An administrator called me last week and asked, “What’s the purpose of the quarterly nutrition assessment? Corporate just sent me a 13-page quarterly nutrition assessment. Is that really necessary?”
F276 Quarterly Review states the resident’s assessment is updated at least quarterly. Keep in mind CMS’ idea of assessment is the MDS, not the assessment piece completed by the RD. The question F276 asks, “ is the quarterly review of the resident’s condition consistent with information in the progress notes, plan of care, and your resident observation and interviews?” In other words, is the MDS completed accurately based on information found in the chart, through resident interview and observation.
Let’s start with observation & interviews. Bottom line, CMS wants you to observe your residents eating at least once a quarter. Hopefully you’re more attentive than that, but at a minimum have someone take a peek in the dining room every 92 days (don’t forget it’s a 7-day look behind
for section K). Same goes for talking with the resident, family, and/or staff about nutrition and food preferences. Document in the medical record what you observed and heard from the resident, family, or other health care professional. If you see a problem refer to the RD. If you are the RD assess the data and determine if there is a nutritional problem, etc.
The care plan has a measurable goal and multiple approaches intended to move the resident toward the goal. CMS is saying quarterly take a look at the care plan and see if the resident has met the goal or not. If the resident has met the goal then document in a nutrition progress note whether the care plan will be d/c’d or continued. If the resident has not met the goal document that and identify if the goal or approaches will be changed so the resident can achieve the goal.
So bottom line the IDT reviews the health status of each resident quarterly. Nutrition notes include progress toward goal, changes in care plan, observation of oral intake, tolerance of diet, and interview results.
Most facilities have systems in place to continuously identify and refer residents at increased nutritional risk to the RD. The quarterly review is just another opportunity to identify at risk residents. Typically there is a 7-day look behind for most MDS items. Chart at the end of the 7-day look behind and document in the medical record using current data that supports the MDS. Remember weight has a 30-day and 180 day look-back.
Who should complete the Quarterly Review for nutrition? Someone qualified by experience and education. CMS does not mandate the RD complete the Quarterly Review. In today’s economic climate excessive paperwork, like a 13-page quarterly nutrition assessment completed by the RD, is an expensive luxury most facilities can no longer afford.