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Shawford Lodge Aegis, WA - Nutrition Project - awarded 2010

Aegis Shawford Lodge, WA

Shawford Lodge Aegis is another Better Practice in Aged Care Award winner for the Nutrition Project developed to reduce potential malnutrition through nutrition screening, weight monitoring and the implementation of nutrition support.

A combined clinical and hospitality project to standardise the home’s approach to weight monitoring, identification and treatment of possible malnutrition.

The home undertook an organisation-wide audit that identified:

  • Inconsistency across the group of homes and even within the individual sites
  • There was no weighing of residents in some instances. “We just look at the resident and can see they’ve lost weight”
  • Different methods to track weights
  • Malnutrition wasn’t understood. ‘We didn’t know what malnutrition was’
  • The type of residents who could be at risk was not understood.
  • No clear process to clarify what happens after weight loss was identified. In some instances, no action was taken.
  • No clear system to identify residents’ special diets, supplements and fluid thickening. White board listings were common.
  • Inconsistent methods of providing dietary supplements, frequently based on personal preferences of Clinical Managers or Registered Nurses.

A literature search was conducted to determine if there was a validated screening tool to identify risk of malnutrition for residents in aged care. The Mini Nutritional Assessment (MNA) was selected as the gold standard for identifying “at risk” residents for malnutrition. Clinical staff were trained and deemed “competent” at using the tool and a flowchart was developed to direct clinical staff with their decision making for nutrition support. Nutritional smoothies were developed and made in the kitchens for those residents deemed “at risk”. Each home has a “nutrition champion” leading the nutrition project. Each step was documented as “project updates” to ensure clarity of expectations and also celebrate project and resident achievements along the way. A strong partnership between hospitality services and the clinical care team ensured greater success of the nutrition project. Resident focus remains a priority and determines preference for flavours of smoothies and diet. Resident feedback is considered to improve the smoothie recipes. The nutrition project team are now trialing a reduced volume recipe using resident and staff feedback.

 Here is what the Nutrition Project achieved.

  • The nutrition project team researched the evidence for best practice in resident nutrition assessment and implementation of actions to avoid malnutrition.
  • Introduced a validated instrument for assessing risk of malnutrition in residents.
  • Educated staff, including professional reading for Registered Nurses within a “nutrition information pack”.
  • Introduced a standardised approach for initial supplementation with nourishing smoothies made in kitchen.  The intent of the smoothie is that the Registered Nurse can initiate a supplement without referral to dietitian where required. By introducing a nutritional smoothie early enough, health risks to residents associated with malnutrition can be reduced.
  • Introduced a flow chart to guide staff in their practice.
  • Nutritional risk assessment policy and procedure endorsed.
  • Staff awareness and knowledge improved.
  • Clinical staff are competent and can make clinical judgements.
  • Provision of appropriate scales for accurate weight monitoring
  • Menu standardised throughout group and now includes texture-modified diets.
  • Residents who had a smooth pureed diet and were missing out on snacks now have planned menu.
  • All jugs of fluids are labeled. Colour-coded stickers are used for fluids with thickener as required by the Australian Standards for Texture Modified Food and Fluids.
  • Staff competency for nutritional tool and texture modified food and fluids developed. This has been implemented across the group. All kitchen and care staff deemed competent with texture modified food and fluids using the same product.

 

The success of the project has been a team effort. The Nutrition project has proven to be sustainable long term, even with changes in key staff. The Nutrition project provides a focus which is holistic and resident centered - our key priority

A formal evaluation of the project was conducted in March 2009. Staff and residents provide feedback as part of their continuous improvement plan. The Nutrition project team now have data on residents risk status for malnutrition, where previously there was none, and the Nutrition project has implemented nutritional smoothies where required by residents. Staff have clear direction nutritional support within the overall care for residents.