Browsing "Weight Loss/Dining"

Weight Loss/Dining – Entry 3

Dear Diary,

We’ve made a lot of changes in our dining program. To enhance the meal experience, we have moved to an open breakfast from 7:00-9:30 and we are now serving meals in the dining room as well as 2 of our 4 neighborhood dining rooms. We’ve also increased satisfaction with meals on our TCU unit by offering more meal options.

Our team is hoping these changes will help decrease unintended weight loss, but we also wanted to see if there is anything else we could do. I talked with another nursing director and she shared how their scales were causing part of the problem with inaccurately recording weight. So, we had our scales recalibrated by our maintenance department director. Maintenance staff will calibrate the scales each quarter.

At our staff meeting we discussed the process of weighing residents. Monthly and weekly weights are being done before bathing. The weights are entered into our electronic health record. We were able to set up some alerts in the system to monitor if there is a 3-lb change from the last weight. This triggers a reweigh alert to the nursing assistant. The nurse manager and dietician are sent an alert also.

The dietician also is meeting with the neighborhood staff on a weekly basis to review everyone whose weight is being monitored, whose meal intake is less, and those with pressure ulcers, infections, and any other concerns that might be related to weight loss or gain. This huddle meeting is about 10 minutes on each neighborhood. The dietician told me she loves those meetings as she gets to ask questions of the staff, talk with the nursing assistants, and do any follow up she feels is needed. For example, she recently asked for therapy to re-evaluate a resident to see if some adaptive eating equipment might help them remain independent. They recommended a non-tipping cup and built up utensils. The resident agreed to try these. The dietician then talked with the nursing assistants and dietary aides to assure the resident would get this equipment each meal. She’ll follow up with the resident and staff. I love it when the different departments work together with the resident to meet changing needs.

Is there a way I can promote this more? I shared the example at our staff meeting and asked staff to be aware of other residents who could benefit from reassessments.

Signed, Donna

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Weight Loss/Dining – Entry 2

Dear Diary:

Our Performance Improvement Project (PIP) team did a great job completing a root cause analysis on why we are seeing increased resident rates of unintended weight loss. They found one of the root causes is some residents are skipping breakfast.

The team planned these interventions:

  • Individualize resident therapy times based on their preferences. Assure therapy times don’t interfere with meal times.
  • Schedule therapy appointments after 10 am for those residents preferring to sleep later in the morning. Give them time to eat breakfast before their therapy appointment.
  • Keep high-calorie “finger food” snacks and beverages in the therapy department. Offer these snacks to each resident after their therapy appointment.
  • If a resident refuses breakfast before their therapy appointment, offer them a high protein/high calorie drink to finish after therapy.

Our weight loss PIP team has been working hard implementing changes on our transitional care unit (TCU) to ensure that all residents who want breakfast receive it prior to therapy in an effort to prevent weight loss. During their initial assessments with new residents, the therapists are having conversations with the residents to individualize therapy schedules based on their preferences, asking questions about what time they like to get up in the morning, when they’d like therapy, when they’d like breakfast, etc.

It turns out that didn’t always work. For example, some residents said they would like to get up early and have therapy. But on some days they weren’t up in time for the early appointments, therapy was trying to reschedule and some of them were missing breakfast again.

The team came up with a great idea to solve this problem. They now have a huddle at 8:30 am every morning on the TCU to quickly review the therapy schedule with the nursing assistants, see if it will work out, leave time for breakfast, and make any quick changes to meet the needs of each resident. It seems to be working! In the last two months, only three residents had an unexplained weight loss compared to 12 the two months prior to starting this PIP. It also turns out the snacks in the therapy department are a big hit!

To make lasting improvements, we are learning how important it is to involve all departments as we work to change the way we do our work.

How can our long-term neighborhood teams come up with changes in the way they do their work to prevent unintended weight loss?

Signed, Donna


  • We have open dining from 7:30am to 9:00am everyday. 9:00am morning huddle with nursing, TREC, care attendants to ensure everyone has been offered breakfast. If residents are not still in the dining room they are offered a breakfast tray in their room and or their choice of snack. Residents are allowed to sleep in every day, however, care attendants are giving a list of when resident received their last snack the previous night. We make every attempt to ensure that residents have been at least offered a snack within 14 hours of their food intake. (state guidelines) If a resident has a bath that morning they are still assisted to the dining room in their bathrobes rather than putting on all their clothing. Dietary Manager, AMY, tracks all weekly weights and meets with nursing staff every Friday to review any weight loss issues or potential for weight loss. Interventions are discussed and put into an action plan. The interventions are then put on the daily care sheets to inform staff of add’l nutritional support. Casper reports are reviewed for residents that flag in the weight loss QI’s to review hx of weight loss in the facility. Discussions on past weight loss issues and how to prevent them from happening in the future.

  • Our root cause annalysis indicated significant flucuations in residents weights week to week. During an investigation of our process, re noted an equipment malfunction. Equipment has been replaced. Staff has been educated. Results; we do not have weight flucuations as previously noted.

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Weight Loss/Dining – Entry 1

Dear Diary:

At our QAPI meeting last month, our dietitian shared that she has noted a trend of unexplained weight loss in several residents on our transitional care unit during the last quarter. She has not noted this trend on our long-term care neighborhoods.

Because weight loss is a high risk problem for our residents, we decided to start a performance improvement project (PIP) on this weight loss trend. We formed a PIP team that includes the registered dietitian, nurse manager, nursing assistant, social worker, and physical therapist. They did a great job completing a root cause analysis and brought the results of that RCA to our QAPI meeting today.

Their root cause analysis found:

  • About 20% of our residents on the transitional care unit do not eat breakfast.
  • Most of those not eating breakfast have therapy appointments before 10 am
  • Many residents on the TCU choose to “sleep in” as long as they can. Many are tired as they recuperate from surgery and/or as a side effect of pain medications.
  • Many residents with early therapy appointments choose to skip breakfast and just go straight to therapy.

The team is meeting next week. I wonder—what ideas will they have for action steps?

Signed, Donna


  • Developed a meal monitoring flowsheet which includes snacks. Charge nurse checks off and initials that she has observed residents eating or they are offered meals/snacks in their rooms. This is to ensure they have at least been offered nutrition.

  • Having an open breakfast works and bringing breakfast to those who do not want to get up. Start therapy later so it does not interfere with breakfast times.

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