AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention
Facilitator Training—Additional Exercises
Contents
Nutrition Risk Reports Information Exercises
Exercise #1: Risk Criteria and Rules
Exercise #2: Identify Residents Meeting High-Risk Criteria
Exercise #3: Identify Residents Meeting Medium-Risk Criteria
Exercise #4: Spot Potential Report Inaccuracies
Exercise #5: Prioritize Residents for Followup: High-Risk Report
Exercise #6: Prioritize Residents for Followup: Medium-Risk Report
Exercise #7: Nutrition Report Calculations
Nutrition Risk Reports Implementation Exercises
Exercise #8: Implementation: Weekly Nursing Assistant Nutrition Risk Huddles
Exercise #9: Coaching Teams Through Use of Report Information
Risk Change Report Information Exercises
Exercise #1: Risk Criteria and Rules
Exercise #2: Prioritize Residents at Highest Risk
Exercise #3: Report Data
Exercise #4: Report Calculations
Risk Change Report Implementation Exercises
Exercise #5: Implementation: Key Points
Exercise #6: Coaching Teams Through Use of Report Information
Trigger Summary Report Information Exercises
Exercise #1: Resident-Level Report: Risk Criteria and Rules
Exercise #2: Prioritize Residents for Followup
Sample Trigger Summary Report #1
Sample Trigger Summary Report #2
Exercise #3: Resident-Level Data
Using Trigger Summary Report #1
Using Trigger Summary Report #2
Exercise #4: Unit-Level Data
Exercise #5: Report Calculations
Trigger Summary Report Implementation Exercises
Exercise #6: Implementation: Key Points
Exercise #7: Implementation: Factors for Success
Exercise #8: Coaching Teams Through Use of Report Information
Weight Summary Report Information Exercises
Exercise #1: Risk Criteria and Rules
Exercise #2: Report Information
Exercise #3: Prioritize Residents for Followup
Weight Summary Report Implementation Exercises
Exercise #4: Report Calculations
Exercise #5: Implementation: Key Points
Completeness Report
Exercise #1: Report Information: Entire Facility
Discussion Questions
Exercise #2: Report Information by Shift
Discussion Questions
Intervention History for Nutrition Risk Report
Exercise #1: Report Information
Exercise #2: Using the Intervention History for Nutrition Risk Report
Sample Intervention History for Nutrition Risk Report: High-Risk Residents
Sample Nutrition Report: High Risk
Resident Clinical, Functional, and Intervention Profile Report
Exercise #1: Report Information
Exercise #2: Using the Resident Clinical, Functional, and Intervention Profile Report
Nutrition Risk Reports Information Exercises
Objective: Facilitators will understand criteria for high and medium nutrition risk.
Exercise #1: Risk Criteria and Rules
Please choose the best answer to the questions.
- Residents who display on the Nutrition Report: High Risk (circle all that apply):
- Must have met at least one of two high‐risk criteria for nutritional risk
- Must have lost weight during the report week
- Must have consumed an average weekly meal intake of ≤50% for the report week
- Must have consumed ≤50% for at least one meal during the report week
- Must have consumed ≤50% for two meals in a single day during the report week
- None of the above
- All of the above
- Residents who display on the Nutrition Report: High Risk must have a pressure ulcer.
- True
- False
- Residents who have not been weighed during the report week cannot display on the Nutrition Report: High Risk.
- True
- False
- Residents receiving nutritional supplements cannot display on the Nutrition Report: High Risk.
- True
- False
- A resident must have lost a minimum of 1.0 pound in order to display either on the Nutrition Report: High Risk or Nutrition Report: Medium Risk.
- True
- False
- Residents 75 years old or younger cannot display on the Nutrition Report: High Risk but may display on the Nutrition Report: Medium Risk if medium risk criteria are met.
- True
- False
- A resident may display multiple times on the Nutrition Report: High Risk if risk criteria are met more than once during the report week.
