I think we can all agree that getting weights on time is one of the toughest parts of being a long term care Dietitian. The requirements to have weights completed falls under the Dietitian in part when going through an audit.
Here I will breakdown the methods that have been successful for me in improving weights getting done. I’ve tried a few different approaches and this method is what I have found the most effective.
Weights in Long Term Care: Help This Dietitian!
I have tried every approach you can think of.
Gentle reminders to the health care aides to please get the weights done
Talking to the Director of Care
Charting that Nursing did not get the weights done (aka throwing them under the bus)
Talking to the CEO (they’re wonderful but don’t really understand the process)
Trying to be buddy buddy with Nursing to get them to help
Offering to help weigh residents…None of it worked.
I would typically get about 50% of the buildings weights, which is not helpful at all. There was nothing more I hated than going to a meeting with a family and having zero weights to give them when asked.
Talk about looking incompetent.
BUT there is hope! After much trial and error, I found a way that worked for the past number of facilities I’ve worked with. Weights in long term care does not need to be a breaking point in the team.
Step 1: Make Peace with Your Team!
The first thing you have to do is make peace with Nursing/Health Care Aides.
In all the facilities I have worked in the care aides are in charge of getting the weights done, but it is the job of the nurse to make sure they get it done.
Being rude, combative, and worst of all throwing them under the bus in official documentation is really not a good thing to do.
Patient charts aren’t places to gripe about other departments, there are other avenues. So leave the passive aggressive chart notes in your past. It’s time to find a way to work together to get weights in long term care done!
Step 2: Have the Team Talk
You should sit down and talk with your team now.
This can be a 5-minute conversation with the Nurse in that wing and then the care aides on that wing, and repeat this until you get somewhere.
I have found the most effective starting place, is the people directly responsible for doing the weights. I have gone above their heads to Directors and typically am quoted the policy, they then raise hell on the wings repeating the policy, and nothing changes, except damaging your relationship with the staff.
People are more likely to help you out if your focus is on the task you need done, not getting them in trouble.
It could be possible that there is a reason weights aren’t being done, or they’re having difficulty. Listen to their concerns and try to address the reasons with them.
Talking Points in Your Discussion:
Tell Them WHY Weights are So Important! Also include:
1. Provincial Standards and State Audits requires weights to get done, we all fail when it’s not done.
2. Weights help to figure out if there is something wrong with the resident, it may be age related decline, there could be a wound not healing that is taking energy, weight loss could indicate they aren’t eating enough, disease progression that we don’t know about (Cancer can be a common cause), indicative of malnutrition, many many reasons…
3. Family members like the be kept updated on weights, when they aren’t done, it makes the facility look neglectful in care.
Are there any other reasons you can think of?
Here’s Your Solutions to Getting Weights Done!
These are some practical ways that I have sorted through the dreaded weight problem. Number 5 is probably the best route to go, but no matter what your facilities problem is, you can work through it.
Here’s some examples of the problems that I’ve been told and how to solve them:
1. Problem: The weigh scale is broken or isn’t consistent.
My Solution: We had the company that makes the scales come in and do 5-minute tutorials for all staff repeated for 5 days how the scale works, they ensured it was accurate and working properly. We had staff sign off that they had attended the session.
2. Problem: They forget to weigh them, the papers are out of sight out of mind.
My Solution: I had maintenance install hooks right beside the tub, the weight sheets were then put on a clipboard and hung RIGHT BESIDE THE TUB (tub scale used in this instance). You couldn’t miss it. I also put a laminated bright orange paper on top of the clipboard that stated, “Weight Sheet – Must Be Done By the First Week of the Month.” You couldn’t miss the laminated sheet.
3. Problem: Some residents don’t get out of bed for their bath/refuse.
My Solution: At the end of the first week I would collect the weight sheets, I would note who wasn’t completed. I quickly typed up the names, printed it out on bright orange paper (trust me, paper colour matters), in big big print (Size 20 – obnoxiously large), I had 3 copies, 1 went to the tub room again where health care aides could see it, 1 went to the nurse in charge on that unit and I asked if they could get their staff to weigh those people that day, 1 went to the nurse manager on that floor so she could also let staff know to get those done.
