This is the second part of this article. Please go to Part 1 if you have missed it.
The DAA suggests that we catch the problem early and monitor food intake in our residents. Every facility, no matter which provider they belong to, should have some kind of a food intake monitoring form. If you are concerned with intake you don’t need a GP or dietician approval to start one of these, you simply state in the residents notes that you are concerned about nutritional intake and you want to start investigating, thus you are commencing a food intake form. This is where who ever is the person to feed this resident/pt needs to be diligent in documenting exactly what he/she ate for that meal. All 3 shifts must do this for however many days the form stipulates. Then, when you have evidence that intake has in fact decreased you can raise your concern with the GP or dietician. They will be pleasantly surprised that you have already completed the form and have the data waiting for them. Then you can start other investigations like find out if they are in pain, are no longer able to eat on their own, have problems swallowing, are becoming depressed, decreased cognitive ability etc.
The other way you know if someone is getting malnutrition is by regularly weighing them. They may have a great appetite but may not be absorbing anything. At our facility we weigh people monthly and have a special obs form that it goes into and I as the care manager type it onto a special excel program that our IT department developed, and it shows me if someone is starting to become malnutritioned. When I can see someone is starting to lose weight, according the amount of weight the person has lost I am to follow certain directives to try and reverse the malnutrition process. You don’t need a fancy system however to tell you there is a problem, all you have to do is weigh them and write it down somewhere in their file, if there is a weight loss do some investigating, consult their GP and their family maybe they have an explanation, or have noticed something that you haven’t. There are also a huge range of great products now that help boost protein and caloric intake which I am sure you provider already has or can easily order, and these days they come in lots of different flavours that your residents will love.
You may not be able to stop everyone from becoming malnutritioned, but you can reduce the numbers with very small simple steps. Simple observations in behaviour, intake, and surroundings will prove very useful in aiding you to look after our frail and aged.
How do you feel about the statistics of malnutrition in our elderly? How have you helped a person from becoming malnutritioned? Have you witnessed some poor practices that have resulted in malnutrition?
Yes read Part1 and posted on it;now Pt2:-
Stats can be all over the place unless a specific person it allocated to compile the counting and an audit is carried out.
No provider want it known they ‘are slack’ re food etc.Yes there is too much waste however on-site kitchens do make great quality foods.If noted specific high qual products can be added.
1: Weigh all new presentations each alternative day for two weeks and record this weight.Weigh at the same time..suggest early AM…and gives you a chance to walk them to the loo as well..or use the bed-side commmode..do remember to empty it asap!!
2:Start a FBC [fliud balance chart]this will assist rehydration rates and fluid intake.
After two weeks you will see any changes in this person.Give them time to eat and don’t rush them.Morning tea and cake is important to them as is evening night supper.Record it all.Then weigh them twice each month,depending on your place of employment.
If you recognise any swollow or chewing problems ask for/order a’speechy-review’ASAP.
I have seen meals totally left untouched as the person was asleep in the chair or bed and drink-caps were never taken off or straws put into product containers..this is so just not on !!PLEASE report it in the clients/residents.pt notes.If you don’t this problem will never stop.
AND DO remember..all rest periods are vital as it is in this state the clincal cell boots get into action and we all ‘self-heal’.
Bureaucrats preach about residents rights and choice. what about the choice not to eat? Is force feeding what they are advocating.?? Now we have the Vulnerable persons food act so residents are denied the right to eat food they have eaten all their lives because now they are “old and vulnerable” and the food is suddenly high risk. Where is the residents rights now?? Maybe instead of making sweeping statements and accusations that lump every resident losing weight as being neglected a thought should be given to the fact that food refusal,weight loss is a part of aging and dying. Cases should be investigated individually. Attacking aged care nurses is not the answer. calling pureed food “Slop” is not very helpful. What should we feed people who can’t chew, have forgotten how to eat ,have dysphagia etc. No wonder nurses are disillusioned.
Oh golly oh gosh! We all see mashed or pureed food used for kids prior too starting on solids ok.The media is not’hell-bent’in this area is it?
So much for’informed media reporting’..and kids do get weighed.
The press is after the Government in any way it can grab our attention and education of food-tyes is of no great interest to them regarding our aged persons and their specific clinical needs in this area.
Some exemptions exist,sadly too few.Added here is the reality that mnay visitors and relatives depart as soon as it is meal time.They are stressed-out to see their loved one trying to eat.
This is not a nursing problem.
There is of course a great ractial note here to add: Many residents or Pts who are not Asutralian by birth or Anglos do get extra national common foods bought in by relatives or friends who feed them.
They consider it a DUTY to do so.