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Part II Nutrition Assessment, Consequences, and Implications

BOX 15.2 Recommendations from the National Pressure Ulcer Advisory Panel 2014 Guidelines for Prevention and Treatment of Pressure Ulcers Nutrition Screening

Introduction

The recommendations in this section of the guideline are predominantly for adult individuals and have been derived from evidence conducted in adult populations. Recommendations for nutritional assessment and treatment in pediat- ric populations are presented in the section Special Populations: Pediatric Individuals.

Nutrition Screening

1. Screen nutritional status for each individual at risk of or with a pressure ulcer: ●

at admission to a health care setting;

● with each significant change of clinical condition; and/or ●

when progress toward pressure ulcer closure is not observed. (Strength of Evidence = C; Strength of Recommendation = )

Nutrition screening is the process used to identify individuals who require a comprehensive nutrition assessment due to characteristics that put them at potential nutritional risk. Any qualified member of the health care team may com- plete nutrition screening, and it should be conducted on admission to the health care facility, or at first visit in com- munity settings.

2. Use a valid and reliable nutrition screening tool to determine nutritional risk. (Strength of Evidence = C; Strength of Recommendation = ) 3. Refer individuals screened to be at risk of malnutrition and individuals with an existing pressure ulcer to a regis- tered dietitian or an interprofessional nutrition team for a comprehensive nutrition assessment. (Strength of Evidence = C; Strength of Recommendation = )

Nutrition Assessment

1. Assess the weight status of each individual to determine weight history and identify significant weight loss (≥ 5% in 30 days or ≥ 10% in 180 days). (Strength of Evidence = C; Strength of Recommendation = ) 2. Assess the individual’s ability to eat independently. (Strength of Evidence = C; Strength of Recommendation =

) 3. Assess the adequacy of total nutrient intake (i.e., food, fluid, oral supplements and enteral/parenteral feeds). (Strength of Evidence = C; Strength of Recommendation = ) The focus of nutrition assessment should be on evaluating energy intake, unintended weight change and the effect of psychological stress or neuropsychological problems. Additionally, assessment should include a determination of the individual’s caloric, protein and fluid requirements.

Care Planning

1. Develop an individualized nutrition care plan for individuals with or at risk of a pressure ulcer. (Strength of Evi- dence = C; Strength of Recommendation = ) An RDN, in consultation with the interprofessional team (including, but not limited to, a physician, nurse, speech pathologist, occupational therapist, physical therapist and dentist) should develop and document an individualized nutrition intervention plan based on the individual’s nutritional needs, feeding route and goals of care, as determined by the nutrition assessment.

2. Follow relevant and evidence-based guidelines on nutrition and hydration for individuals who exhibit nutritional risk and who are at risk of pressure ulcers or have an existing pressure ulcer. (Strength of Evidence=C; Strength of Recommendation = )