Med Pass® Fortified Nutritional Shake Medication Pass Program

Unintended Weight Loss—Identification and Prevention—Post Test

1. Anorexia and weight loss are the most prevalent nutritional disorders found in the LTC setting.
True or False

2. Common conditions associated with undernutrition (malnutrition) include:
a) anemia
b) pressure ulcers
c) cognitive abnormalities
d) all of the above

3. An initial nutritional assessment is key in identifying clinical conditions that may put the resident at risk for unintended weight loss.
True or False

4. Residents identified as “potential for weight loss” will have one or more of the following conditions:
a) dysphagia
b) depression
c) ideal body weight < 90%
d) dehydration
e) all of the above
f) b, and d

5. Providing oral supplementations to residents is one method to meet resident’s nutritional needs.
True or False

6. Oral supplements, such as MED PASS^® 2.0 , given at medication passes promote positive results (weight gain) due to:
a) routine distribution of product by designated personnel
b) small volumes given more frequently
c) flavor and color of product
d) a & b only
e) all of the above

7. Oral supplementations, such as MED PASS^® 2.0, are usually given to residents in the amounts of
(Quantity) cc at medication passes.

8. Oral supplementation, such as MED PASS^® 2.0, can be given to residents prior to assessing their nutritional needs.
True or False

9. Residents receiving oral supplements need to be monitored and evaluated routinely by the interdisciplinary health care team.
True or False

10. Supplements, such as MED PASS^® 2.0, can safely remain on a medication cart up to six hours if product is handled in a sanitary manner.
True or False

Unintended Weight Loss—Identification and Prevention—Post Test Answers

1. True. The prevalence of undernutrition in long term care facilities has been reported to range from 20% – 54%.

2. D – Numerous conditions are associated with undernutrition including anemia, pressure ulcers and cognitive abnormalities.

3. True. A thorough initial nutrition assessment is the key in identifying residents for nutritional risk.

4. F -Dysphagia, depression and dehydration are just three of the numerous conditions that may be associated with potential for weight loss. Ideal body weight at < 90% is not considered a risk factor.

5. True. Oral supplementation is only one method to provide the additional calories and protein that a resident may need.

6. A – Studies have shown that providing small volumes of oral supplementations frequently by designated personnel usually promises weight gain for nutritionally at risk residents.

7. 60 – 90 cc – The success of the program is serving small volumes of supplementation more frequently.

8. False. Residents must be assessed for their nutritional needs by dietetic professionals and the health care team to ensure the appropriate treatment is provided.

9. True. Routine monitoring of the resident by the health care team is essential to ensure positive outcomes are being achieved from the treatment plan.

10. True. MED PASS^® 2.0 can safely remain on a medication cart up to 6 hours as long as product is covered with avoidance of touch contamination. However, residents usually enjoy a chilled product!

MED PASS^® 2.0 Supplement Approval Form

Dear Doctor,

Nutrition intervention is the key in achieving a cost effective weight gain and wound-healing program. Providing additional calories and protein to a resident’s diet, in concentrated form, will help promote weight gain and healing of pressure ulcers or wounds. The interdisciplinary care team at _________________ (Facility Name) has developed a new program using Hormel Health Labs MED PASS^® 2.0 to support weight gain and wound healing for the nutritionally at risk residents. Offering 60-90cc of Med Pass^® 2.0 during routine medication pass allows residents to receive additional calories and protein without interfering with meals.

MED PASS^® 2.0 is a lactose-free, 2 cal/cc formula that contains 480 calories and 20 grams of protein per 8 oz serving (120 cal/5 gm PRO per 2 oz). Administering small amounts of MED PASS^® 2.0 with medications allows for nursing to better document intake as well as improved resident compliance. All supplement intake is recorded by nursing staff just like a medication.

We will be checking resident medications to confirm that there is no contraindication with the consumption of MED PASS^® 2.0.

If you wish to have your patient participate in this program, please complete the form below and return it to the facility (or DON). Upon receiving your form, we will make the appropriate revisions to the physician orders. If you need more information, please contact me. Thank you for your approval.

Sincerely,

Inservice Training—Unintended Weight Loss—Identification and Prevention

Objectives:
Participant will be able to:

understand the relationship of weight loss and common conditions affecting the long term care resident
identify the risk factors associated with unintended weight loss
evaluate effective nutrition intervention programs
implement a MED PASS^® supplementation program
evaluate the effectiveness of a weight management program

PROGRAM OUTLINE:

I. Effects of weight loss and undernutrition

II. Identification of risk factors

III. Effective nutrition intervention program

IV. Implementation of MED PASS^® products program

V. Sanitation Issues

VI. Activities

Attendance of Participants:
MED PASS^® Program

POLICY:

A. Residents identified as nutritionally at risk and exhibit one or more of the following criteria shall be referred to the MED PASS^®* Program. Criteria includes:

Poor acceptance of routine between meal supplements.
Evidence of significant weight loss (5%) over a 30-day period or exhibited a trend of progressive weight loss over 3-6 months (7.5% – 10%).
Inability to tolerate or refusal to accept “normal” volumes of fluids per serving.
Diagnosis or conditions requiring increased calories and protein, i.e. Stage II or greater pressure ulcers, cancer therapy, infection, COPD.
Low body weight (80% or less of ideal body weight or BMI below 19) and intake less than 50% of meals.
B. Residents identified as nutritionally at risk and exhibit the following criteria shall be referred to the MED PASS^® No Sugar Added (NSA) Program.

Diagnosis or conditions requiring increased protein and calories with need for controlled carbohydrate intake, i.e. insulin dependent diabetics with Stage II or greater pressure ulcers or multi pressure ulcer sites.

PROCEDURE:

1. Residents will receive 60-90 cc (2-3 oz) of MED PASS^® 2.0/MED PASS^® Reduced Sugar at each medication pass based on the resident’s individualized medication pass routine, care plan and physician order.

2. MED PASS^® 2.0 provides 120 calories, 5 gm PRO per 2 oz. MED PASS^® Reduced Sugar provides 105 calories, 5 gm PRO and 7.75 gm CHO per 2 oz. serving. (2 – 2 oz. servings daily would equal one CHO exchange.)

3. The MED PASS^® 2.0/MED PASS^® Reduced Sugar order will be placed on the medication administration record (MAR) and signed out as a routine medication or treatment. The amount of MED PASS^® 2.0/MED PASS^® Reduced Sugar taken will be documented on the MAR and signed out by the designated person passing the medications.

4. A full day’s supply of MED PASS^® 2.0/MED PASS^® Reduced Sugar will be delivered from dietary to the nourishment refrigerator located at the nursing Unit on the evening prior to the follow day’s supplement pass. If MED PASS^® 2.0/MED PASS^® Reduced Sugar remains in nourishment refrigerator at the next delivery, the stock will be rotated by designated delivery person to insure the FIFO (first in, first out) principle.

5. If partial containers of MED PASS^® 2.0/MED PASS^® Reduced Sugar are left after a medication pass, the remaining quantity will be stored in the nourishment refrigerator for the next medication pass or no more than 48 hours.

6. Residents receiving MED PASS^® 2.0/MED PASS^® Reduced Sugar Supplements will be evaluated routinely by the consultant dietitian, certified dietary manager and licensed nursing personnel to assess progress toward nutritional goals and to determine need for continuation on the MED PASS^® program.

7. Assignment of residents to the MED PASS^® 2.0/MED PASS^® Reduced Sugar program will be based on the initial nutritional assessment by the consultant dietitian/certified dietary manager and routine nutrition risk monitoring conferences with dietary, nursing and other pertinent disciplines.