Weight loss prevention strategies: what is your facility's score? preventing unintended weight loss in residents requires a multidisciplinary approach - Feature Article

Nursing Homes, June, 2003 by Annette M. Kobriger

Nursing. The dining room is where the responsibility for residents' nutrition shifts to nursing staff This is where the nutrition care plan is implemented. Feeding is generally designated as a nursing responsibility. In the past, only licensed professional staff were permitted to feed, and most feeding and assistance to residents was the responsibility of CNAs. However, this spring the Centers for Medicare and Medicaid Services approved the use of feeding assistants in the dining room.

A licensed nurse has typically been present in the dining room to pass medications, but he or she obviously cannot monitor the dining room at the same time. Often this means that there is no one to make sure the nutrition care plan is implemented in the dining room. This gap needs to be filled.

A licensed nurse in the dining room should ensure that:

1. Residents are participating in the walk-to-dine program.

2. Residents transfer from a wheelchair to a regular chair for dining.

3. Therapeutic diets and texture-altered foods and beverages are served correctly.

4. Residents are positioned properly and table height is correct.

5. Food is served properly and in the proper sequence.

6. Needed positioning aids and adaptive equipment are present.

7. Swallowing precautions are taken and that other special resident needs for dining are met.

8. Recording of food and fluid intake is accurate.

9. Residents are fed with dignity.

10. Substitutes are offered.

Physician (medical director). When residents experience a weight loss, the medical director must be notified, because lack of food intake and weight loss frequently are caused by a new or worsening disease process, and changes in residents' health status require the intervention of a physician. The medical director also participates in the development of facility protocols and is the most likely person to communicate with residents' attending physicians.

Residents at Risk

The teamwork of the professionals mentioned in this article also extends to assessing which residents are at risk for nutritional problems. A multidisciplinary "nutrition-at-risk" committee--typically consisting of the DON or assistant DON, dietary director, nursing representative(s) and skin-care nurses, administration, therapies, and social service representatives--usually meets weekly to discuss the nutritional needs of residents, between quarterly care conferences. The weekly meetings are needed because residents' status can change quickly with the development of a new illness, fever, deteriorated eating ability, or swallowing difficulties. These weekly meetings can be quite effective in preventing weight loss. After the committee's initial meetings, most facility staff say that these weekly meetings last only about 20 minutes--a small commitment of time for such a large potential benefit.

Residents who have been determined to be at nutritional risk must be tracked so they do not fall between the cracks. This tracking should be carried out at least monthly, to allow staff to stay up to speed as to whether current interventions are working.