- True
- False
- If a resident displays on the Nutrition Report: High Risk and is receiving tube feeding then the following will display:
- The amount of tube feeding in cc's/ hour
- The amount of tube feeding in cc's/day
- The date tube feeding was ordered
- An X to indicate the presence of tube feeding
- All of the above
- None of the above
- If a resident has not lost weight during the report week but is receiving tube feedings, the resident will always display on the Nutrition Report: Medium Risk.
- True
- False
- A resident admitted within 7 days of the report date cannot display on either Nutrition Report: High Risk or Nutrition Report: Medium Risk.
- True
- False
- A resident may display on both the Nutrition Report: High Risk and the Nutrition Report: Medium Risk during the same report week.
- True
- False
- A Nutrition Risk report always displays 4 consecutive weeks of average meal intake values.
- True
- False
- The current date is always used to determine which weeks to display on the Nutrition Risk reports.
- True
- False
Answers:
- b, e
- b
- a
- b
- b
- b
- b
- d
- a
- b
- b
- a
- b
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Exercise #2: Identify Residents Meeting High-Risk Criteria
Using the table below, circle all rows (residents) you would expect to see on the Nutrition Risk: High Risk report, based on high-risk criteria.
Sample Nutrition Report Unit A |
||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb | Most Recent Ulcer Assess Date | # of PrUs |
A | 001 | 03/22/2014 | 50 | 41 | 36 | 29 | Pureed 2/28/14 |
X | -1.5 | |||
B | 002 | 03/16/2014 | 64 | 52 | 47 | 45 | Mech 1/22/14 |
50% | -3.3 | 3/25/14 | 1 | |
C | 003 | 03/19/2014 | 74 | 62 | 58 | 42 | Reg 3/22/14 |
-1.5 | ||||
D | 004 | 86 | 89 | 71 | 59 | Reg 12/3/13 |
-10.5 |
Answers: Residents A, B, and C.
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Exercise #3: Identify Residents Meeting Medium-Risk Criteria
Using the table below, circle all rows (residents) you would expect to see on the Nutrition Risk Report: Medium Risk, based on medium-risk criteria.
Sample Nutrition Report: Medium Risk | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb | Most Recent Ulcer Assess Date | # of PrUs |
A | 001 | 03/17/2014 | 60 | 71 | 76 | 69 | Pureed 2/28/14 |
|||||
B | 002 | 94 | 92 | 97 | 85 | Mech 1/22/14 |
50% | -0.6 | ||||
C | 003 | 03/22/2014 | 49 | 52 | 37 | 32 | Reg 3/22/14 |
-1.6 | ||||
D | 004 | 03/22/2014 | 33 | 45 | 31 | 22 | Reg 12/3/13 |
-2.2 | ||||
E | 005 | 03/17/2014 | 10 | 11 | 0 | 0 | NPO 3/10/14 |
X | 3/21/14 | 2 | ||
F | 006 | 03/17/2014 | 0 | 0 | 0 | 0 | NPO 2/28/14 |
X | -2.2 | |||
G | 007 | 96 | 88 | 85 | 92 | Reg 12/3/13 |
-10.5 | |||||
H | 008 | 03/18/2014 | 0 | 0 | 0 | 0 | Mech 1/22/14 |
X | -2.2 | |||
I | 009 | 65 | 72 | 78 | 85 | Pureed 2/28/14 |
||||||
J | 010 | 03/22/14 | 26 | 30 | 40 | 45 | Pureed 2/28/14 |
0.8 | ||||
K | 011 | 03/17/2014 | 0 | 0 | 0 | 0 | NPO 1/22/14 |
X | 3/20/14 | 3 | ||
L | 012 | 03/17/2014 | 98 | 95 | 92 | 88 | Reg 12/3/13 |
Answers: Residents A, B, E, G, K, and L.
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Exercise #4: Spot Potential Report Inaccuracies
Using the table below, identify report data that could be inaccurate.
