Food First - Nutrition

Food First - Nutrition 

Effective Date: [Original NPP Date] 
Revised Date: [Current Date] 

Standard: 

Residents in this facility will receive adequate nutrition provided in a comfortable, home-like environment. The facility honors residents’ decisions related to their quality of life, including their informed decisions to accept or refuse dietary and/or speech therapy recommendations. Residents are offered liberalized diets, as experience has shown that residents eat better when served less restrictive diets with regular foods. The interdisciplinary team works with the resident and family to offer creative alternatives to supplements to decrease the risk of weight loss, such as fortified foods and high-calorie nutritional snacks. 

Policy: 

It is the policy of this facility to assess all residents, identify those at risk for weight loss, and provide appropriate interventions according to the resident’s physical and mental abilities and their wishes. Residents will receive nourishing, attractive meals to meet individual nutritional and special needs while providing a positive dining experience to enhance the resident’s quality of life and respect their rights. This will be monitored and evaluated by the administrative staff to ensure positive resident outcomes. 

Practice Guidelines: 

I. Assessment: 

• Upon admission, a resident is weighed and measured within 24 hours. 

• Upon re-admission, a resident is weighed within 24 hours, with height taken from the previous admission. 

• An assessment of nutritional status is done with the nursing clinical assessment, including the resident’s physical abilities and need for assistance with feeding. 

• Dining Services Personnel will meet with each newly admitted resident for initial nutritional assessment and food preferences. 

• The resident will be assessed by a Registered Dietitian or Registered Diet Technician within 7 days. 

II. Weight: 

• The following residents are weighed weekly for 4 weeks: 

• Newly admitted residents. 

• Newly readmitted residents (unless clinically not indicated). 

• Residents with unanticipated, unplanned weight loss of >5% in one month. 

• Residents with a new feeding tube. 

• Residents with an MD order for weekly weights. 

• Other residents at the discretion of the IDT. 

• Thereafter, residents will be weighed monthly, unless clinically indicated. 

• The same scale should be used for each weighing to ensure consistency and accuracy. If a change must occur, note the change on the weight worksheet. Scales should not be moved from their locations to maintain calibration. 

• All weight loss/gain of 5% or more requires a reweigh for verification, done on the same scale with a licensed nurse present. For residents weighing 100 lbs or less, a weight loss of no more than 3 lbs is acceptable, and a reweigh is done. 

• Weights are documented in the resident’s medical record. 

• Significant weight loss/gain (>5% in 30 days or >10% in 6 months) is reported to the IDT, Dietitian, Physician, and Family. 

• All residents with significant weight loss are reviewed by the IDT and resident/responsible party, with appropriate interventions implemented. 

III. Dining Experience: 

• Meals will be served in a comfortable, safe, and home-like environment. 

• Menus are posted with portions in designated areas. 

• Meal times are closely observed, and all resident meals are served promptly. Individual preferences for meal times are incorporated into the resident’s plan of care. 

• Meals will be served with food taken off the delivery trays and placed in front of the resident with all equipment/assistive devices and assistance available. Serving meals on trays in resident’s rooms is acceptable. 

• A Resident Dining Services Identification System is established and presented with each meal. 

• Clothing protectors will be offered to residents and handled according to the Infection Control policy/procedure. 

• All meals are documented by percentages (0%-25%, 26%-50%, 51%-75%, 76%-100%). 

Dining Room Monitoring: 

• Maintaining residents’ rights 

• Socialization 

• Location of each resident 

• Accuracy of diet 

• Consistency of diet 

• Proper positioning 

• Staff sitting while feeding residents 

• Infection Control standards 

• Safety 

• Staff needing further instruction on proper feeding techniques 

• Use of assistive devices 

Infection Control/Safety in Dining Rooms: 

• All dining rooms will have hand washing areas and/or hand sanitizer available. Staff will wash their hands before serving/distributing food. 

• All soiled linen carts and housekeeping equipment will be removed before food delivery trucks arrive. 

• Medication administration should not occur in the dining room when residents are eating. 

• Emergency equipment will be available for all dining areas. 

• All nursing staff will be trained in Abdominal Thrust/Choke Rescue. 

Snacks: 

• Snacks will be available to residents at designated times and upon request. 

• Diabetic residents with HS snacks recommended by Dietitian and Physician will have snacks documented on MAR by a licensed nurse as “accepted or refused” – “A” or “R”. The ECS system will be initialed and noted as being refused. 

• Supplements, when recommended by Dietitian and ordered by the physician, are documented as percentage or cc by the licensed nurse on the MAR. 

References: 

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities. [Link to current CMS SOM] 

• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]