Nutrition 411: 3rd Annual Nutrition Best Practices, Tips, Tricks, and Techniques
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In this annual “innovations” column, registered dietitians from across the United States offer their best practices, tips, tricks, and techniques for dealing with unintended weight loss and wounds to help improve the level of care we offer when faced with these challenging problems.
Often patients with unintended weight loss, malnutrition, or wounds who live at home do not have the energy to shop for food or prepare meals. In addition, many caregivers lack cooking skills for special diets. One solution is to have meals delivered to the home. National and local meal providers are available, including Meals On Wheels, Mom’s Meals, or local providers who may deliver meals. Mom’s Meals, for example, has meals for diabetic, heart health, gluten-free, renal, vegetarian, and low-sodium diets. These fresh meals are delivered by FedEx® and keep in the refrigerator for up to 18 days. Just heat and eat. Ask the meal providers in your area if they are able to provide meals for people on special diets. — Dee Sandquist, MS, RD, LD, CDE, Fairfield, IA
Each of the standard diets we use is listed with a description that includes high-calorie/high-protein supplements as part of the diet order. Once the attending physician signs off on the diet order, we can determine which supplements the patients will accept and start them immediately. The charge nurse gives the protein modules as part of the medication administration record (MAR) rather than giving them with meals, which the patients may not eat. In this way, we are sure of what the patients have accepted, because the nurse must initial the MAR when the item is given. — Stephanie A. Perez, MS, RD, Pomona, NJ
For patients with reduced volume tolerance and increased nutrient needs, I developed simplified, flavorful recipes using everyday ingredients in six food categories: beverages, breads and cereals, desserts, main dishes, side dishes, and soups and sauces. Flavorful Fortified Food— Recipes to Enrich Life includes a collection of 60 tested recipes by authors Digna Cassens, MHA, RD, and Linda S. Eck Mills, MBA, RD, FADA. The recipes, from sweet to savory, are appropriate for various textures and include helpful hints to make changes to further expand the variety offered. In quantities of one or 10 portions, they are practical for home or community use. Many of these recipes become favorites of residents, staff, and families. The recipe for peanut-butter cup pudding was frequently requested by residents who were refusing any other supplement or food. A cereal recipe packs 700 calories in 1 cup and is easily accepted by the very weak and cachectic. The book also includes dairy-free recipes for those unable to tolerate dairy products. — Digna Cassens, MHA, RD, La Habra, CA
What is effective for one resident may not work for another, which is why individualizing interventions is so important. I prefer not to use standing orders for additional food and/or supplements, but rather to review each patient and decide what intervention will work best for that individual. Some will accept food; others prefer supplements. Some residents like more meat on their tray; others want more dessert. I have one patient who has lived off Hershey’s Kisses® and chocolate Ensure®, six each day for many years! Not all interventions are food-related. Sometimes speech therapy and consistency changes, feeding assistance, or changing the dining environment is all that is needed to help a resident maintain or improve their nutritional status. — Elizabeth Friedrich, MPH, RD, CSG, LDN, Salisbury, NC
Timeliness of nutrition interventions is my tip! The best process is when weekly weights are obtained on a scheduled day by the same person and reported by the next day.