Malnutrition can develop quickly in hospital, so it is important that food intake and body weight monitoring occurs for all patients.
Why do we need to monitor nutrition in hospital? (expand +/-)
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.
How do I measure food intake? (expand +/-)
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!
How do I connect food monitoring to treatment? (expand +/-)
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.
How do I start regular measurement of body weight during hospitalization? (expand +/-)
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.
Food Intake Monitoring:
Models of Food Intake Monitoring
Models of food intake monitoring based on the examples from the More-2-Eat sites.
My Meal Intake Tool: Guidance Document
This form explains how the patient or family member is to complete the My Meal Intake Tool.
Visual Estimation of Food Intake Form
Tired of “calorie counts” because they are not completed accurately and no one has time to analyze the results? Try using this quick form to estimate the percentage of food and fluid intake that a patient consumes at meals and snacks. The Canadian Malnutrition Task Force reported that eating less than 50% of the food and fluids provided is an independent risk factor for malnutrition. This quick, simple tool can provide valuable results.
Food Monitoring Tools Presentation
This PowerPoint presentation explains how and when to use the My Meal Intake Tool (M-MIT) and the Mealtime Audit Tool (MAT)
Documenting Food Intake:
Patient Meal Intake Record
This form is placed on the door of a patients’ room and is completed for every meal. When the form is full, it is placed in the chart. The staff info sheet for this document is available here.
This whiteboard is from an Accountable Care Unit that has incorporated food intake monitoring into their design. At this site, the food service worker delivering the tray moves the magnet to the correct percentage. A nurse can also document intake.
Examples of posters used to train staff to accurately monitoring food intake. These posters can be placed on the unit or in a patient’s room.
Example 2 (Note: For this example, the food is the percent of the total for the meal).
Example 3 (Note: For this example, the food is the percent of the total for the meal).
Weight Monitoring Training
This PowerPoint can be used to demonstrate the importance of taking regular and accurate weights.
This is a template that can be used for recording regular weights before adding into the chart.
Reminder about Weights
This poster template can be used as a reminder to zero the beds for hospitals with bed scales.
This site can provide you with the necessary equipment for obtaining anthropometric measurements. Equipment used in the Nutrition Care in Canadian Hospitals study included: digital chair scale, knee-height caliper, portable stadiometre, dynamometer and measuring tape. http://www.weighandmeasure.com/
Acknowledgment: The ideas and resources included on this page are provided in part by the hospitals involved in the More-2-Eat project.