by Nancy Munoz, DCN, MHA, RDN, FAND
By Mary Ellen Posthauer RDN, CD, LD, FAND
My first year in practice, I volunteered with the local dietetic association when they launched “Dial a Dietitian”. The goal of the program was to capture the attention of the community and encourage people to phone a dietitian and seek help to solve their nutritional problems.
While we no longer use “dial” telephones, the mission of the program continues as registered dietitians (RD) strive to optimize the nation’s health through food and nutrition. The dietitian should be a vital and productive member of the wound care team. Often physicians, nurse practitioners and other wound care clinicians fail to request the expertise of the RD. Dietitians must also be proactive and contact the wound care team and define the benefits of a nutrition assessment nutrition assessment and interventions.
The protocol in the facilities where I consult includes an automatic request for RD consultation by the physician or nurse practitioner for any nutrition problem. While some nutrition interventions, such as commercial supplements, are not reimbursed, they are cost-effective and less expensive than wound care dressing or support surfaces. When a nutrition intervention promotes healing, it may postpone the need for more aggressive, expensive treatment. The RD is responsible for alerting clinicians when new research evolves with an effective nutrition intervention. Nutrition research that indicates even a small measure of healing speaks volumes, in particular when we are treating frail, older adults with wounds.
The long-term care facilities where I consult have a policy and procedure for the prevention and treatment of wounds that includes a nutrition component. The procedure stipulates:
• RD will be notified when a wound has been identified
• Following notification, the RD will complete a nutrition assessment and develop a care plan
• Prior to implementing the nutrition intervention, the RD consults with the resident and the interprofessional team to verify the feasibility of the intervention
• RD requests a physician order for oral supplements, if appropriate
• RD is a member of the wound care team
The wound care team meets weekly to review and document in the medical records all aspects of the treatment plan. Documentation includes stating the type of wound (pressure ulcer, venous, diabetic), location, size and depth of the wound compared to the previous week, all treatments, support surfaces, appetite, weight, and the acceptance of nutrition intervention. If the wound is not progressing toward healing or the nutrition intervention is not accepted, the team discusses alternate interventions and takes action to adjust the plan.
Nutrition interventions should be both flexible and aggressive. Flexible includes providing the RD with an arsenal of products from fortified foods to a variety of oral supplements (liquids and solids) including modular protein supplements. Often facilities are locked into certain products depending on the purchasing contract of the organization. The RD must be assertive and request the consideration of more aggressive and perhaps expensive nutrition products for difficult to heal wounds. The RD should also be aggressive and willing to work with patients with wounds and individualize their nutrition plan.
Please, "dial a dietitian" and ask him/her to join the wound care team.
About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Panel and the American Dietetic Association’s Unintentional Weight Loss work group.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.