Following on from our March blog on nutrition screening, we can now look at Nutrition Care Plans (NCP) for people considered at risk of malnutrition or those who are already malnourished. Below is an overview of the different steps to take once nutrition screening is completed:
NB Everyone with a pressure injury or at high risk of pressure injuries should have a NCP in place.
We’ve screened, but the person is not at risk, what do we do now?
Best practice is to maintain a copy of the screening form in the person’s clinical notes for comparison with future screens and for auditing purposes. No change to their diet is required.
We’ve screened and the person’s nutrition screening score indicates risk of malnutrition, what do we do now?
A NCP needs to be developed by a nurse or dietitian.
We’ve screened and the person’s nutrition screening score indicates they’re already malnourished, what do we do now?
You should refer to a dietitian immediately where they will assess the individual and develop a NCP. Older people with malnutrition have a high risk of developing pressure injuries, along with a greater risk of poor wound healing, falls and balance problems. It’s important to intervene as soon as possible.
What’s a nutrition care plan (NCP)?
It’s a detailed plan of interventions/actions to support a person to achieve their nutrition goals.
The NCP includes:
- Person Centred goals based on both decreasing nutrition risk and increasing quality of life
- Prescribed intake of fortified meals and fluids for 3 main meals and 3 in between meal snacks
- Details of any modification in food or fluid
- Any assistive equipment required for meal times
- Assistance required for eating and drinking
- Home delivered pre-prepared meals (or for those eligible, Meals on Wheels) for people living independently in the community
- Food allergies and intolerances
- Other details specific to the individual concerned e.g. special diet needs such as gluten free
Who develops the NCP?
Clinical teams at aged care facilities or practice nurses in the community can work with dietitians to develop a NCP template for nursing staff to use as an outline for developing individual plans. This will save time and ensure that all key issues are incorporated.
The NCP gives clear guidance to all carers on the food and fluids required for an individual’s recovery and auditing can take place around food received, eaten, and discarded. Any concerns can be addressed and documented in a timely manner.
Implementing the NCP is everybody’s responsibility!
The NCP must be an easily accessible, transparent document that gives everyone who cares for the individual a clear understanding of what is required for their nutrition rehabilitation. This includes: the individual concerned, carers, family members, the nursing and allied health team, the food service team (for those in residential care) and the individual’s doctor.
Getting family members and carers involved in developing the NCP will lead to better outcomes. If a family member can’t be present in person during the NCP development process, ask them if they would like to join the conversation by phone. This can work well for busy family members who are keen to get involved but who might not live or work nearby to where the individual resides.
Remember, family members are often interested in the nutritional status of their loved ones, they’re all experts in nutrition in their own way and might be keen to support the successful implementation of the NCP.
When should the NCP be reviewed?
The nutrition care plan is a living document which can be updated as required to meet the individual change in nutrient needs, appetite and ability to access food etc.
- Malnourished individuals: Weekly reviews of NCPs are recommended. This is best achieved when one carer (a nutrition champion role could be implemented) has the responsibility for the weekly review of NCPs and the individual’s progress. Regular dietitian reviews would also be required as indicated in the facility’s Nutrition Policy .
- Individuals at risk of malnutrition. Monthly reviews of the NCP are recommended or more frequently as required.
Helping a resident or individual return to a healthy nutrition status has a massive impact on that person, their family, staff, facility and business. Click through to our NCP Example below:
Disclaimer: Please note our NCP Example has been specifically developed by our dietitian for "Betty Boo'' - all NCP's are to be personalised and tailored to each individuals needs.