Quality Indicators in Residential Aged Care Services (RACS) Unplanned Weight Loss Indicator

What are the Victorian Residential Aged Care Quality Indicators all about ? The online resource:  Enhances knowledge of residential aged care QIs  Explains how to use them as part of your improvement toolbox 2 Why?  Helps residential aged care facilities monitor and focus on areas of high risk to residents  Improves resident quality of care and quality of life

1. The What: What do we want to achieve by monitoring unplanned weight loss? Know the proportion of your residents with unplanned weight loss and the trends and scope of the issue so you can take action to:  Actively manage residents with unplanned weight loss  Implement strategies for reducing unplanned weight loss Recommended reference range Unplanned weight loss per 1,000 occupied bed days Quality Indicators in RACS Resource: Unplanned weight loss3 MeasuresLower target rate Upper limit rate Significant weight loss Consecutive weight loss 01.0

The Why: Why is monitoring unplanned weight loss important? Quality Indicators in RACS Resource: Unplanned weight loss4 Unplanned weight loss occurs among older people for many reasons, including: Behaviours linked to dementia: inability to recognise food, forgetting to eat, inability to feed themselves Polypharmacy Age-related changes such as loss of taste, smell, sight and swallowing difficulties Depression and chronic disease Social isolation Between 13–31% of residents in aged care experience weight loss. Reported prevalence of malnutrition in residential aged care ranges from 40-70% Dementia has been linked to weight loss. Adverse events or harm associated with unplanned weight loss include:  death  increased risk of hip fractures  pressure injury development  poor wound healing  malnutrition

3. The How: How to collect and report this indicator How many/how often? Two measures for unplanned weight loss: Significant and Consecutive Every resident, every month Using monthly weight records Quality Indicators in RACS Resource: Unplanned weight loss5 How do you collect and report the data? For significant weight loss, record residents with loss of 3 or more kgs in a quarter For consecutive weight loss, record residents with weight loss each month over the quarter Note the residents who do not wish to participate, meaning there is a discrepancy between total number of eligible residents and numbers of those weighed Do not cause residents pain or distress – if so, find another way to monitor the resident’s weight Record on data recording sheet with comments Include: only residents who have all three weighs done for the quarter Exclude: respite residents and those who are absent or receiving end of life palliative care

3. The How: How to collect and report this indicator Quality Indicators in RACS Resource: Unplanned weight loss6 Quick tips for accurate data collection  Regularly calibrate weighing devices  Weigh residents at around the same date and time as the previous month and deduct clothing weight  If resident has unplanned weight loss or gain, consider weighing the resident again the next day to check if this is normal fluctuation  Investigate unplanned weight loss promptly

4. Definitions are important! Unplanned weight loss is that which is beyond the control of the individual. Unplanned weight loss refers to weight loss where there is no written strategy and ongoing record relating to planned weight loss for the individual resident. Significant weight loss is defined as unplanned weight loss equal to or greater than three kilograms over a three month period. Consecutive weight loss is defined as unplanned weight loss of any amount every month for a three month period. See the QIs Resource Materials Manual for more detail – and supporting evidence! Quality Indicators in RACS Resource: Unplanned weight loss7

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1.True or False: Unplanned weight loss can cause death  True  False 2. Residents to be excluded from the unplanned weight loss indicator data collection are: A.Respite residents B.Residents receiving end of life palliative care C.Residents who have not had three weighs done for the quarter D.All of the above Quality Indicators in RACS Resource: Unplanned Weight Loss9 Quiz

3. True or False: The unplanned weight loss indicator can be collected using incident reports  True  False 4. Unplanned weight loss data will be more accurate if: A.Scales are regularly calibrated B.Residents are weighed at the same time every month C.A and B D.A only Quality Indicators in RACS Resource: Unplanned Weight Loss10 Quiz

5. True or False: Up to 70% of residents experience malnutrition  True  False 6. The upper limit rate of the reference ranges for consecutive weight loss is 1 per 1000 bed days. If your organisation’s rate is higher than this, it means: A.The residents’ nutritional needs may not be being met B.You may have a problem with the way you count weight loss C.You should investigate to see if there is a special cause D.All of the above Quality Indicators in RACS Resource: Unplanned Weight Loss11 Quiz

How did you go? Quality Indicators in RACS Resource: Unplanned Weight Loss12 Quiz

Using Quality Indicators to make a positive difference to resident care Quality Indicators in RACS Resource: Unplanned Weight Loss19 End of Unplanned Weight Loss Indicator

Quality Indicators in RACS Resource: Unplanned weight loss14 To receive this publication in an accessible format Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, December 2015 Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. ISBN (Online) Available at quality/workforce-training-development/online-training