[2] Malnutrition: Role of the TwoCal® HN Med Pass Program

MedSurg Nursing, Dec, 2000 by Stacy Bender, Marlo Pusateri, Abby Cook, Maree Ferguson, Joyce C. Hall

Implementing the TwoCal[R] Med Pass program can assist facilities in complying with and documenting adherence of care standards and therefore prevent survey citations. Consumption of the MNS is documented by the nurses on the medication administration record (MAR), thereby demonstrating to state and federal surveyors that nutritional interventions were implemented. Second, weight gain may allow for some medications given to promote appetite to be discontinued. This is particularly helpful to facilities where there is concern about the HCFA quality indicator of "greater than 9 medications per resident."

Implementing the TwoCal[R] HN Med Pass program can save money in two ways. First, it reduces waste of snacks, nourishments, and MNS that are only partly consumed, refused, or ignored. Second, it eliminates staff time for preparing, labeling, and distributing between-meal snacks, nourishments, and MNS, encouraging residents to consume them, and disposing of leftovers. In addition, it adds little to the time that nursing staff spend on the medication pass.

The Med Pass program costs less than traditional nutritional interventions. Grover et al. (1998) found that on average, the Med Pass program costs $0.37 less than the mean cost of previous supplement delivery systems. Robinson (1997) found even larger cost savings with an average daily cost of $1.11 for the Med Pass program versus $2.04 for previous methods of delivery (a savings of $0.93/day).

Case Studies

The following two case studies report actual experiences of two facilities who have used the Med Pass program.

Case Study # 1

A LTC dietary manager describes marked changes for many residents on the Med Pass program (Ross Products Division, 1997). Before the 115-resident facility implemented the Med Pass program, 33% of residents had significant weight loss. In addition, 12 residents had pressure ulcers ranging from stage II to stage IV. The dietary department observed considerable waste of the modular products and milkshakes used as between-meal nourishments. The facility wanted to reverse these weight loss and pressure ulcer trends, yet reduce supplementation costs and save staff time. Hence, the TwoCal[R] HN Med Pass program was implemented.

One resident who had significant weight loss as a result of pneumonia had refused to eat regular food but took the TwoCal[R] HN offered in the Med Pass program. Another resident had lost 8 pounds when she suffered a fractured pelvis, but with the extra nutrition from the TwoCal[R] HN Med Pass program the weight loss was halted.

With the TwoCal[R] HN Med Pass program, 24 of 28 residents who had significant weight loss regained weight; the remainder stopped losing weight. All pressure ulcers healed, and no new ulcers developed, and long bone fractures healed more quickly. Giving TwoCal[R] HN during the medication pass rather than as a between-meal snack saved 1 hour a day that the dietary staff had to spend in labeling nourishments.

Case Study #2

Finding a medical nutritional supplement that residents would readily consume and streamlining the supplementation process were two goals that a registered dietitian had when she initiated a 90-day test of the TwoCal[R] HN Med Pass program at a LTC facility in Omaha, Nebraska (Ross Products Division, 1997).