Enhancing oncology care at Mercy Hospital Dunedin

FEATURE -  Industry Innovation Article - InterSystems

Mercy Hospital in Dunedin is screening 99 percent of oncology patients for malnutrition after implementing an online Malnutrition Screening Tool (MST) as part of its patient management system, InterSystems TrakCare. 

Speaking at Digital Health Week NZ 2024, clinical applications specialist and registered nurse Elena Gibaviciene told attendees this evidence-based initiative addresses a crucial gap in malnutrition screening and management, improving patient outcomes by enabling timely nutritional support.

Seamless integration of the screening tool into TrakCare was a key factor in the project’s success.

Addressing malnutrition in cancer patients

Cancer treatments, such as chemotherapy and radiotherapy, often lead to significant weight loss and nutritional issues. 

Gibaviciene told the conference in December that even minimal weight loss during cancer treatment is associated with reduced survival. 

“Malnutrition is a pretty frequent problem for a cancer patient, which leads to prolonged hospitalisation, higher degree of treatment-related toxicity, and reduced response to cancer treatment,” she said. 

“Even minimal weight loss during chemotherapy or radiotherapy is associated with significantly reduced survival, so we really wanted to prevent that before it becomes a problem.”

Recognising these risks, Mercy Hospital decided to implement a standardised malnutrition screening process for all oncology patients, as recommended by global evidence-based guidelines.

Before the introduction of the MST, patient referrals to the dietitian were made on an “ad hoc basis”, which meant patients in need of nutritional support were not regularly identified, Gibaviciene explained.

Introduction of the MST has enabled early identification of at-risk patients and therefore timely interventions.

A collaborative approach 

The project was driven by a multidisciplinary team led by dietitian Angie Lucas alongside Mercy Cancer Care coordinator Edith Paulsen, and Mercy Cancer Care nurses. 

Using the Plan-Do-Study-Act (PDSA) model, the team designed and implemented the use of MST within TrakCare, Mercy Hospital’s existing patient management system from InterSystems. 

"We were able to easily implement our project because TrakCare already had customisable modules and a library of validated tools," said Gibaviciene.

“TrakCare supports the multidisciplinary team by integrating various resources within a single system. It facilitates clinical observations, nursing assessments, and allied health assessments throughout a patient's hospital stay and discharge into the community.”

The MST works by guiding nurses through a brief questionnaire with patients. Based on the responses, the tool calculates a malnutrition risk score and triggers an automated email to the dietitian if needed. 

Nurses were initially concerned about the potential increase in workload, however, their feedback post-implementation was overwhelmingly positive.

"The response was, ‘wow, I do not really spend any time on it. It is just a few questions and a few tick boxes’," Gibaviciene told the Digital Health Week audience.

Improved outcomes

The MST is integrated with TrakCare’s clinical decision support tools. 

"The system highlights whether screening has been done and what the risk score is, making it easy for practitioners to take action,” she explained.

High-risk patients, such as those with head and neck cancer or undergoing major surgery, are flagged with a High Nutritional Risk Alert upon admission. This ensures immediate notification to the dietitian, who can then assess the patient and develop a personalised nutritional care plan.

Within six months of implementation, 99 percent of oncology patients were screened, with 30 percent identified as being at high nutritional risk. Referrals to dietitians doubled, and interventions improved patient outcomes. 

Gibaviciene said that after the dietitian assesses the patient, they create a dietary assessment and plan within TrakCare so all relevant information is accessible to treating clinicians and nurses for ongoing and future patient care.

She described a case where a patient with significant weight loss was referred to the dietitian within minutes of admission for treatment. 

With nutritional support, the patient’s weight stabilised and then improved before their procedure, leading to a successful outcome and a happy patient, she said.

A quality project

Gibaviciene said that while nurses had been concerned about an increased workload, the tool’s simplicity and efficiency meant any fears were quickly put to rest, adding that the team’s proactive approach to training and communication ensured smooth adoption across all departments.

The implementation of the MST at Mercy Hospital highlights how evidence-based practice, supported by technology, can transform patient care. 

The project gained both the Excellence Award and the Supreme Award for Best Quality Project in 2024 at a celebrated every year at Mercy Hospital Dunedin.

Image: MST project team winning an award at Mercy Hospital’s Quality Improvement Award Ceremony – Edith Paulsen, Angie Lucas, Elena Gibaviciene, and Chris Jackson (left to right)

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