40 – 85% of patients and nursing home residents experience protein-calorie malnutrition, which promotes involuntary weight loss, pressure wound development, poor wound healing and other negative patient or resident outcomes. Because malnutrition and many of its unintended consequences can often be prevented, appropriate recognition and management of malnutrition or the risk for malnutrition is of primary importance in assessing the status of patients and residents.
An evaluation of the nutritional assessment, care planning, interventions and monitoring should be completed for each case involving malnutrition, weight loss or pressure wounds. Janet McKee, a nutritional expert, exposes the practices that lead to malnutrition. This interactive webinar provides the knowledge to determine when nutrition is a key issue in case evaluations and screening a claim for merit.
This program will help you to:
- Identify the signs and symptoms of malnutrition and the cascade of negative outcomes promoted by malnutrition
- Identify the medical nutrition therapy documentation required by the nutrition standards of care
- Determine when a nutrition expert may be needed to help support your claims or defend your case
This webinar is narrated by Janet McKee and is presented with Powerpoint slides. Viewers will have an opportunity to download the slides in advance of the program.
Audience: Defense and plaintiff attorneys, legal nurse consultants, and healthcare providers
Janet S. McKee, MS RD CSG LD/N DAPWCA has been a registered and licensed dietitian for over 25 years. Ms. McKee is the president and owner of Nutritious Lifestyles, Inc. Nutritious Lifestyles has a staff of 35 registered dietitians and allied nutrition professionals that offer nutrition consulting services to the health care and foodservice industry in Florida, as well as nationally. Ms. McKee is a nationally recognized author, presenter, and nutrition liability expert. Ms. McKee has provided consultation to healthcare organizations and to legal professionals, including attorneys, legal nurse consultants, educators, risk managers, and insurance personnel, for over 15 years. Ms. McKee has also spoken at numerous state and national healthcare conferences. Ms. McKee’s special topics of interest and expertise include the nutritional care of adult, geriatric and bariatric patients and residents, as well as nutritional therapy for the prevention and treatment of protein-calorie malnutrition, dehydration, and pressure ulcers.
Moderator: Patricia Iyer, who has 22-years of experience as a legal nurse consultant.
Excerpt from Feinsod, F. and Riggs, A, “Defending Long-Term Care Facilities: Unraveling Clinical Outcomes from the Natural History of Aging” in Patricia Iyer, Editor) Nursing Home Litigation: Investigation and Case Preparation, Second Edition:
Weight loss and concomitant protein calorie malnutrition have major implications for prognosis as well as predispose individuals to pressure ulcer risk, falls, and infections. Indeed, clinical outcomes can be correlated with weight. Weight loss is a common problem in frail, elderly residents in LTC facilities and can evolve from a number of causes.
Nutritional health requires the complex interaction of psychosocial, environmental, medical, and functional systems. Identifying contributing issues can be complex. This includes ensuring that residents are served the correct diet (including consistency, texture, temperature, and so on). In addition, residents should be observed for ability to sequence eating tasks. Demented residents may be overwhelmed by large portions and do better with multiple small portions at a time or throughout the day. Demented residents may have to be followed with food as they ambulate if they are unable to sit for meals. Unpleasant table mates may discourage appetite. Other contributors to weight loss, include medications that can alter sense of taste and decrease appetite, alter swallowing ability, increase confusion or sedation, cause nausea or diarrhea, or increase movement disorders that interfere with getting food to the mouth. Dental abscesses may disrupt appetite by causing pain or malaise.
Chronic or acute pain, until adequately treated, can markedly affect appetite. Treatable endocrine etiologies should be considered such as thyroid dysfunction or uncontrolled diabetes. Depression, dementia or other psychiatric etiologies may also exert major effects on eating.
Special and invasive procedures can be disruptive to cognitively impaired residents and should be carried out with family (or proxy) permission and coordinated with resident (and/or proxy) expectations. This includes speech therapy intervention as well as modified barium swallows. PEG tubes are ethically complex and benefit has not been established in demented populations.
Decisions to use or not use such interventions should be discussed with the resident (and/or proxy) in detail and should not necessarily be considered standard of care.