For several decades, providers have routinely restricted the diets of neutropenic cancer patients by eliminating foods that might harbor pathogenic microbes to reduce infection rates. These diets, known as neutropenic or low-bacteria diets, are prescribed across the country with little uniformity in the extent or content of prescription. These diets are difficult to follow and force patients to omit fresh fruits and vegetables and limit dairy and meat products from their diet. These dietary omissions compromise nutritional intake in patients who are already at high risk of malnutrition. Randomized trials have shown that these restrictive diets are not superior in preventing infections than more liberalized diets. Evidence shows that adherence to the Safe Food-Handling guidelines issued by the Food and Drug Administration, a mandate for all hospital kitchens, provides adequate protection against food-borne infection, precluding the need for the neutropenic diet. Thus, routine use of the neutropenic diet should be abandoned.

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143 Background: Patients with GI malignancies suffer from weight loss, sarcopenia and malnutrition contributing to poor outcomes and reduced survival. Early nutritional intervention in at-risk patients by a clinical dietitian can prevent or delay the onset of malnutrition. In the GI Oncology clinic at the UTSW SCCC, the rate of documented nutritional plan by a clinical dietitian within first 90 days of new patient encounter was low. Methods: We aimed to increase the rate of a documented nutrition assessment by a clinical dietitian to 65% within 90 days of a new patient encounter. Baseline data from the electronic medical record were obtained from Sep 2017-Oct 2018. Group sessions were arranged to apply QI methodologies to determine steps to a documented nutritional plan by a clinical dietitian. Patient advocates were interviewed to assess patient perspective. Sequential PDSA cycles were planned to improve rates of nutritional plan documentation and data were obtained every 2 weeks. Results: At baseline, 41.1% of new patients in the two-month data collection period had documented nutrition plans within 90 days of their first appointment. Most of these patients were on intravenous chemotherapy. EMR-based nutrition assessments identified 17% of all new patients at risk of malnutrition. Multiple causes for low baseline rates of nutrition plans were discovered, including patient or family characteristics and needs, clinical dietitian resources, physician limitations, process flaws, as well as difficulty with the EMR. Patient-centered PDSA cycles directed toward patients, and clinical staff to increase the rate of documented nutritional plan are ongoing. After the first PDSA cycle, early 2-week assessment shows documented rate of nutritional plan of 28%. Authors expect it to increase with longer follow-up and subsequent PDSA cycles. Conclusions: Malnutrition in GI cancer is prevalent and under-recognized in routine clinical encounters. Addressing malnutrition is important aspect from patient perspective. We are continuing ongoing efforts to increase the rate of nutritional assessments in these patients.