MAXIMIZING CL INICAL OUT COME S BY MINIMIZING DIE T ARY DE F - PowerPoint PPT Presentation

MAXIMIZING CL INICAL OUT COME S BY MINIMIZING DIE T ARY DE F ICIE NCIE S: A MUL T IDISCIPL INARY APPROACH Appra ise a nd Asse ss the Nutritiona l & Die ta ry Ma na g e me nt of the Comple x L T C r e side nt fr om the nur sing pe r spe c tive

CMS RE GUL AT ORY GUIDE L INE S F OR L T C Qua lity of L ife Die ta ry Se rvic e s  F - 240 Qua lity o f L ife  F - 363 Me nus a nd Nutritio na l Ade q ua c y  F - 241 Dig nity  F - 365 F o o d Me e ts I ndividua l Ne e ds  F - 325 Nutritio n  F - 367 T he ra pe utic Die ts  F - 327 Hydra tio n Re side nt Asse ssme nt CASPE R Me tric s  F - 272 Co mpre he nsive Asse ssme nt  Ce rtifie d And Surve y Pro vide r E nha nc e d Re po rts Qua lity of Ca re MDS  F - 314 Pre ssure Ulc e rs  Minimum Da ta Se t: Pro vide r/ Sta te / Na tio na l  F - 321 Na so g a stric T ub e s b e nc hma rks  F - 322 Se rvic e s to Pre ve nt Aspira tio n  Nursing Ho me Co mpa re De nta l  5 ST AR Nursing Ho me Qua lity Ra ting Syste m  F - 412 Nursing F a c ilitie s De nta l Se rvic e s

NE CE SSARY, MUL T IF ACE T E D… AND CHAL L E NGING F OR T HE MUL T IDISCIPL INARY T E AM Coa lition of or g a niza tions a nd individua ls to c ha ng e the c ulture of a g ing a nd long te rm c a re “Pe rson Ce nte re d Ca re ” Pre mise o f pe rso n c e nte re d c a re a pplie s to a ll disc ipline s, e spe c ia lly nursing a nd die ta ry: Re side nt should pa rta ke in : • Die ta ry a nd me a ltime de c isio ns • Who re side nt dine s with • Whic h fo o ds a re o ffe re d • Ho w fo o ds a re o ffe re d • Re side nt c ho ic e s stro ng ly influe nc e q ua lity o f c a re a nd q ua lity o f life , multidisc iplina ry te a m is c ha lle ng e d to mitig a te po te ntia l risks, a sso c ia te d with tho se c ho ic e s • Pro viding c ho ic e s a re b a c ke d b y re se a rc h a nd CMS re g ula tio ns • Dining e xpe rie nc e is so c ia l b ut ye t c a n b e c ha lle ng ing b a se d o n o ur a g ing po pula tio n • Va st diffe re nc e s in the ne e ds o f o ur e lde rs • Ong o ing g o a l to de ve lo pme nt sta nda rds fo r dining pra c tic e whic h suppo rt individua lize d c a re a nd se lf dire c te d living ve rsus tra ditio na l dia g no sis-fo c use d tre a tme nt

T RANSIT IONS IN T RADIT IONAL L T C HOME S  Glute n F re e Ma ny of our L T C home s  Re g ula r/ L ib e ra lize d ha ve tra nsforme d into  Sma ll a nd la rg e po rtio ns Post Ac ute / L T C home s  No Sa lt a dde d … . And now fa c ing the  Dyspha g ia a dva nc e d c ha lle ng e of  2 Gm So dium ma na g ing short sta y  Dyspha g ia pure e pa tie nts a nd L T C  Co nsiste nt Ca rb o hydra te re side nts in the ir  Cho ppe d/ g ro und me a ts home s… .  He a rt He a lthy  T T oo ma ny diffe re nc e s hic ke ne d liq uids:  L ib e ra lize d Re na l - T hin - Ne c ta r-like - Ho ne y-like - Spo o n – thic k

NURSING PE RSPE CT IVE KE Y: E ARL Y ASSE SSME NT AND IDE NT IF ICAT ION Dise a se a nd func tiona l de c line c an affe c t an individuals ability to swallow, food or fluid; this inability c an r e sult in c hoking and/ or aspir ation Diffic ulty with swa llowing or dyspha g ia c a n inc re a se the individua ls risk of : • Ma lnutritio n • De hydra tio n • Aspira tio n Pne umo nia • Unne c e ssa ry Ho spita liza tio n I MPORT ANT to I de ntify Dyspha g ia – Swa llo wing Co nc e rns Nursing 's E a rly Asse ssme nt a nd Ide ntific a tion of Dyspha g ia or a ny swa llowing c onc e rns will: • Ma inta in nutritio na l re q uire me nts • Pro te c t the a irwa y during swa llo wing • Pre ve nting a ny a dditio na l c o mplic a tio ns

