MDS Alert

Keep weights in the healthy zone with trigger points for action.

Poor scores on weight loss quality measures and indicators can weigh heavily on a facility's standing with surveyors and consumers.

A higher-than-average prevalence of weight loss can also signal a facility needs to beef up its nutritional assessment or dietary program.

In that regard, facilities can take some lessons from United Helpers Nursing Homes, which has standardized a best practices dietary program in its three facilities in New York State.

The numbers tell the story: Two of the nonprofit organization's three facilities had only 2 percent of residents with weight loss on their most recent weight-loss quality measures, compared to the national average of 9 percent (and 8 percent for New York). The third facility has about half the national average of residents with weight loss.

The nonprofit organization launched the project at its Canton Nursing Home in Canton, NY in 2003, an effort that won it a quality practice award from the state health department.

How they pulled it off: Before implementing the project, the United Helpers team trained staff and implemented a system to track residents' meal intake percentages, according to Colleen Aldridge, RD, CDN, food service director for United Helpers Management Co.

To train staff, the team started with pictures and then moved to actual plates and glasses to help CNAs estimate cc's of fluid intake correctly. "Food-service staff went into the dining room to work with CNAs to estimate meal intake," adds Aldridge. "Food-service staff still performs audits of the accuracy of meal intake assessment, which remain on target."

Next, dietary technicians began calculating weekly averages on all residents to provide a baseline. "Once we obtain the baseline, then we take action when someone's intake drops by 20 percent in a week," says Aldridge, noting that a loss of appetite can be one of the earliest signs of illness.

Analyze Decreased Intake

As a first step when a resident's intake drops, the staff simply asks the person why he isn't eating as well as usual. That assessment occurs as part of meal observations where nursing and dietary aides talk with the resident and his family, as appropriate, says Aldridge.

When a resident's intake has decreased by 20 percent in a week, the staff implements dietary interventions immediately - and weighs the resident weekly for a minimum of four weeks. If the resident's intake doesn't recover in two weeks or he loses more weight, the interdisciplinary team does an in-depth assessment to determine the cause.

The most common reason residents don't eat well is lack of appetite after a hospitalization, in Aldridge's experience. "So we may implement fortified foods and supplements at such times before a resident loses weight," she adds.

If the dietary and nursing staff can't identify a visible reason for  the person's meal intake decline and/or weight loss - or they suspect medication may be the culprit - they contact the attending physician to do a workup.

"We may ask the physician to order labs to look for a potential physical cause, such as systemic infection, UTI or anemia, as examples," says Norma Jean LaPoint, RN, MDS coordinator for United Helpers Nursing Home in Ogensburg, NY.

The facility uses albumins to assess nutritional status in someone who is losing weight.

Help Residents Put on the Pounds

If meal intake is the problem, the team springs into action with several interventions, as follows: