Authors (including presenting author) :
Chan WHA(1), Lau YM(2), Wong WS(2), Ng TS(2), Chan HL(2), Wong YY(2), Chan SHB(2), Tong CTL(2), Tsui KW(2), Lo WKS(1)
Affiliation :
(1) Dietetic Department, Alice Ho Miu Ling Nethersole Hospital, (2) Department of Paediatrics & Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital
Introduction :
Malnutrition in paediatric patient is associated with poor clinical outcomes and increased healthcare costs. Early detection of malnutrition risk in children is essential and supported by international guidelines. A nutrition screening tool for clinical use has to be simple, quick and well accepted by nurses. Therefore, the Australian developed and validated ‘Paediatric Nutrition Screening Tool’ (PNST) has been selected to pilot, under multidisciplinary collaboration, in one of AHNH P&AM wards during 8-9/2018.
Objectives :
1) To pilot the adaptation of PNST for nutrition screening. 2) To evaluate the inter-rater reliability of PNST. 3) To collect nurses’ feedback about the screening procedure.
Methodology :
PNST consists of four questions: “presence of weight loss”, “poor weight gain”, “poor oral intake”, and “being obviously underweight”, patients are considered at malnutrition risk with any two affirmative responses. To enhance sensitivity of screening, a second level screening has been added to screen for a single affirmative response to “being obviously underweight”. All patients (n=72) on admission were screened by nurses, of which 50 patients randomly selected for inter-rater reliability assessment. At the end of pilot, nurses’ feedbacks were collected.
Result & Outcome :
There were 12.5% (n=9, 5 males with age 1.7-4.4 years old; 4 females with age 1-17.2 years old) patients (8% by PNST, 4.5% by second level screening) identified at malnutrition risk. Patients at risk were provided with necessary nursing interventions and referral to dietitian based on doctor’s decision. The inter-rater reliability of PNST was in good agreement (kappa = 0.85). Twenty out of twenty-two participating nurses returned the questionnaires. The mean time to complete screening was 3.5 minutes. On a scale of 1-5 (highest score refers to strongly agree), nurses rated the screening process as simple (mean score=4), quick (mean score=4.2), and useful for malnutrition risk detection (mean score=4.2). Conclusions: There were 12.5% patients identified at malnutrition risk during the pilot period. PNST is a reliable tool with good inter-rater agreement for use by nurses. It took about 3.5 minutes to complete the screening, which was considered by nurses as simple, quick and useful for malnutrition risk detection. Nutrition screening aims to detect malnutrition risk promptly. Further studies are warranted to examine the prediction validity of the nutrition screening process and its impact on patients’ clinical outcome.
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