Malnutrition Screening at Starship Child Health: A review of the use of the STRONGkids malnutrition screening tool and the barriers to implementation

Abstract

Paediatric malnutrition is a prevalent issue in developed countries and the identification of groups that are more susceptible to malnutrition allows close monitoring in the hospital setting to prevent further deterioration and adverse outcomes associated with malnutrition. The aim of this two part study was to evaluate the use of the STRONGkids malnutrition screening tool at Starship Child Health. Part one aimed to identify children that are more at risk of malnutrition using a crosssectional study that involved the analysis of malnutrition screening data. This was split into two phases: a 3- month pilot study and a 3-day audit. Part two aimed to identify the barriers and facilitators to use the STRONGkids tool using a qualitative study with nurses. The pilot study identified a significant relationship between malnutrition risk and the following factors: gender (p<0.017), age (p<0.002), length of stay (p<0.000), and clinical business unit (p<0.000). A significant relationship between ethnicity was not identified. The audit study identified a significant relationship between malnutrition risk and the following factors: length of stay (p=<0.035) and clinical business unit (p<0.002), however, a significant relationship between ethnicity, gender, and age was not identified. The main barriers preventing nurses to use the STRONGkids tool on admission were busyness, lack of time, and not being a priority. However, insufficient knowledge was observed to be the predominant barrier and reason Starship nurses screening rates were low. The findings from the malnutrition screening audit suggest that patients with the following factors should be closely monitored at Starship Child Health: being of the female gender, an age between 11-18 years old, an increased length of stay, and having renal, gastrointestinal, respiratory, cardiology, or haematology/oncology conditions. The implementation of additional training and education, and the establishment of an organisational structure around nutrition and the malnutrition screening tool is required to resolve knowledge gaps and motivate nurses to use the tool. This aims to improve nurses’ screening rates, allow the early identification of malnutrition, and thus the timely implementation of preventative measures to impede the adverse effects of malnutrition at Starship Child Health.