UBC DIETETICS PROGRAM RESEARCH EXCHANGE Thurs, May 28, 2020 2:00 – 4:00PM
LAND ACKNOWLEDGEMENT 2
HOST/MODERATOR Heather Vass, RD, CDE • Dietetics Education Coordinator 3
MODERATOR Tamara Cohen, PhD, RD • Director of Dietetics, Assistant Professor 4
MODERATOR Ali Browes, RD, MHA • Dietetics Education Coordinator 5
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 6
FH2: “Plate Waste” HOUSEKEEPING • Questions: www.slido.com code 73426 • Group name: Research nickname, question • E.g. FH2: Plate Waste, question www.slido.com 73426 7
MORGAN MEDAL ACKNOWLEDGEMENT Ilan Wright, RD • Impact of the Malnutrition Screening Tool on Dietitian caseload at Nanaimo General Hospital . 8 www.slido.com 73426
www.slido.com 73426 GROUP A STUDENT 3-MINUTE PRESENTATIONS Group Research Topic Nickname (use when directing questions to group) “PSLS” 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 “Plate Waste” FH2 Comparison of inter-rater agreement when performing visual plate waste audits with standardized instructions vs. without standardized instructions “Delirium” 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? “RVL” NH A retrospective chart review to assess the sustainability of the impact of the Robson Valley Lifestyle in Vanderhoof, British Columbia “HPN” 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 “Malnutrition” 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 9
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
PHC1: “PSLS” Food Service: A Matter of Patient Safety Providence Health Care, May 28, 2020
FH2: “Plate Waste” INTER-RATER AGREEMENT OF VISUAL PLATE WASTE AUDITS WITH INSTRUCTIONS VS. WITHOUT INSTRUCTIONS Melanie Newman • Fraser Health • FH2:“Plate Waste” www.slido.com 73426
Inter-rater agreement of visual plate waste audits with instructions vs. without instructions FH2: “Plate Waste” Comparison of Agreement on Amount of Food Remaining (ICC) Without Instructions With Instructions (2019 Data) Excellent reliability (>0.90) Beef and Macaroni 0.95 (95% CI = 0.93-0.97) 0.98 (95% CI = 0.97-0.98) Good reliability (0.75-0.90) Soup 0.87 (95% CI = 0.81-0.91) 0.99 (95% CI = 0.98-0.99) Comparison of Agreement on Presence of Food Item (Kappa) Almost perfect agreement (0.90) Strong agreement (0.80--0.90) Without Instructions With Instructions (2019 Data) Moderate agreement (0.60-0.79) Beef and Macaroni 0.76 0.83 Weak agreement (0.40--0.59) Soup 0.58 0.91 May 28, 2020
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 14
VCH2: “delirium”
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 16
NH: “RVL” Robson Valley Lifestyle Diet: Impacts Over Time Systolic Blood Pressure (mmHg) Diastolic Blood Pressure (mmHg) 135 84 82 130 * 80 * 125 * 78 * 76 120 Pre Post Present 74 Pre Post Present Fasting Glucose (mmol/L) Weight (kg) 6 115 * 110 5.8 105 5.6 * * * 100 5.4 95 5.2 90 5 Pre Post Present Pre Post Present Pre – January 1 st 2013 to December 31 st 2014 Post – January 1 st 2013 to December 31 st 2014 May 28th, 2020 Present – December 1 st 2018 to December 2 nd 2019 17 * Statistical Significance
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” 18 www.slido.com 73426
