From the desk of Dr Nancy Collins, PhD, RDN, LD, NWCC, FAND

Nutritional problems are easy to identify at the extremes of the condition. For example, the extremely underweight or overweight patient is easy to spot even for the layperson. However, a patient who appears to be normal weight may have just as many nutritional problems but may not receive the appropriate nutritional interventions post-discharge unless a nutritional screening is performed, and some pointed questions are asked about food habits.

As an example, think of optimal nutritional status as the equivalent of having an umbrella over your head when it is raining. If only one spoke of the umbrella is broken, you will probably remain dry. However, if many are damaged you will certainly get wet. The spokes of the umbrella are equivalent to factors which impact nutritional status. If one of the factors is broken, the patient’s nutritional status may only be mildly compromised. As more factors are compromised, the patient’s nutritional status begins a downward spiral that can interfere with recovery, wound healing, and independent living once discharged from the hospital.

For this reason, home caregivers and discharge planners must ask appropriate nutritional questions to be certain the patient has all he or she will need to continue wound healing post-discharge. The following are areas to focus on.

• Perform a nutritional screening for every patient. A simple and validated screening tool is easy to incorporate into an initial visit. One such tool is called Determine Your Nutritional Health, or more commonly the Determine Checklist. This screening tool highlights the factors that play a role in the determination of nutritional status. The ten questions fall into three major groups: economic status of the person, health status of the person, and food and psychosocial issues. When you identify a nutrition-related concern, include it in your documentation, notify the physician, and consult a registered dietitian nutritionist (RDN) if necessary.

• Ask questions about the economic status of your patient, especially in the current inflationary times. Most government food programs assist people who live at less than 130% of the poverty level. However, it is not one set number. It depends on the state, and how many people live in the household. If food insecurity is a problem, connect your patient with food banks and assistance programs. Wound healing requires adequate energy (also known as calories) and protein daily.

• Although unintended weight change is not a specific disease or condition, it is a good barometer that something is wrong. Obtaining an accurate measure of body weight at regular intervals is paramount so that trends can be identified in a timely fashion. Try to weigh the patient wearing the same type of clothing each visit and about the same time of day for consistency.

• Be knowledgeable of grocery stores or food markets in the local area where patients may shop. Include questions about shopping and food preparation in your conversations with your client. Peek in the refrigerator to see what they have on hand.

• Don’t accept pat answers about food and mealtimes. Just because one meal was good, doesn’t mean the rest of the meals were equally stellar. Remember, patients tell you what you want to hear. It is often the probing follow-up questions that get down to what you really want to know.

• Suggest nutritional supplements to fill in nutritional gaps. Medtrition offers something to meet everyone’s special needs. For wound healing, Expedite provides targeted ingredients including the collagen peptides Prolyl-Hydroxyproline (PO) and Hydroxyprolyl Glycine (OG) in either a 2-oz liquid or a 2-oz gelled cup. Gelatein protein supplements are 4-oz gelled cups and are easily served between meals as a tasty dessert. ProSource liquid protein supplements are another option to help patients meet protein needs in a small 1-oz serving especially good for patients with small appetites or volume concerns. These products can be conveniently ordered for home use on Amazon or directly from Medtrition at https://store.medtrition.com/.

By knowing the factors or spokes of sound nutrition in your patients, you can assess your patient’s ability to improve their nutritional health after hospital discharge. Early identification of the broken spokes and then creating care plans to strengthen them will help your patient have the best chance of a successful recovery and wound healing through the transition from hospital to home.

References
A copy of the Determine Checklist can be downloaded at https://acl.gov/sites/default/files/nutrition/NSI_checklist_508%20with%20citation.pdf