www.slido.com code 73426
• Group name: Research nickname, question
• E.g. FH2: Plate Waste, question

www.slido.com 73426 FH2: “Plate Waste”

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MORGAN MEDAL ACKNOWLEDGEMENT

Ilan Wright, RD

• Impact of the Malnutrition Screening Tool
• n Dietitian caseload at Nanaimo General

Hospital.

www.slido.com 73426

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GROUP A STUDENT 3-MINUTE PRESENTATIONS

Group Research Topic Nickname (use when directing questions to group) PHC1 A description of food service related errors reported using the Patient Safety and Learning System (PSLS) from Providence and Vancouver Coastal Health sites between September 2017 to September 2019 “PSLS” FH2 Comparison of inter-rater agreement when performing visual plate waste audits with standardized instructions vs. without standardized instructions “Plate Waste” VCH2 Workup of delirium on hospitalist medicine units at Vancouver General Hospital: How frequently are we investigating and treating vitamin B12 or thiamine deficiency as a potential cause? “Delirium” NH A retrospective chart review to assess the sustainability of the impact of the Robson Valley Lifestyle in Vanderhoof, British Columbia “RVL” PHC2 Assessing the nutritional adequacy of multi-chamber parenteral nutrition solutions to meet macronutrient and fluid needs of adult patients on the BC Home Parenteral Nutrition (HPN) program “HPN” Island Health A retrospective chart review at Nanaimo Regional General Hospital comparing implementation of the Canadian Nutrition Screening Tool (CNST) to the previously used Malnutrition Screening Tool (MST): Influence on malnutrition screening frequency, subsequent dietitian referrals, and dietitian involvement in patient care “Malnutrition”

www.slido.com 73426

PHC1: “PSLS”

A DESCRIPTION OF FOOD SERVICE RELATED ERRORS REPORTED USING THE PATIENT SAFETY AND LEARNING SYSTEM (PSLS) FROM PROVIDENCE AND VANCOUVER COASTAL HEALTH SITES BETWEEN SEPTEMBER 2017 TO SEPTEMBER 2019

Katie Bartel

• Providence Health Care
• PHC1:“PSLS”

www.slido.com 73426

Food Service: A Matter of Patient Safety

Providence Health Care, May 28, 2020

PHC1: “PSLS”

INTER-RATER AGREEMENT OF VISUAL PLATE WASTE AUDITS WITH INSTRUCTIONS

• VS. WITHOUT INSTRUCTIONS

Melanie Newman

• Fraser Health
• FH2:“Plate Waste”

FH2: “Plate Waste” www.slido.com 73426

Inter-rater agreement of visual plate waste audits with instructions vs. without instructions

May 28, 2020

Comparison of Agreement on Amount of Food Remaining (ICC) Comparison of Agreement on Presence of Food Item (Kappa)

Without Instructions (2019 Data) With Instructions

Beef and Macaroni 0.95 (95% CI = 0.93-0.97) 0.98 (95% CI = 0.97-0.98) Soup 0.87 (95% CI = 0.81-0.91) 0.99 (95% CI = 0.98-0.99)

Without Instructions (2019 Data) With Instructions

Beef and Macaroni 0.76 0.83 Soup 0.58 0.91

Excellent reliability (>0.90) Good reliability (0.75-0.90) Almost perfect agreement (0.90) Strong agreement (0.80--0.90) Moderate agreement (0.60-0.79) Weak agreement (0.40--0.59)

FH2: “Plate Waste”

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VCH2: “delirium”

WORKUP OF DELIRIUM ON HOSPITALIST MEDICINE UNITS AT VANCOUVER GENERAL HOSPITAL: HOW FREQUENTLY ARE WE INVESTIGATING AND TREATING VITAMIN B12 OR THIAMINE DEFICIENCY AS A POTENTIAL CAUSE?

Caroline Kaufman

• Vancouver Coastal Health
• VCH2:“Delirium”

www.slido.com 73426

VCH2: “delirium”

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NH: “RVL”

A RETROSPECTIVE CHART REVIEW TO ASSESS THE SUSTAINABILITY OF THE IMPACT OF THE ROBSON VALLEY LIFESTYLE IN VANDERHOOF, BRITISH COLUMBIA

Marianne Thomas

• Northern Health
• NH:“RVL”

www.slido.com 73426

120 125 130 135 Pre Post Present

Systolic Blood Pressure (mmHg)

5 5.2 5.4 5.6 5.8 6 Pre Post Present

Fasting Glucose (mmol/L)

90 95 100 105 110 115 Pre Post Present

Weight (kg)

74 76 78 80 82 84 Pre Post Present

Diastolic Blood Pressure (mmHg)

