Surveyors are frequently asking the RD’s during their annual CMS survey to explain their “Nutrition Care Process”. One of our Vice Presidents has recently been in three different surveys and was asked this question in each survey. This RD shared the following process with all three surveyors, who each praised her for her process.
- Step 1:
a) Interview the resident, preferably within 72 hours of admission, for food preferences i.e.: what to eat, where to eat, with whom to eat, and when to eat.
b) Identify any swallowing disorder or other high-risk factors, i.e., weight variance, pressure injuries, Tube Feeding (TF), Total Parenteral Nutrition (TPN), Ventilator, poor PO (oral) intake, and/or dialysis.
c) Note the resident’s agreement with the diet, consistency and fortified foods ordered.
- Step 2: Complete the Minimum Data Set (MDS) and Care Area Assessment (CAA) per Assessment Reference Dates (ARD).
- Step 3: Complete Initial Assessment within 7-14 days (some states require 7 days). For Patient Driven Payment Model (PDPM) do a 7 day look back.
- Step 4: Monthly and Quarterly chart on residents with poor PO intake, weight variances, pressure injuries, TF/TPN, Dialysis, Vents, and abnormal labs.
- Step 5: Quarterly chart on Low/Moderate risk residents.
- Step 6: Make clinical recommendations in a timely manner after each assessment and confirm implementation.
- Step 7: Complete a 48 hour and Comprehensive Care Plan within 7-14 days following the assessments.
- Step 8: Weekly a High-Risk Team Meeting is held to review the following: New Admits for the first month, poor PO intake, weight variances, pressure injuries, dialysis, TF/TPN, Vents and abnormal labs.
- Step 9: Complete an annual assessment/MDS/CAA and updated care plan.