Weight Loss Prevention
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OPTION A: SUPERVISORS ESTIMATE INTAKE
Assign to the dining room a supervisory staff person, ideally a licensed nurse or dietician, to estimate food and fluid intake based on direct observations of residents' meal trays.
This need not be a daily assessment for all residents. Rather, it can be conducted as a part of a resident's periodic MDS assessment (about 10% to 15% of residents need MDS assessments each month) or as an initial assessment for all residents to identify those at risk for undernutrition and weight loss. At some point in their stay, all residents should undergo an oral intake assessment by a supervisory-level staff member. DO NOT rely on nurse aides' estimates of consumption because too often these are inaccurate (1).
The supervisor should:
- Use our Mealtime Observational Protocol to conduct assessments.
- Estimate the total percentage eaten during meals on two days (a total of six meals) within the same week for each resident.
Typically, supervisors can complete oral intake assessments for 6 to 8 residents during each mealtime period, assuming that the residents targeted for assessment are eating within the same area (all in the dining room or in their rooms on the same hallway).
Advantages:
The supervisor can collect additional information that may be useful in improving feeding assistance and, thus, preventing undernutrition and weight loss. He or she can assess how nurse aides and feeding assistants provide mealtime help and recommend changes if improvement is needed. Common problems include:
- umet needs for assistive devices, such as large-handled utensils and plate guards
- meal trays being cleared too soon (less than 20 minutes following delivery)
- oral nutritional supplements being given during meals as a substitute for feeding assistance
- televisions or radios played so loudly that they interfere with feeding assistance provision; they distract staff and prevent residents from hearing staff instructions to eat more.
The supervisor can also determine whether a resident's intake level is being affected by other mealtime occurrences, such as workers eating some of the food, residents' sharing food, or family members bringing in food. Additionally, mealtime observations give licensed nurses and dieticians the opportunity to identify residents with swallowing difficulties (e.g., coughing, drooling, spitting while eating) or symptoms of depression (e.g., crying, negative self-statements, refusal of food), both of which warrant referrals for further evaluation. Finally, the presence of a licensed nurse or dietician supervisor in the dining room can help counter any criticism the facility may receive if it chooses to employ single-task feeding assistants to help residents at mealtimes (3, 4).
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