ROL E OF NURSING ST AF F Nursing sta ff a re ofte n the first pe rsons to r e c og nize the sig ns a nd symptoms of dyspha g ia . Norma l re sponse to dyspha g ia is c oug hing , a bnorma l is sile nc e Nursing sta ff re c og nizing the c linic a l signs of aspir ation is c r itic al • F e ve r • Sho rtne ss o f bre a th • We a kne ss • Co ug hing • T hic k, c o lo re d sputum Nursing Asse ssme nt • Re vie w o f Re side nt histo ry/ c ha rt to ide ntify risk fa c to rs/ unde rlying c o nditio ns fo r dyspha g ia • Ne uro musc ula r dise a se • Pulmo na ry issue s/ Pne umo nia • He a d a nd Ne c k Ca nc e r • De me ntia • Bra in Ca nc e r / Me ta sta tic Ca nc e r • Stro ke • Ora l He a lth / Po o r o ra l c a re / Physio lo g ic al c ha ng e s • Ag ing • Me dic a tio ns –po lypha rma c y • UT I

ROL E OF NURSING ST AF F Nursing Asse ssme nt/ Inte rvie w Nur sing Physic al Asse ssme nt Ask a nd/ o r o b se rve Re vie w o f re side nts:  F  o o d stic king Ab ility to ma na g e fo o d – o b se rva tio n during me a ls,  Cha ng e s in ta ste me dic a tio n pa sse s  Co ug h with fo o d o r liq uids b e fo re ,  Swa llo wing func tio n during o r a fte r swa llo wing  Po sitio ning  Co ug hing b e twe e n me a ls  Che st a nd Ce rvic a l Ausc ulta tio n  Ac ute o r c hro nic we ig ht lo ss  L e ve ls o f a wa re ne ss- Co g nitio n  E xc e ssive o ra l se c re tio ns  Airwa y pro te c tio n  Cha ng e s o r ina b ility to ma na g e spe c ific te xture s o f fo o ds  So c ia l c ha ng e s re la te d to dining  F a mily re c o g nitio n

ROL E OF NURSING … . IN NUT RIT IONAL AND DIE T ARY MANAGE ME NT Nur sing sta ff a r e ke y in the imple me nta tion of : • Ma na g ing c o mpe nsa to ry stra te g ie s, whic h a re individua lize d fo r e ac h re side nt • Re info rc ing a ppro a c h to nutritio n/ hydra tio n • T e c hniq ue s • Po sitio ning • Minimizing distra c tio ns • Re info rc ing re side nt re c e ive d re c o mme nde d die t/ liq uid le ve ls

ROL E OF NURSING ST AF F ( Continue d ) Nursing sta ff a re ke y in the imple me nta tion of : Co mmunic a tio n o f c ha ng e s/ info rma tio n to the physic ia n, sta ff, fa mily a nd o the r c a re pa rtne rs Me thods of tube fe e ding s: • F lush • Bo lus F e e ding s • Co ntinuo us F e e ding s • T o le ra nc e / I nto le ra nc e to fe e ding • Mo tility/ dysmo tility • Sto ma Ide ntifying the ne e d for a re fe rra l / e va lua tion by SL P • Nursing re info rc e s the re ha b ilita tio n o f e a c h sta g e in swa llo w a s dire c te d b y SL P • Spe c ific po sitio ning during o ra l inta ke • Supe rvisio n • Cue ing • Assista nc e • Spe c ia l e q uipme nt a va ila b le during me a ls

MUL T IDISCIPL INARY APPROACH Alo ng with the c urre nt tre nds o f po pula tio n a g ing , c hro nic c ha ng e s in mo rb idity, func tio na l impa irme nt o f he a lth, pro g re ssive c o mple xity o f c a re c o nte nt, the e lo ng a tio n o f the c a ring pe rio d a nd the c o nse q ue nc e s o f the se tre nds, o ur wo rld o f lo ng -te rm c a re ha s b e c o me mo re c ha lle ng ing tha n e ve r. Nursing is just o ne o f the ma ny c a re pro vide rs tha t ma ke a diffe re nc e in the live s o f o ur e lde rs. Our ro le is va st b ut ma na g ing the nutritio na l a nd die ta ry ne e ds o f o ur e lde rs is CRI T I CAL