Sample Nutrition Report | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb | Most Recent Ulcer Assess Date | # of PrUs |
A | 001 | 3/17/2014 | 60 | 71 | 76 | 69 | Pureed 2/25/14 |
X | -0.2 | |||
B | 002 | 03/18/2014 | 94 | 92 | 97 | 85 | Reg 12/10/13 |
-60.6 | 3/15/14 | 3 | ||
C | 003 | 03/17/2014 | 49 | 52 | 37 | 32 | Pureed 1/15/14 |
50% | -1.6 | |||
D | 004 | 03/19/2014 | 33 | 75 | 31 | 92 | Reg 2/22/14 |
-0.2 | ||||
E | 005 | 03/16/2014 | 10 | 11 | 0 | 0 | Puree 3/12/14 |
25% | -212.2 | |||
F | 006 | 03/19/2014 | 0 | 0 | 0 | 0 | NPO 2/5/14 |
X | -2.2 | 3/18/14 | 2 | |
G | 007 | 03/18/2014 | 96 | 88 | 85 | 92 | Reg 2/2/14 |
-10.5 | ||||
H | 008 | 03/19/2014 | 0 | 0 | 0 | 0 | NPO 3/1/14 |
X | -0.8 | |||
I | 009 | 03/17/2014 | 85 | 92 | 38 | 85 | Mech 3/20/14 |
+1.2 | ||||
J | 010 | 03/16/2014 | 26 | 30 | 40 | 25 | Pureed 3/25/14 |
75% | -1.8 | |||
K | 011 | 03/19/2014 | 0 | 0 | 0 | 0 | NPO 3/10/14 |
-1.0 | 3/20/14 | 4 | ||
L | 012 | 03/17/2014 | 98 | 95 | 92 | 88 | Reg 1/14/14 |
-6.1 |
Answers:
- Resident A. Verify that this person is eating 60-76% and on a tube feeding
- Resident B. Very large weight loss (60 pounds). Is this accurate?
- Resident C. Is it really possible that the resident was eating between 32% and 52% and lost only 1.6 pounds?
- Resident D. It seems unusual to see average weekly meal intake drop to 30% range every other week. Is this a staffing issue? Agency staff? New staff? Is the resident's family bringing in food at times other than meal times?
- Resident E. Another very obvious inaccurate weight loss (212.2 pounds) value that is due to an inaccurate weight entry.
- Resident G. Eating 85-96% and still losing weight. Is this accurate?
- Resident I. The 38% weekly average meal intake value seems odd for 2 weeks ago. Is this a documentation issue or was something going on with the resident?
- Resident J. Eating 25-40% and lost only 1.8% pounds. Is this accurate? Would you expect a greater weight loss?
- Resident K. No intake and no tube feeding and only 1 pound weight loss. Is this accurate? Is it possible to not have taken a weight? Has it not been entered into the system?
- Resident L. Eating 88% plus with a 6.1 pound weight loss. Is this accurate?
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Exercise #5: Prioritize Residents for Followup: High-Risk Report
Objective: Facilitators will understand how to prioritize residents on high and medium risk reports for the Weekly Nutrition Risk Huddles.
Using the sample high-risk report below, select up to five residents you would consider highest priority for discussion at the Weekly Nutrition Risk Huddle. Plan to discuss your rationale.
Sample High-Risk Nutrition Report | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb | Most Recent Ulcer Assess Date | # of PrUs |
A | 001 | 03/17/2014 | 50 | 41 | 36 | 29 | Pureed 2/2/14 |
-7.5 | 3/21/14 | 1 | ||
B | 002 | 03/16/2014 | 44 | 52 | 47 | 55 | Reg 2/1/14 |
-0.5 | ||||
C | 003 | 03/17/2014 | 54 | 52 | 48 | 48 | Pureed 2/11/14 |
50% | -1.2 | |||
D | 004 | 03/16/2014 | 33 | 45 | 41 | 22 | Pureed 2/10/14 |
x | -2.2 | |||
E | 005 | 03/19/2014 | 88 | 92 | 95 | 85 | Pureed 1/21/14 |
25% | -0.2 | |||
F | 006 | 03/19/2014 | 35 | 30 | 35 | 35 | Mech 2/14/14 |
-5.6 | 3/20/14 | 2 | ||
G | 007 | 03/17/2014 | 86 | 89 | 75 | 89 | Reg 1/12/14 |
-1.1 | ||||
H | 008 | 03/17/2014 | 0 | 0 | 0 | 0 | NPO 2/27/14 |
X | -0.2 | |||
I | 009 | 03/16/2014 | 65 | 71 | 29 | 21 | Reg 3/10/14 |
-1.0 | ||||
J | 010 | 03/19/2014 | 86 | 90 | 100 | 89 | Reg 2/26/14 |
-11.5 |
Answer: Residents A, B, F, I, and J
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Exercise #6: Prioritize Residents for Followup: Medium-Risk Report
Using the sample medium-risk report below, select up to five residents you would consider highest priority for discussion at the Weekly Nutrition Risk Huddle. Plan to discuss rationale.