Robson Valley Lifestyle Diet: Impacts Over Time

May 28th, 2020

Pre – January 1st 2013 to December 31st 2014 Post – January 1st 2013 to December 31st 2014 Present – December 1st 2018 to December 2nd 2019 * Statistical Significance

* * * * * * * *

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NH: “RVL”

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PHC2: “HPN”

ASSESSING THE NUTRITIONAL ADEQUACY OF MULTI-CHAMBER PARENTERAL NUTRITION SOLUTIONS TO MEET MACRONUTRIENT AND FLUID NEEDS OF ADULT PATIENTS ON THE BC HOME PARENTERAL NUTRITION (HPN) PROGRAM

Victoria Janzen

• Providence Health Care
• PHC2:“HPN”

www.slido.com 73426

Count and proportions of prescriptions meeting calories or macronutrients by multi-chamber solution (n=40)

PROVIDENCE HEALTH CARE MAY 28, 2020

CENTRAL 1.0 CENTRAL 1.5 CENTRAL 2.0 PERIPHERAL 1.2 PERIPHERAL 1.9 Meets macronutrients

3% (1)

Meets macronutrients and fluid Meets calories

25% (10) 20% (8) 23% (9) 8% (3) 28% (11)

Meets calories and fluid

3% (1) 3% (1) 3% (1)

Fluid ranges*

• 2.2L to 0.5L
• 2.2L to
• 0.3L
• 1.4L to

0.4L

• 1.5L to
• 0.2L
• 1.3L to 0.5L

Total number exceeding ESPEN guidelines for lipids

5% (2) 50% (20) 88% (35) 3%(1) 48%(19)

*Fluid ranges for prescriptions that meet macronutrient or calories

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PHC2: “HPN”

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Island Health: “Malnutrition”

A RETROSPECTIVE CHART REVIEW AT NANAIMO REGIONAL GENERAL HOSPITAL COMPARING IMPLEMENTATION OF THE CANADIAN NUTRITION SCREENING TOOL (CNST) TO THE PREVIOUSLY USED MALNUTRITION SCREENING TOOL (MST): INFLUENCE ON MALNUTRITION SCREENING FREQUENCY, SUBSEQUENT DIETITIAN REFERRALS, AND DIETITIAN INVOLVEMENT IN PATIENT CARE

Alison Quinlan

• Island Health
• Island Health:“Malnutrition”

www.slido.com 73426

Canadian Nutrition Screening Tool (CNST) vs. Malnutrition Screening Tool (MST):

Influence on malnutrition screening frequency, subsequent dietitian referrals, and dietitian involvement in patient care

May 28, 2020 SGA C SGA B SGA A NUTRITIONAL RISK, RD CONSULT & INVOLVEMENT 81.5% (n=75/92) 39.2% (n=11/28) NUTRITIONAL RISK & RD CONSULT 94.6% (n=87/92) 50.0% (n=14/28) "AT NUTRITIONAL RISK" IDENTIFICATION 27.4% (n=92/336) 56.0% (n=28/50) COMPLETION RATES 62.2% (n=336/540) 18.5% (n=50/270) SCREENING TOOLS

Canadian Nutrition Screening Tool Malnutrition Screening Tool

Island Health: “Malnutrition”

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GROUP A PANEL DISCUSSION

www.slido.com 73426

• Kate Stafford
• Vancouver Coastal Health
• “Delirium”
• Gladys Liu
• Fraser Health
• “Plate Waste”
• Bethany Del Begio
• Providence Health Care
• “PSLS”
• Yee Jin Low
• Northern Health
• “RVL”
• Iris Lopez
• Providence Health Care
• “HPN”
• Nikki Lenzen
• Island Health
• “Malnutrition”

BREAK

www.slido.com 73426

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GROUP B STUDENT 3-MINUTE PRESENTATIONS

Group Research Topic Nickname (use when directing questions to group) FH1 A descriptive retrospective review of Fraser Health acute care dietitians diagnosing and documenting malnutrition using Subjective Global Assessment “SGA” Interior Health Comparison of completion rates of the nutrition screening component of the 48/6 Admission History Form (AHF) at Royal Inland Hospital (RIH) and after the More-2-Eat research project at Kelowna General Hospital (KGH) “Screening” PHSA A description of the characteristics and nutrition-related outcomes of patients with head and neck cancers receiving feeding tubes at BC Cancer “Oncology” FH3 A description of adult patients admitted with an eating disorder to any Fraser Health Authority emergency department or acute care unit from January 1, 2008 to December 21, 2018 “ED” VCH1 Description of calorie and protein provision in enterally-fed, mechanically ventilated VGH ICU patients during the first 7 days of admission “ICU”

www.slido.com 73426

DIETITIANS DIAGNOSING AND DOCUMENTING MALNUTRITION USING SGA AT FRASER HEALTH AUTHORITY

FH1: “SGA”

