IMPROVING THE NUTRITIONAL HEALTH OF THE GERIATRIC POPULATION.

1. IMPROVING THE NUTRITIONAL HEALTH OF THE GERIATRIC POPULATION. KATHY GARCIA RN AND KATHERINE RUSSELL RN. WCMC. TELEMETRY .

2. Introduction Geriatric patient population nutritional requirements are not consistently met. This situation is a concern which could potentially prolong length of hospital stay and long term recovery. Plan developed to increase awareness and educate staff concerning this issue.

3. Target Population: Telemetry unit. Geriatric patients. Families of patients. RN�s and PCA�s. Dietary support staff.

4. Unit for implementation: 24 bed acute med/surg telemetry unit. Staffing matrix is 5 RN�s and 3 PCA�s Majority of patients are over 65 and suffer from chronic illnesses such as CHF and diabetes. Dietitian available on a daily basis for referrals.

5. Observations: Elderly patients often do not understand the meal ordering process. Necessary dietary referrals are often missed on admission. Patients do not receive help required with meals, cutting up food, opening packets and arranging tray for ease in eating

6. Observations cont: Trays are left untouched for too long and food becomes less appetizing. Patients are often fed without any personalized care for the task. Intake and output are not accurately documented in a consistent manner. Patients experience frustration with selection and delay in receiving meals.

7. Potential Benefits/Goals: Improve patient, family satisfaction. Improve nurse satisfaction. Decrease length of stay. Improve utilization of food available. Assist in better wound healing. Enhance clinical outcomes. Increase patient self esteem and dignity. More accurately detect malnutrition with closer staff interventions

8. Resources. Dietician. Nurse manager. Nurse educator. RN�s.

9. Personnel Effected: RN�s. PCA�s. Dietary support staff. Patients and families.

10. Review of literature: Malnutrition can go easily undetected without staff intervention.(Hartford institute Jan 2008). Maintaining a sound nutritional status is important for the health and functional capacity of the elderly patient. (Elipoulos 2001). New research shows that nutrition may be critical in the prognosis and treatment of CHF patients.(Delorgil et al Sept 2005).

11. Review of Literature Mezey, Mathy D. Fulmer Mezey, Mathy D., Terry. Geriatric Nursing protocols for best practice. Geriatric Nursing protocols for best practice. 2nd Ed, Ivo Abraham, Deanne Zwicker. New York, 2003. Morley, John E. �Anorexia of aging:Physiology and pathologic.� The American Journal of clinical Nutrition. June 1997. April 2008 http://www.ajcn.org Delorgeril, Michel. Salen, Patricia. Defaye, Pascal.� Importance of nutrition in chronic heart failure patients�. European heart journal. Sept 2005. <http.://eurheartj.oxfordjournals.org> Eliopoulos, Charlotte. Gerontological Nursing. 5th Ed. Philadelphia, Lipincott, Williams + Wilkins, 2001. Amella, Elaine. �Assessment and management of mealtime difficulties.� Hartford institute for geriatric nursing. Jan 2008. May 2008 http ://consultgerirn.org/topics/mealtime_difficulties.

12. Expected outcomes: Nurses more aware of importance of initial nutritional screening and make earlier referrals to dietician. Nurses and PCA�s more proactive in assisting patients with meals. Improved documentation of intake and output. Increased patient and family satisfaction. Closer communication between nurses,PCA�s and dietary staff.

13. Project Methodology: Literature review. Meeting with dietician to review current nutrition policy. Meeting with nurse manager to discuss concerns and present proposal. Conversation with dietary support staff to enlist their help. Development of power point presentation. Staff inservice. Feb 2008 � ongoing.

14. Activities. Provided inservice for RNs and PCA�s. Met with dietician and arranged for RN�s and dietician to meet 3 times a week to discuss patients nutritional requirements. Arranged for food services to be more proactive at notifying nurse when tray arrives and is taken away. Met with nurse manager to improve I+O form and request that nutritional supplements are available as floor stock.

15. Projected Cost Analysis Workshop education for RN�s: $1632. RN brainstorming time: $1088. Lamination and posterboard supplies: $50. Total cost: $2770.

16. Evaluation of project: Receptive staff. Support from nurse manager. Interesting topic. Patient and family satisfaction increased when they receive necessary help. Staff more aware of importance of nutritional screening. Observed that nurses/PCA�s more personally involved with patients during mealtimes.

17. Evaluation of project: Limited time available for CAP project. Ongoing process small changes made but education and encouragement needs to continue. Dietician unreceptive. Inadequate or inconsistent assessment of daily data.

18. Road blocks! Some members of staff unmotivated. Very busy unit where consistency is difficult to maintain. Common for unit to be short staffed. Constant turnover of staff. SSP staff frequently working on unit.

19. Conclusion. Difficult to measure outcome in numerical terms. Improvement in the process. Ongoing need for education and development.

20. Thank You !