Sample Nutrition Report: Medium Risk | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb | Most Recent Ulcer Assess Date | # of PrUs |
A | 001 | 03/19/2014 | 70 | 81 | 76 | 79 | Pureed 3/14/14 |
|||||
B | 002 | 44 | 42 | 47 | 55 | Reg 3/20/14 |
-0.5 | |||||
C | 003 | 03/17/2014 | 54 | 50 | 48 | 52 | Pureed 2/10/14 |
50% | ||||
D | 004 | 03/19/2014 | 33 | 45 | 31 | 22 | Puree 3/14/14 |
x | ||||
E | 005 | 03/16/2014 | 88 | 92 | 95 | 85 | Pureed 2/24/14 |
25% | ||||
F | 006 | 03/17/2014 | 35 | 30 | 35 | 35 | Mech 2/26/14 |
-4.2 | 3/21/14 | 1 | ||
G | 007 | 96 | 89 | 72 | 60 | Reg 3/7/13 |
-6.6 | |||||
H | 008 | 03/16/2014 | 0 | 0 | 0 | 0 | NPO 2/17/14 |
X | ||||
I | 009 | 03/17/2014 | 65 | 71 | 29 | 21 | Mech 1/14/14 |
|||||
J | 010 | 55 | 45 | 45 | 60 | Reg 3/18/14 |
-7.2 |
Answer: Residents B, F, G, I, and J
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Exercise #7: Nutrition Report Calculations
Please choose the best answer for each of the following questions about report calculations.
- The following rule is used to trigger for decreased meal intake:
- Resident consumed ≤50% for 2 or more meals in a single day during report week
- Resident consumed ≤50% for 2 or more meals everyday during the report week
- Resident consumed <50% on any one day during the report week
- Resident average meal intake ≤75% for the report week
- None of the above
- The average weekly meal intake is computed by averaging breakfast, lunch, and dinner for each day during the report week and then computing the average using all possible meals as the denominator.
- True
- False
- If a nursing assistant records that a resident consumed 75% of breakfast, the following value would contribute to the weekly average meal intake for that resident:
- The midpoint of 51‐75% or 63%
- The midpoint of 76‐100% or 88%
- 75%
- None of the above
- If a nursing assistant records that a resident consumed 51‐75% of breakfast, the following value would contribute to the weekly average meal intake for that resident:
- 51%
- 75%
- The midpoint of 51‐75% or 63%
- None of the above
- Information that displays in the TF column may originate from (circle all that apply):
- Nursing assistant daily documentation
- Nurse weekly documentation
- Physician orders
- MDS assessment
- None of the above
- What value might you expect to see on the report for average weekly meal intake if the resident received tube feedings and no pleasure foods?
- 0%
- Dash (‐)
- Blank cell
- a & b
- All of the above
- None of the above
- A resident receiving tube feeding will always display on the Nutrition Report: High Risk.
- True
- False
- How is Weight Change in lb calculated?
- Current Weekly Weight minus Previous Weight, only if Previous Weight taken the prior week; otherwise, cannot compute weight change
- Current Weekly Weight minus Previous Weight, using lowest Previous Weight taken in the last 30 days (use 25‐35 day range)
- Current Weekly Weight minus Previous Weight, using most recent Previous Weight (weight closest to and prior to Current Weekly Weight, up to 200 days prior to current weight)
- None of the above
- What weight value is used in weight calculations if multiple weights are recorded for the resident during the report week?