Natasha Schwab

• Fraser Health
• FH1:“SGA”

www.slido.com 73426

Figure 1: Proportion of SGA completed and malnutrition diagnoses categorized by SGA score Figure 2: Most Frequently Documented NCPT Diagnosis for SGA B/C

DIETITIANS DIAGNOSING AND DOCUMENTING MALNUTRITION USING SGA AT FRASER HEALTH AUTHORITY

Initial Nutrition Assessment Reports (N=432)

Complete SGA 62.5% (n=270) Incomplete SGA 37.5% (n=162) Malnutrition Dx. 0% (n=0) Malnutrition Dx. 51.1% (n=96) SGA B or C 69.6% (n=188) SGA A 30.3% (n=82) Legend Fraser Health Authority 28-May-2020 SGA = Subjective Global Assessment NCPT = Nutrition Care Process Terminology

FH1: “SGA”

51% 22% 12% 5% 10% Malnutrition (n=96) Inadequate protein-energy intake (n=41) Underweight (n=23) Unintentional weight loss (n=10) Other (n=8)

COMPARISON OF COMPLETION RATES OF THE NUTRITION SCREENING COMPONENT OF THE 48/6 ADMISSION HISTORY FORM (AHF) AT ROYAL INLAND HOSPITAL (RIH) AND AFTER THE MORE-2-EAT RESEARCH PROJECT AT KELOWNA GENERAL HOSPITAL (KGH)

Mio Lainchbury

• Interior Health
• InteriorHealth:“Screening”

Interior Health: “Screening”

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www.slido.com 73426

Comparison of completion rates of the nutrition screening component of the 48/6 Admission History Form (AHF) at Royal Inland Hospital (RIH) and after the More-2-Eat research project at Kelowna General Hospital (KGH)

Interior Health Authority May 28 2020 Interior Health: “Screening”

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Adelia Jacobs

• Provincial Health Services Authority
• PHSA:“Oncology”

A DESCRIPTION OF THE CHARACTERISTICS AND NUTRITION-RELATED OUTCOMES OF PATIENTS WITH HEAD AND NECK CANCERS RECEIVING FEEDING TUBES AT BC CANCER

PHSA: “Oncology” www.slido.com 73426

A description of the characteristics and nutrition-related

• utcomes of

patients with head and neck cancers receiving feeding tubes at British Columbia (BC) Cancer

May 28th 2020

Treatment summary refers to the time immediately after a patient has completed their dual modality treatment. Post treatment refers to 4-6 weeks after dual modality treatment has completed.

10 20 30 40 50 60 <5 5 to 10 >10

% of Patients % Weight Loss

% Weight Loss

Treatment Summary Post Treatment

PHSA: “Oncology”

Raihan Hassen

• Fraser Health
• FH:“ED”

FH3: ”ED”

A DESCRIPTION OF ADULT PATIENTS ADMITTED WITH AN EATING DISORDER TO ANY FRASER HEALTH AUTHORITY EMERGENCY DEPARTMENT OR ACUTE CARE UNIT FROM JANUARY 1, 2008 TO DECEMBER 21, 2018

www.slido.com 73426

May 28, 2020

Fraser Health Eating Disorder Patients

58%

• f hospitalisations involved a

dietitian

89%

• f patients presented with a

psychiatric comorbidity

5 days

was the median length of stay

79%

• f readmissions were related

to the eating disorder

1 to 68

Eating disorder related readmissions per patient

FH3: “ED”

DESCRIPTION OF CALORIE AND PROTEIN PROVISION IN ENTERALLY-FED, MECHANICALLY VENTILATED VGH ICU PATIENTS DURING THE FIRST 7 DAYS OF ADMISSION

Nisha Takhar

• Vancouver Coastal Health
• “ICU”

VCH1: “ICU”

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www.slido.com 73426

May 28, 2020

Male: 28 (80%) Female: 7 (20%) Mean Age: 57yo Average LOS* ICU: 14 days Hospital: 39 days

*LOS = length of stay

⤉PRO = protein

VCH1: “ICU”

23 patients received ≥80% PRO⤉ needs (7-day average) 12 patients received <80% PRO⤉ needs (7-day average)

Number of patients who received 80% or more of caloric needs

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GROUP B PANEL DISCUSSION

• Mio Lainchbury
• Interior Health
• “Screening”

www.slido.com 73426

• Natalie Sousa
• Provincial Health Services Authority
• “Oncology”
• Emma Louie
• Fraser Health
• “SGA”
• Gloria Sun
• Vancouver Coastal

Health

• “ICU”
• Sarah Walters
• Fraser Health
• “ED”

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THANK YOU!