Nutrition 411: The Winning Nutrition Team

Ostomy Wound Management is pleased to introduce a new monthly column to help readers optimize their patients’ nutritional care. A different nutrition topic will be presented each month to provide information to readily put into practice

     While we all recognize body temperature, pulse, blood pressure, and respiratory rate as crucial vital signs of health, many consider nutritional status to be a fifth vital sign. Often, patients present with insidious weight loss, depleted visceral protein stores, and suboptimal food and fluid intake. Knowing how to deal with these challenges can make a difference in the clinical outcome of your patient, particularly in the area of wound healing.

     A facility culture that emphasizes the importance of nutrition is paramount to the success of any multidisciplinary team. Facility administrators must be willing to commit resources to the nutrition department. In long-term care, recent regulatory changes are driving a renewed focus on nutritional care. The revised federal tag for nutrition (F-325) has given the Centers for Medicare and Medicaid Services (CMS) surveyors much clearer guidance on issues such as maintaining nutritional status and prescribing therapeutic diets (see Table 1). In the acute care environment, CMS payment changes relating to pressure ulcers have increased scrutiny regarding optimization of patient nutritional status, even during short hospital stays.

     Nutrition is finally recognized as a major factor critical to health and well being. Proper assessment, treatment, and documentation of nutritional status takes the cooperation and participation of every department — nurses, physicians, pharmacists, social workers, rehabilitation therapists, and family members are all part of the nutrition team. Table 2 lists some of the key information a thorough nutrition assessment must include.

     Today, many nutritional interventions are available. The marketplace offers a multitude of adjunctive amino acid products, protein modules, vitamin and mineral preparations, high-calorie supplements, and meal replacements. Keeping up with developments and research can be time-consuming for even the most conscientious practitioners. The best way to sort science from hype and obtain reliable advice is through your nutrition professionals. The registered dietitian (RD) credential is the gold standard; several other specialty certifications and support personnel work with the RD. For example, a dietetic technician, registered (DTR) works under the supervision of an RD and performs tasks such as obtaining food preferences and a dietary history. Table 3 outlines some of the various nutrition credentials.

     The next time you see a patient with a nutritional concern, remember: You are part of the team. We must all work together to communicate the nutrition message.

Nancy Collins, PhD, RD, LD/N, FAPWCA, is founder and executive director of RD411.com and Wounds411.com. For the past 20 years, she has served as a consultant to healthcare institutions and as a medico-legal expert to law firms involved in healthcare litigation. Correspondence may be sent to Dr. Collins at NCtheRD@aol.com.

Next month’s Nutrition 411: Calculating caloric needs