- The highest recorded weight value
- The lowest recorded weight value
- An average of all weight values
- The difference between the highest and lowest value
- None of the above
- Which weight value is used in Weight Change in lb calculations if a single weight value is recorded during the report week and the most recent previous weight was recorded 98 days prior?
- Use the weight recorded 98 days prior to the current weight as the previous weight and subtract the current weekly weight from it
- Use the weight recorded 98 days prior to the current weight for the previous weight only if the weight value is lower than the weight for the report week (shows weight loss)
- Do not calculate; Weight Change in lb cell will be blank
- None of the above
- On the Nutrition Risk Report: Medium Risk, if a resident was not weighed during the report week, then the Weight Change in lb cell will be blank.
- True
- False
- Meal documentation for a resident must be at least 75% complete for the resident to display on the Nutrition Risk Report.
- True
- False
- A dash (‐) in any Average Meal Intake column in the weeks leading up to the report week indicates meal intake documentation was incomplete for that report week for that resident.
- True
- False
- A resident will not display on the Nutrition Reports if meal documentation for the current report week is incomplete.
- True
- False
- The total of possible meals is used as the denominator for computing weekly average meal intake percentage.
- True
- False
- If a resident is admitted midweek of the report week, then average meal intake may be reported as low because the resident was not present for many of the meals and intake was recorded as 0%.
- True
- False
- Which of the following contribute 0% to average meal intake percentage? (Choose all that apply.)
- NPO
- Refused meal
- Unavailable for meal or LOA
- Missing documentation
- None of the above
- Which of the following will affect the denominator when calculating average meal intake percentage for the current report week? (Choose all that apply)
- Resident unavailable for meal or LOA
- Missing documentation
- Report generated midweek
- None of the above
Answers:
- a
- a
- c
- c
- a, b, c
- a
- b
- c
- b
- a
- True
- True
- True
- False
- True
- False
- a, b
- a, b, c
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Nutrition Risk Reports Implementation Exercises
Objective: Facilitators will understand how to coach teams on implementation of report use. The data that display on the sample Nutrition Risk: High and Nutrition Risk: Medium reports are representative of report results encountered in actual clinical settings. Sample report results will be used to discuss the various ways to interpret report results. Facilitators will be prepared to respond to a variety of questions from clinical teams implementing Nutrition Risk Reports for the first time.
Exercise #8: Implementation: Weekly Nursing Assistant Nutrition Risk Huddles
- Primary objectives for conducting Weekly Nursing Assistant Weekly Nutrition Risk Huddles are to (choose all that apply):
- Facilitate use and understanding of Nutrition Report information
- Identify residents at nutritional risk before weight loss occurs
- Facilitate communication of resident nutritional status across disciplines
- Elicit nursing assistant feedback on resident eating habits and preferences that may provide insight for licensed staff
- Promote nursing assistant staff as an integral part of the clinical team and key informants to licensed staff
- All of the above
- None of the above
- The nursing assistant is the facilitator of the Weekly Nutrition Risk Huddle.
- True
- False
- The Nursing Assistant Weekly Nutrition Risk Huddles are implemented only on nursing units having pressure ulcer rates ≥10%.
- True
- False
- Incorporating Nursing Assistant Weekly Nutrition Risk Huddles during change of shift report is highly recommended.
- True
- False
- Following a structured meeting format and maintaining focus on meal intake and weights during a weekly meeting offers the following benefits (choose all that apply):
- Keeps meetings brief
- Encourages team members to stay on topic, as team members become distracted if meetings cover too many topics
- Keeps the meeting focused on report results; meetings are data driven versus open ended
- Reduces risk of meeting turning into lengthy "shift report" type of meeting
- Helps CNAs prepare for the meeting and know what to expect
- All of the above
- None of the above
- Nursing Assistant Weekly Nutrition Risk Huddles should not be implemented on any nursing unit until documentation completion rates for a nursing unit are 90% for a minimum of 2 months.
