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.

Share your nursing home perspective on this quality improvement issue.