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.

Share your nursing home perspective on this quality improvement issue.