Gold Medal Winners of Nutritional Care in Rehabilitation Settings: Using Nutrition to Promote Maximum

Transcription

1 Gold Medal Winners of Nutritional Care in Rehabilitation Settings: Using Nutrition to Promote Maximum Recovery and Rehabilitation Janet S. McKee, MS, RDN, CSG, LD/N President Nutritious Lifestyles Link between Nutritional Status and Rehabilitation Outcomes 1

2 Poor Nutrition and Hydration Status during Rehabilitation can lead to Re-hospitalization and adverse clinical events Typical Rehabilitation Patients Nutritional Spectrum in Rehabilitation Settings Debilitated Undernourished Stroke Post-illness Need Optimal Nutrition Recuperation Participation in therapy Post-surgical Closed Head Injury Complications of Obesity Heart Disease Stroke 2

3 Patients need adequate calories, increased protein, fluids and vitamins and minerals to promote successful rehab. Nutritional Goals during Rehabilitation General Rule: 75% intake of meals Nutrition Therapy during Rehabilitation and resident or family/surrogate choice! 3

4 Young, old and old-old rehab patients need more calories, protein, fiber and fluids! PAIN Poor Appetite Nutrition Needs Differ 4

5 Stroke Rehabilitation Patients Risk high Pre-existing malnutrition Increased calorie-protein needs Protein is needed for neurological cellular and muscle regrowth Nutrition Care and LTC Stroke Rehabilitation Patients are at high risk for malnutrition. Need nutrition TLC. 5

6 Need aggressive nutrition care and high protein diet to promote rehab, build muscle strength, mass and functionality. Risk Factors Dysphagia Polypharmacy Functional disability Eating difficulties Fatigue It requires strength to eat! 6

7 Nutritional Success Care for Stroke Victims Comprehensive Nutritional Assessment by RDN, NDTR, OT and ST team Nutrition and hydration care plans that reflects patient needs and goals Monitoring Give residents good nutrition, choices and what they want Nutrition Keys: High Protein 7

8 Provide feeding support as needed and monitor. Orthopedic Rehabilitation Patients Need increased protein and nutrients to rehab. Good Nutritional Care Promotes Orthopedic Rehab Success 8

9 Customize Nutrition POC Vitamin C and Zinc Supplementation Promotes Healing Comprehensive nutrition assessment by RDN, NDTR and team. 9

10 Rehabilitation after hospitalization At risk Debilitated Protein-calorie malnutrition often present Rehabilitation At high risk for malnutrition and dehydration Eating well is key to healing, quality of life and preventing rehospitalization Adequate Nutrition is a Must Sickest of the sick Honor food preferences Most likely to need fortified foods, vitamins/minerals and oral supplements 10

11 Provide Support at Meals Traumatic Brain Injury Rehabilitation Adequate calories and protein are needed for brain to function Nutrient deficiencies can disrupt brain functioning/rehab Traumatic Brain Injury Rehabilitation (TBI) Need comprehensive assessment by RDN, OT and ST to address dysphagia, eating, drinking/feeding problems 11

12 Customized Resident-Centered Nutrition Plans of Care Temporary Enteral Feeding Needed Spinal Cord Injury Rehabilitation Patients (SCI) At severe nutrition risk 12

13 Spinal Cord Injury Rehabilitation Patients Lower calories and high protein needs High Protein Builds Muscle Monitor Excessive Weight Gain 13

14 Fiber & Fluids Needed Customized Nutrition for Spinal Cord Injury Rehabilitation Comprehensive nutritional plan of care and assessment by RDN and team Some rehab patients require temporary tube feedings to recover and rehab. Goal is to provide adequate calories, protein and fluid to support needs Complications Monitor 14

15 Where Does this Leave Us? Residents at NAR Admitted with PCM Specialized nutrition care needed for rehab and successful discharge Regulations Matter!! F272: Comprehensive individualized assessment of resident s needs, including calories, protein, nutritional needs. Includes: F279: Comprehensive care plan to meet resident s needs and attain or maintain highest level of wellbeing Customized nutrition POC required. Regulations Matter!! F314: No avoidable pressure ulcers; care and services to promote healing of existing pressure ulcers F325: Must maintain nutritional parameters, including weight, unless unavoidable Must assess, develop care plan, monitor and revise plan to prevent avoidable pressure ulcers and/or weight loss 15

16 Good Nutrition Promotes Successful Rehab Create a cultural center in which everyone values good food and nutrition. Include comprehensive nutritional care plans at all phases admission, during rehabilitation and upon discharge Discharge nutritional care and educational plan a must. Need a Road Map TEAM APPROACH It is imperative that rehabilitation patients receive adequate nutrition, including protein, calories and fluids, to heal and optimize rehabilitation prior to discharge!! RDN, OT and ST should be active member of interdisciplinary team. 16

17 However, we can t stop there. Pay For Performance is Here! YOU CAN AVOID REHOSPITALIZATIONS A nutritional discharge plan is necessary to ensure that the patient maintains nutritional status after discharge. 17

18 Nutrition Discharge Planning a Must! Successful Resident-Centered Nutritional Discharge Planning Goals Review goals with family, patient, resident Provide easy-to-read, understandable goal sheet My Nutrition Goals are: Ways I can meet my goals: Who will help me if I need help: I will know I am meeting my goal by: Components of Successful Discharge Planning Education Importance of adequate diet, nutrition and hydration daily and prescriptions Information on assisting patient/resident with eating and preparing foods OT 18

19 Education Easy to read and understand. Components of Successful Discharge Planning Use community resources. Elderly Nutrition Program Congregate meals and Meals on Wheels: derly_nutrition_programs_1.pdf Congregate Meal Centers nutrition screening assessment, education and counseling Meals on Wheels A meal and visit a day can keep malnutrition, relapse and readmission away! 19

20 Components of Successful Discharge Planning Cont. Local Area Agency on Aging Senior Farmers Market Nutrition Program: SNAP Program (food stamps): Local County Extension Agency education Nutrition Services Incentive Program (USDA commodity foods): Local food banks Eldercare Locator: NLS can Help Survey problems? Call us! We provide 24-7 coverage and can help in survey emergencies Visit our webpage at NLS Can Help New Service to meet your staffing needs Dietary Staffing Solutions Temp-to-perm, interim or permanent placement of RDNs, DTRs and CDMs 20