PHC2: “HPN” Count and proportions of prescriptions meeting calories or macronutrients by multi-chamber solution (n=40) CENTRAL CENTRAL CENTRAL PERIPHERAL PERIPHERAL 1.0 1.5 2.0 1.2 1.9 3% (1) 0 0 0 0 Meets macronutrients 0 0 0 0 0 Meets macronutrients and fluid Meets calories 25% (10) 20% (8) 23% (9) 8% (3) 28% (11) 0 3% (1) 0 3% (1) 3% (1) Meets calories and fluid -1.5L to -2.2L to -1.4L to -2.2L to 0.5L -1.3L to 0.5L Fluid ranges* -0.3L 0.4L -0.2L Total number exceeding ESPEN 5% (2) 50% (20) 88% (35) 3%(1) 48%(19) guidelines for lipids *Fluid ranges for prescriptions that meet macronutrient or calories PROVIDENCE HEALTH CARE 19 MAY 28, 2020
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” 20 www.slido.com 73426
Island Health: “Malnutrition” Canadian Nutrition Screening SCREENING TOOLS Tool (CNST) vs. Malnutrition Canadian Nutrition Screening Tool Malnutrition Screening Tool Screening Tool (MST): Influence on malnutrition screening COMPLETION RATES frequency, subsequent dietitian 62.2% (n=336/540) 18.5% (n=50/270) referrals, and dietitian involvement in patient care "AT NUTRITIONAL RISK" IDENTIFICATION 27.4% (n=92/336) 56.0% (n=28/50) SGA C SGA A NUTRITIONAL RISK & RD CONSULT 94.6% (n=87/92) 50.0% (n=14/28) SGA B NUTRITIONAL RISK, RD CONSULT & INVOLVEMENT 81.5% (n=75/92) 39.2% (n=11/28) May 28, 2020
www.slido.com 73426 GROUP A PANEL DISCUSSION • Iris Lopez • Kate Stafford • Bethany Del Begio • Providence Health Care • Vancouver Coastal Health • Providence Health Care • “HPN” • “Delirium” • “PSLS” • Nikki Lenzen • • Gladys Liu Yee Jin Low • Island Health • • 22 Fraser Health Northern Health • “Malnutrition” • “Plate Waste” • “RVL”
www.slido.com 73426 BREAK
GROUP B STUDENT 3-MINUTE PRESENTATIONS Group Research Topic Nickname (use when directing questions to group) “SGA” FH1 A descriptive retrospective review of Fraser Health acute care dietitians diagnosing and documenting malnutrition using Subjective Global Assessment “Screening” Interior Comparison of completion rates of the nutrition screening component of the 48/6 Admission Health History Form (AHF) at Royal Inland Hospital (RIH) and after the More-2-Eat research project at Kelowna General Hospital (KGH) “Oncology” PHSA A description of the characteristics and nutrition-related outcomes of patients with head and neck cancers receiving feeding tubes at BC Cancer “ED” 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 “ICU” VCH1 Description of calorie and protein provision in enterally-fed, mechanically ventilated VGH ICU patients during the first 7 days of admission www.slido.com 73426 24
FH1: “SGA” DIETITIANS DIAGNOSING AND DOCUMENTING MALNUTRITION USING SGA AT FRASER HEALTH AUTHORITY Natasha Schwab • Fraser Health • FH1:“SGA” www.slido.com 73426
FH1: “SGA” DIETITIANS DIAGNOSING AND DOCUMENTING MALNUTRITION USING SGA AT FRASER HEALTH AUTHORITY Figure 2: Most Frequently Documented Figure 1: Proportion of SGA completed and NCPT Diagnosis for SGA B/C malnutrition diagnoses categorized by SGA score 10% Initial Nutrition Assessment Reports (N=432) 5% 12% 51% Incomplete SGA Complete SGA 37.5% (n=162) 62.5% (n=270) 22% SGA A SGA B or C 30.3% (n=82) 69.6% (n=188) Legend Malnutrition (n=96) Malnutrition Dx. Malnutrition Dx. Inadequate protein-energy intake (n=41) 0% (n=0) 51.1% (n=96) Underweight (n=23) Unintentional weight loss (n=10) Other (n=8) Fraser Health Authority SGA = Subjective Global Assessment 28-May-2020 NCPT = Nutrition Care Process Terminology
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