- True
- False
Answers:
- g
- b
- b
- b
- f
- b
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Exercise #9: Coaching Teams Through Use of Report Information
Scenario: The sample Nutrition Risk: High Risk and Medium Risk reports below were generated for a single nursing unit. The team you are facilitating is assembled for routine consultation.
- What questions are you going to ask your core team about the Nutrition Report information?
- How many residents flagged for high risk? How many of these residents would you review with the team?
- Does the team have any concerns about the report data? Do the data appear accurate? Do the data reflect the actual clinical picture of the resident?
- Did you notice anything unusual about the Medium Risk report?
- What questions are you going to ask your core team about interventions with residents?
- What questions will you ask them about the Weekly Nutrition Risk Huddle process?
- What questions should you ask about the process used to document weights and assess accuracy at the facility?
Sample Nutrition Risk Report: High Risk | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb | Most Recent Ulcer Assess Date | # of PrUs |
A | 001 | 03/22/2014 | 50 | 41 | 36 | 29 | Pureed 1/10/14 |
X | -1.5 | |||
B | 002 | 03/17/2014 | 94 | 92 | 97 | 85 | Reg 2/8/14 |
-3.3 | ||||
C | 003 | 03/19/2014 | 54 | 52 | 48 | 52 | Pureed 2/25/14 |
50% | -1.5 | |||
D | 004 | 03/16/2014 | 86 | 89 | 71 | 59 | Reg 12/14/13 |
-10.5 | 3/16/14 | 2 |
Sample Nutrition Report: Medium Risk | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb | Most Recent Ulcer Assess Date | # of PrUs |
E | 001 | 03/19/2014 | 70 | 81 | 76 | 79 | Pureed 2/2/14 |
|||||
F | 002 | 44 | 42 | 47 | 55 | Reg 3/20/14 |
-0.5 | |||||
G | 003 | 03/17/2014 | 54 | 50 | 48 | 52 | Pureed 2/25/14 |
50% | ||||
H | 004 | 03/19/2014 | 33 | 45 | 31 | 22 | Pureed 3/20/14 |
X | ||||
I | 005 | 03/16/2014 | 88 | 92 | 95 | 85 | Pureed 2/10/14 |
|||||
J | 006 | 03/17/2014 | 35 | 30 | 35 | 35 | Reg 3/16/14 |
-4.2 | 3/18/14 | 2 | ||
K | 007 | 96 | 89 | 72 | 60 | Reg 2/15/14 |
-6.6 | |||||
L | 008 | 03/16/2014 | 0 | 0 | 0 | 0 | NPO 2/26/14 |
X | ||||
M | 009 | 03/17/2014 | 65 | 71 | 29 | 21 | Mech 3/10/14 |
|||||
N | 010 | 55 | 45 | 45 | 60 | Reg 1/19/14 |
-7.2 |
Answers:
- Does the information presented for the residents listed on the report agree with your clinical knowledge of these residents? Is this information helpful? In what way? How would you use this information?
- Four residents triggered as high risk. Resident D has good meal intake but is losing weight. This should be reviewed with the team.
- On the Nutrition Risk Report: High Risk, the data for Resident C should be verified. The meal intake is about 50 percent for 4 weeks, but the weight loss is only 1.5 pounds. On the Nutrition Risk Report: Medium Risk, Resident F appears to be high risk rather than medium risk.
- Resident B has average meal intake less than 50% during each of the 4 weeks shown but does not have an entry under Decreased Intake: First Date. Resident F has decreased meal intake and weight loss, which would indicate high risk for nutrition.
- At which meetings are these reports used? Who attends the meetings, who leads the meetings, how are interventions proposed, and who is responsible for seeing that interventions are carried out?
- Who attends the meeting, when is it held, who leads the meeting, who reviews the report in advance of the meeting, and who prioritizes the residents for discussion? Do the meetings occur as scheduled? Do all the nursing assistants attend? Do the nursing assistants offer input.
- When there is concern about the accuracy of weights, what is the process for verifying weights? Are weights reviewed before they are entered into the electronic medical record? Who is responsible for the review? How often does the review occur?
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