Nutritional Screening in Ambulatory Oncology: A Quality Improvement Project

Author(s) Information

Amy PasmannFollow

Nature and scope of the project

This quality improvement project aims to implement the evidence-based practice of a validated nutrition screening tool in an ambulatory oncology setting to identify cancer patients at risk for malnutrition and subsequent supportive interventions based on the patient's nutritional risk score.

Synthesis and analysis of supporting literature

Malnutrition affects cancer treatment tolerability, hospital length of stay, and overall mortality. 60-80% of cancer patients experience disease-related malnutrition, and approximately 10-20% of cancer patients die secondary to malnutrition issues versus cancer itself. Cancer patients are at risk for malnutrition, and frequent nutritional screening mitigates that risk and improves patient outcomes. Resources such as Registered Dietician Nutritionists (RDN), found within acute medical centers, are lacking in the ambulatory community environment. Nursing and dietary literature support a multi-disciplinary approach to validated nutritional screening methods in ambulatory oncology.

Project implementation

The Ottawa Model for Research Use and Pettigrew and Whipp's Model of Strategic Management and Change are the theoretical models used to identify barriers, early adopters, and steps in the change process. The chosen pilot location is a community oncology center, one of 12 within the organization. Nursing staff will screen all cancer patients who receive active chemotherapy or immunotherapy infusion treatments using a validated tool for ambulatory cancer patients, the Malnutrition Screening Tool (MST). The implementation strategy includes completing a nurse education bundle, implementing a nutrition screening tool (MST), and reviewing the MST-generated risk score by Advanced Practice Registered Nurses for a planned intervention.

Evaluation criteria

Improve nurse knowledge: Change in staff nutritional knowledge comparing pre- and post-test score mean analysis.

Implement nutritional screening tool: Evaluate complete and accurate MSTs compared to the number of eligible patients per week.

Accurate identification of nutritional risk: Compare MST score to provider documentation.


Project outcomes are currently unknown. However, it is anticipated that implementation will demonstrate improved nurse knowledge of nutritional issues in oncology patients and > 90% of eligible patients are screened with interventions identified to mitigate the risk of malnutrition.


Project recommendations are also unknown; however, it is anticipated that the project bundle will demonstrate the ability to mitigate the risk of malnutrition through frequent patient nutrition screening.



Nutritional Screening in Ambulatory Oncology: A Quality Improvement Project