Pardon Me if I have asked this before? Help r/t when to c/p for nutrition

  1. In our LTC, we have been care planning for q one that is not on a regular diet w/o any nutritional issues/dehydration issues. We did well w/ our state survey, No citations. I had spoken to the RA that comes in q month as our consultant, she was the one that stated that q one in the facility needs to have a nutritional care plan unless they are on a regular diet and all is fine. My ? is we are doing away w/ this process, by only care planning for those who are fed via feeding tubes, wt loss or some other issues. Our diabetics will be cp together with nursing and dietary interventions underneath. If the resident is on a mechanically altered diet or theraputic diet no care plan unless wt or skin etc is an issue...HELP. Thanks Tex:
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  2. 9 Comments

  3. by   Catsrule16
    Have you thought about including interventions in other care plans that address nutrition? For the ADL care plan, encourage to eat 50% before assisting with feeding. Invite to food related activities. For the resident who has gone from being sedintary to moving about burning more calories than they did before, you may want to offer snacks at various times of day. For someone with depression, you could include in the problem the risk for weight loss as a result of disease process and/or medication use and include interventions in that problem. Just some suggestions.
  4. by   adrienurse
    That's Greek to me,
  5. by   Talino
    When a Nutrition RAP is triggered because of a mechanically altered or therapeutic diet, even though the resident presents no problem with these nutritional approaches, what do you write on the RAPs sheet?

    Should you consider a progress note of a Dietitian a care plan itself? Absolutely!

    In this case and scenario, when a Nutrition RAP is triggered but there is no actual problem, all you have to say under RAP documentation is... "See Dietitian's Progress Note date XX/XX/XX"

    A Dietitian's progress note would summarize....
    "Resident remains on a 2-gm Na chopped diet; consumes more than 75% of each meal serving, including fluids. No complaints presented regarding diet. Weight has been stable in the last three months. No signs of dehydration. Will continue same approaches."

    The primary concern is decrease in nutritional intake due to the use of a low Na diet (which may not be so palatable) and the consistency - chopped. If these approaches do not affect the resident's intake, why create a specific Nutrition Care Plan in a separate sheet?

    Last edit by Talino on Sep 5, '02
  6. by   tex
    talino thanks. I haven't read of late, your pearls of wisdom. Tex
  7. by   bandaidexpert
    In my experience, it is best to assess each resident individually. If a resident is on a pureed diet r/t dysphagia, however, the diet is tolerated and no s/s of aspiration, I then cp risk for aspiration. I also incorporate approaches in other care plan problems r/t nutrition, like catsrule mentioned. I have always felt if it wasn't a problem or great risk to the resident then don't send up a red flag. The main thing is to look at each resident's nutritional issues, they are all different. tex, in my opinion, you are signing your MDS's and RAPs for accuracy, not the RD. You are the best judge of the resident's needs and issues. RD may be part of the IDT, but you should have final say in what is care planned. Just my 2 sense

    dawn
  8. by   Talino
    you are signing your MDS's and RAPs for accuracy, not the RD
    This is actually incorrect. MDS Coord. signs for "the completeness" of an MDS assm't. In the RAPs process, you sign for the location of the supporting doc'n of a triggered RAP.

    It is good practice to share the RAPs KEY to a discipline, e.g., a Dietitian to Nutritional Status RAPs. Review the Problem, Trigger, and Guidelines. What is the MDS trying to extricate?

    Afterall, when a surveyor finds the nut'l intervention insufficient, they don't ask for an MDS coord. They scrutinized a Dietitian.

    The MDS Coord. being "the best judge of the resident's needs and issues" --- I'll be leary of this notion. MDS Coordinators "coordinate" the assessment and care planning process. You can raise issues with which an MDS assm't is trying to untwist but should not dictate a discipline how to plan their care. Their expertise in the field should not be undermined.

    There is no prohibition about care planning everything, but it can be overkill. Weigh out the triggers, read other discipline's assessment and progress notes. Most of the time, a concern is already addressed. When in doubt, care plan!
  9. by   tex
    My concern is that the LPN that is doing the part of dietary, not to her fault, really didn't have any formal training. She is a good nurse and has been w/LTC for >8 years. Our DON/ADON has helped her and we also have a consultant that comes in qm. BUt as time unravels we have found that she needs to get to the basic's of just understanding the paperwork. Anyway, I understand what my position is but I also during my assessment of the resident, know the complete needs. So I still will give my two cents and my rationale on why they either need to be c/p for or not. I feel that when in doubt, care plan (Per Talino). Yet I do understand overkill on care plans. But it is difficult to change when you get a perfect survey. I am nervous about changing what has worked.. Thanks to all for the advice Tex
  10. by   tex
    I have an LPN that works for me. I sign all of her work. As well as correct her incorrect data that she put;s in. SHe has a tendency to put in weights that are not correct. It is easier for her to put in wts that were last months than go and weigh them herself. We have to put the data in most of the time, d/t our dietary nurse isn't the same speed as us.... tex
  11. by   kids
    Originally posted by Talino
    When a Nutrition RAP is triggered because of a mechanically altered or therapeutic diet, even though the resident presents no problem with these nutritional approaches, what do you write on the RAPs sheet?

    Should you consider a progress note of a Dietitian a care plan itself? Absolutely!

    In this case and scenario, when a Nutrition RAP is triggered but there is no actual problem, all you have to say under RAP documentation is... "See Dietitian's Progress Note date XX/XX/XX"

    A Dietitian's progress note would summarize....
    "Resident remains on a 2-gm Na chopped diet; consumes more than 75% of each meal serving, including fluids. No complaints presented regarding diet. Weight has been stable in the last three months. No signs of dehydration. Will continue same approaches."

    The primary concern is decrease in nutritional intake due to the use of a low Na diet (which may not be so palatable) and the consistency - chopped. If these approaches do not affect the resident's intake, why create a specific Nutrition Care Plan in a separate sheet?


    Wow I am glad I don't do this stuff anymore...I walked away 4 years ago and never looked back. (I started out doing MDSs at a SNF here in WA that was a "pilot" facility,1 year before the "rest of the world"...)

    God Bless those of you who do it


    My only input is...
    When nutrition triggers because of a skin issue I had no problems with the State by incorproating the approaches in the skin problem...its not how many individual problems the person has on their careplan but rather how comprehensive the approaches are (does that make sense?). It is OK to tie body systems togrther in 1 problem (skin at risk & incont) as long as it is fully addressed...we alos didn't due a specific problem for tube feeders (unless it was warented)...usually if there was no problem we put the approaches under mobility (positioning) and general health maintenence.

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