Hardwiring a malnutrition screening tool (MST) into oncology clinical practice involves maintaining an ongoing collaboration with registered dietician colleagues to establish metrics, define the role of each member of the care team, and create reminders and alerts to guide consistency in practice. These findings were presented at the 47th Annual Oncology Nursing Society (ONS) Congress.

Malnutrition is associated with negative outcomes in patients with cancer, including lower tolerance of treatments, delayed wound healing, increased morbidity and mortality rates, and decreased quality of life. Early and ongoing nutritional risk screening is critical to improve clinical and psychosocial outcomes for patients.

The MST is a simple, validated tool for screening patients for risk of malnutrition. MST is applicable to patients in both inpatient and outpatient settings. It consists of 2 questions: Have you lost weight without trying? Have you been eating poorly because of a decreased appetite?

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The pandemic brought dramatic changes to patient care. Face-to-face visits became telehealth sessions, creating new challenges for clinical workflows. Nurses were faced with competing priorities that introduced gaps between MST documentation compliance and the percentage of patients with a nutrition referral on file.

“A lack of traction in this essential area over the past year highlights the importance of continuous improvement through staff-led and leadership-supported interventions,” wrote Angel Barajas, RN, BSN, MSN, and colleagues at UC San Diego Health Cancer Services.

The need to schedule and track COVID-19 testing for patients undergoing cancer treatment was a time drain. “Appointment fatigue” made patients reluctant to schedule additional appointments with an oncology dietician. Staff changes also interfered, with float and new staff not aware of the importance of MST. Lastly, nurses and other staff were experiencing feelings of emotional exhaustion from keeping up with the rapid and ongoing pandemic-related changes.

The team organized focus groups and rounding to identify the barriers that were impeding consistent completion of the MST and referral process, seeking resolutions that would focus on “keeping it real.”

Tools created to address barriers included automating the referral process based on the patient’s MST score, developing quick reference tools for float staff, and improving the staff onboarding process. They also identified disease team champions, who could share their tips and tricks with other staff members.

A competent MST practice takes ongoing collaboration with other specialists to establish metrics, create role-specific reminder cards, and nurse-specific MST best practice alerts for qualifying patients.

Read more of Oncology Nurse Advisor‘s coverage of the 47th Annual ONS Congress by visiting the conference page.


Bradford V, Barajas A. Malnutrition screening tool implementation — hardwiring practice during a pandemic. Oral presentation at: 47th ONS Congress; April 27-May 1, 2022; Anaheim, California.