Monitoring Patients

Poor food intake, even in a well-nourished patient, can extend the hospital stay. As with body weight, this is a ‘vital statistic’ to understand how the patient is recovering.  An accurate body weight at admission and weekly during admission is considered a standard care for all patients. Weight can change quickly due to fluid loss or gain. Being immobile can also result in rapid loss of muscle tissue, especially if a patient is unwell. A rapid weight loss is also an indication of dehydration (unless the patient is edematous), which can cause serious consequences such as delirium, adverse drug reactions and even death.

Low intake is typically defined as ≤50% of the tray. A variety of models can be used for food intake monitoring. Many hospitals will already have some form of food intake monitoring (e.g. nurse flow sheets, vital stats reports etc.), so the focus can be on making sure it is completed regularly, portion of food consumed recorded accurately, and that low intake is connected to an action. One option of monitoring is the My Meal Intake Tool (MMIT) (http://www.nutritioncareincanada.ca/sites/default/uploads/files/My-Mealtime-Intake.pdf). The MMIT has been developed and tested with older patients, and can be completed by patients with adequate cognition, family or a staff member.

If staff complete the food monitoring, education on portion size estimation is particularly important. Pictures of portions of food/trays consumed are helpful for training and as reminders in patient rooms. Education can take many forms including a presentation, reviewing tools, and working with individual staff members on steps in the process. Remember to include training on what to do with the information on low intake, whether it be recorded from MMIT or nursing documentation. There is no point in monitoring food intake if an action to improve intake does not occur when it is low!

Communication of low food intake when it occurs is necessary. Work with staff members that are completing food monitoring to build a process that is feasible and develop buy-in for this improvement in practice. Key to implementing monitoring is to train and motivate staff so they can recognize the importance, accurately monitor intake and connect low intake to an action by identifying the reason for the low intake. Low intake does not always mean referral to a dietitian is necessary. For example, if it is identified that the patient does not like the food, food preferences can be accommodated.

Admission weights and routine monitoring of patient body weight during hospitalization are an important standard care practice. If objective measures of admission weight are not being done, start with educating staff on the importance of this vital statistic to the care and recovery of the patient. Getting regular weights completed during hospitalization can be difficult and there will likely be resistance from staff. However, once started, most staff recognize it does not take long, is fairly easy to do, and it benefits multiple staff. Making weights a routine, such as having a “weigh day” for all patients on the unit, is important for sustainability.