Regulation Matters 2020 - Issue 1, May

Are You a Dietitian in Long-Term Care?

We are seeking your input.

Recently, we received a report from the Chief Coroner of Ontario prepared by the Geriatric and Long-Term Care Review Committee (GLTCRC) resulting from the inquiry into the death of a 76-year-old male resident in a long-term care (LTC) home. The report included recommendations for more detailed documentation of oral intake of food and fluid for long-term care residents.

In their inquiry, the GLTCRC found that prior to his death, the resident was falling, had behavioural deterioration related to delirium, abnormal lab values and was not eating well.  He also had a history of diabetes, recent episodes of watery diarrhea, and was experiencing a significant weight loss. His food and fluid intake were not documented on most days and there was no review of the daily dietary flow sheets, which might have flagged the resident’s low fluid intake. No referral was sent to the dietitian for review during that time.

The Committee reported that a more comprehensive documentation of food intake could have alerted the health care team that this resident was at risk, and that further interventions were required. His chart showed limited evaluation of intake on his diabetes management and bowel issues. Although this did not lead to his death, a better evaluation and documentation of food intake may well have prompted further assessment from the medical care team.

Every Effort Should Be Made to Determine Estimated Food Intake

Aside from recommendations to the College of Physicians and Surgeons, the College of Nurses of Ontario, the LTC home involved and the Ministry of Long-Term Care, the GLTCRC issued the following recommendation to Ontario Long-Term Care Clinicians, the College of Dietitians of Ontario, and the Ontario Society of Nutrition Management:
When conducting assessments of high-risk residents in long-term care homes, every effort should be made to determine estimated food intake. An entry of “not applicable / not available” is insufficient.”

The College agrees with the GLTCRC’s recommendation that every effort should be made to document the estimated food intake of residents in LTC.

Our understanding is that dietitians are not typically involved in documenting oral food and fluid intake, however, they do rely on this information to conduct nutrition assessments.
Dietitians working in LTC who are directly responsible for documenting oral food and fluid intake should make every effort to determine and document the intake. If they are not directly responsible for documenting food and fluid intake, they should work with their interdisciplinary colleagues to ensure this work is completed.

We Would Appreciate Your Thoughts

If you are a dietitian working in long term care, we would appreciate your thoughts on the documentation of oral food and fluid intake. Please take time to give us your feedback in the comment box below. We will share your collective thoughts in a future newsletter article.
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