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Hi Colleagues, This may be of interest: In the last couple months, I have
helped two facilities develop QAPI projects when their CASPAR percentages
were well above the state and federal averages. One was in excess weight
loss and one was in new, acquired pressure injuries.
First, as a former surveyor, I know that part of survey prep is for the
state team to pull the CASPAR report (in the one year look back.) These
scores may determine the selection of high risk sampled residents (they can
track exact resident names from MDS.)
Second, every quarter, the facility (MDS Coordinator) should print this
CASPER report, and RD/team can have a heads up. The QAPI process is all about
identifying weak areas (before the survey team does) and demonstrating the
"Good Faith" effort to aggressively address these. If you can document
improvement and that these weak areas are unavoidable, with all your efforts,
the survey team is to give you credit. It greatly limits the sanction you
In the QAPI on Pressure Injury (this facility had many acquired PI in a row),
we are working with a wonderful Medical Director who is helping initiate a
Nutrition Protocol (unless counterindicated) on admit of any resident with
a pressure injury or immediately when a new acquired PI is identified. (we
have outlined a fortified diet, 2 Cal Med Pass, Juven, MVI w/min, Vit C,
still deciding on Zn for stage III and Iv, for 10-14 days due to interactions.).
Then the RD is to do a full assessment and make recommendations. At first,
I was concerned about a standard, one for all, Nutrition Protocol, but I
am seeing that this is showing a very timely and aggressive approach. We are
still working out the bugs. For instance, the Medical Director and I have
discussed having the 2 CAl Med Pass to be 120 cc TID=720 cal/30 g protein.
We have to ensure that the drug/nutrient interactions (just a few meds may
be impacted if given with high amounts of protein --over 2 oz) Hormel has a
good reference on this:
Has anyone else set up such a Nutrition Protocol?
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