4. Problem: The resident refuses to get their weight done.
My Solution: Every resident has the right to choose and refuse care, this is in most Bill of Rights for every resident. If this is the problem, I have no issue with this, but it NEEDS TO BE DOCUMENTED! If a care aide lets you know that this is the problem then you need to start the process of documenting.
First talk to the nurse on the unit, if they agree that the resident refuses then the family or power of attorney needs to be informed. Also let the Nurse Manager know the issue. Have either the Nurse or Nurse Manager call the family/power of attorney to get their agreement that the resident will no longer be weighed based on their personal choice.
Once this is done, you need to document for yourself.
The Nurse/Nurse Manager are in charge of documenting their conversation with the family/power of attorney, but you need to document that you are aware. It covers your butt.
Document something along the lines of, “RD has been made aware by Care Aide (I write their initials, not their full name), and discussed with RN (again, initials) as well as 1st floor manager (initials), that the resident is refusing to be have their monthly weights done.
Nursing will communicate same to residents family member/power of attorney. RD understands resident has chosen to refuse this level of care – monthly weight. RD will provide no further documentation on residents weight unless in future resident agrees to monthly weights again. No follow up planned at this time unless further consulted.”
Remember, you need to chart to cover your own behind, because you will answer for your care.
5. Problem: Not all residents go to the tub room, some get bed baths.
My Solution: This actually was a pretty big problem in one of my facilities.
I couldn’t change who got bed baths and who didn’t, but what I could do was change the way they were weighed. I spoke with both the Director of Care AND CEO about the issue we were facing, because it is a WE issue, not just an RD issue. I presented my already done research on floor scales, some of your facilities may already have these.
Floor scales can be folded up (don’t take up much space – this is important to care, trust me), they can be wheeled from room to room or they can be set up in front of a nursing desk and residents can be weighed in a conveyor belt type method. The resident doesn’t need to be taken out of their wheelchair, they can walk on, they can use a walker or cane, whatever their method of mobility is. You just need to have a record of what their equipment weighs.
They don’t need to only be weighed on their bath day either which is great. It’s very easy for staff, you can even help out by standing there and recording all the weights. The cost is about $1200 depending how fancy you want to go. If you propose this to your CEO make sure you have your presentation ready. It doesn’t have to be a powerpoint fancy presentation, just know what you are talking about.
Sell it to them by ways that will appeal to them, speak to how important weights are for Standards/State Audits (they could lose funding if it continues to be a problem), level of care, negligence in not obtaining monthly weights, family members frustration in not knowing weights/complaints, etc, you will convince them. I promise.
It took me about 3-6 months to get our floor scale (everything from approval, research, finding one, delivery, it takes time). But our staff were quite happy to get it. After that we designated certain days to weigh residents. I worked with Nursing on each wing which day they would have the scale and that all residents had to be weighed that day.
I continued with my bright laminated paper for a number of months after we had the scale so they knew I was still paying attention.
Lastly: Develop an Audit Process
Once you have your new system in place, develop a monthly audit so your facility doesn’t fall back into their old ways. It’s quite simple and honestly once you have it in place will take about 15 minutes a week.
It’s a way of accountability. Your CEO likely works well seeing numbers as proof, not just your words. Quarterly most facilities will hold Quality Improvement Meetings, I recommend going to these. That is where I would present my monthly audits on how weights were doing, and the progress we had made. You want to show proof that your purchase was a good investment.
I know that the weights are a frustration, but you can be a part of the solution even if you don’t physically weigh any resident. I know you’re probably trying really hard and wanting to bang your head against a wall most days, but don’t give up. Try some of my suggestions and let me know how it goes.
Drop a comment below or send me an e-mail and let me know your progress.
Do you want to know all about the audit process that your facility WILL go through? You can read more in this article!
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.