Weight on patient at home

[Kerber]

How to do get a weight on a patient at home with no scale? And on dementia patient I need to do 90 day recert what do you guys document? What forms ?

[toomuchbaloney]

How to do get a weight on a patient at home with no scale? And on dementia patient I need to do 90 day recert what do you guys document? What forms ?

If the patient has a bathroom scale use that, it is not the method but the trend that you are interested in.

Draw a serum albumin.

Measure the upper arm circumference or the circumference at mid thigh.

Is the patient clothing ill fitting or more ill fitting that previously noted? Do they use a belt? What is the trend with buckle marks on the belt?

Does the family have anecdotal sense that patient has lost weight? Has the appetite or ability to consume foods changed for the worst? Are symptoms managed adequately?

Just document what you observe about the patient that demonstrates either decline or need for the level of care. If they are still in the first 180 days of benefit it is relatively easy to recert them...it is harder in the subsequent 60 day episodes of care and discharge is sometimes required if there is no tangible evidence of decline toward death.

[lifelearningrn, BSN, RN]

Can you get your owner to purchase a scale (cheapo at walmart would work)? If not, do you have beginning MACs and calf circumference? You may also be able to track decline through diet changes, albumin levels, LOC changes, etc.

[Kerber]

I have 2 scales myself maybe I throw one in my car and take it with me to visits. I have 3 certs to do all first 90 days. Never did one before. I was looking at paperwork and I saw mini mental do you use that? I was told to write narrative note that shows decline in past 90 days. My dementia lady haven't really decline she is the same still aggressive can't commumucate word salad when talks hits and spits durning shower. I thought I would weight her she's so skinny

[lifelearningrn, BSN, RN]

Keep one of those scales in the car! Also look for other indicators, clothes looser, size down in briefs, needing more assistance with ADLs, decline in nutrition/fluid intake. We don't use the mini-mental due to licensing rights (or something like that), we use the MOCA. http://www.mocatest.org/pdf_files/test/MoCA-Test-English_7_1.pdf If your facility has no problem using mini-mental, by all means, use it! PPS and FAST are also important. http://geriatrics.uthscsa.edu/tools/Hospice_elegibility_card__Ross_and_Sanchez_Reilly_2008.pdf