Weight Loss Prevention
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MONITOR FEEDING ASSISTANCE DURING SNACK TIMES
It is just as important for supervisors to monitor the quality of feeding assistance during snack periods as it is during mealtimes, especially when you consider that an estimated half of nutritionally at-risk residents need between-meal snacks to increase their daily caloric intake. Unfortunately, in many nursing homes, staff fail to consistently provide snacks and beverages to residents between meals (7), and documentation of residents' food and fluid intake between meals is typically absent or inaccurate. Quality control monitoring can identify such problems and point the way to feasible solutions.
Here are tips for conducting snack-time quality control observations:
- Focus your observations first on residents with low intake who showed a significant gain in daily calories in response to our snack intervention (see Step 2). Staff should offer these residents snacks and beverages between meals at least twice a day (morning and afternoon) and preferably three times a day (morning, afternoon, and evening).
- To start, monitor each resident during two or more snack periods per week, being sure to vary the days of the week and the snack period (i.e., morning, afternoon, and evening). Reduce your observations to every other week or one snack period per week once proper care routines are firmly established.
- Use our Quality Improvement Observation Form: Between Meal Snacks to record important information about snack-time feeding assistance. Like the mealtime observation protocol, this protocol generates information that can be summarized as quality indicators (QIs), which in turn can be used to target improvement efforts. This information also can be entered into our nutrition software program to generate summary QI scores for snack delivery by date or snack period.
- Arrange for snacks to be delivered to residents during group activities so that you can conduct quality control observations in a time-efficient manner.
- If you can, check to make sure that all residents are offered fluids between meals. Studies show that the majority of nursing home residents are at high risk for dehydration (8).
- Be sure that a variety of food and fluid items are offered during each snack period. Choice among items is especially important to more cognitively intact residents (7, 9).
- Also if possible, monitor consumption of oral nutritional supplements among all residents at snack time. Most residents have physician orders for supplements, but staff tend to offer these during meals as food substitutes. If taken between meals, the supplements not only increase caloric intake, but also act as an appetite stimulant so residents eat more during meals.
- Consider increasing the frequency of observations for any resident who starts to lose weight so that you can quickly correct any problems you spot.
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