Weight Loss Prevention
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MEALTIME QUALITY CONTROL MONITORING: PURPOSE AND PROCEDURES
The purpose of mealtime quality control monitoring is twofold:
- To determine whether staff are providing consistent feeding assistance; that is, on all days of the week, for all meals; and
- To assess the quality of feeding assistance for targeted residents
The most reliable way to monitor nursing home care--feeding assistance as well as all other types of care--is to directly observe how the care is provided. This method contrasts with the usual assessment method of using data from medical records and the Minimum Data Set (MDS) to evaluate care. A common problem with both medical record and MDS documentation, say researchers, is that the information is often tainted with inaccuracies (1, 2); in other words, you can't trust it.
A supervisory-level staff person should be assigned to conduct quality control observations during mealtimes. Before you balk at this seemingly expensive requirement, read on:
- Supervisors need focus their attention only on the estimated 50% of residents with low food and fluid intake who proved responsive to the mealtime intervention (see Step 2); these are the residents who should continue to receive feeding assistance during meals.
- One supervisor can reliably observe feeding assistance for five to ten residents at a time, provided all the residents are in the dining room or in their rooms but within the same hallway.
- To start, each resident who needs feeding assistance should be observed during at least three meals per week, alternating days of the week and meals. If nurse aides provide proper feeding assistance consistently for four weeks, reduce quality control assessments to one meal per week, but continue to alternate days of the week and meal periods.
We estimate that in a typical 100-bed nursing home, one supervisor will initially spend 5 hours per week conducting mealtime quality control observations for the estimated 25 residents with low intake who are responsive to the mealtime intervention. Once the feeding assistance protocol takes hold, the supervisor's assessment time should drop to about 2.5 hours per week.
Double-Duty Assessments:
Mealtime monitoring not only ensures quality feeding assistance for at-risk residents, but the presence of supervisory-level staff in the dining room during meals also communicates to those supervised that feeding assistance is an important care routine that is valued by management. Quality control observations should support and reinforce educational in-service training sessions related to nutritional care and weight loss prevention (3).
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