Are you a Wound Care Dietitian? If you are a Dietitian that works with patients that have wounds, then you ARE a Wound Care Dietitian! Read this step-by-step practical advice guide on how to deal with them.
If you want more in-depth information on treating wounds, read this article next!
Getting Started as a Wound Care Dietitian
Starting at a facility means establishing yourself as a Wound Care Dietitian.
This will require a lot of communication with the wound care team to determine a few things:
What will your role be?
How often will they consult you?
What are your expectations of what type of wounds you want to be consulted for?
How will they communicate a wound to you?
When are team meetings?
These are all things that you need to ask because as a Wound Care Dietitian – You NEED to be involved and aware.
For standards/audits it is EXPECTED that as the Clinical Dietitian, you are aware and have nutrition interventions in place for all patients with wounds.
If you want to know more about what’s expected of the Clinical Dietitian for Provincial and State Audits, click here for the easy step-by-step guide.
Below you can read the step-by-step Wound Care systems that I have put in place in every facility I have worked in. Adapt the systems that will work for you.
If you don’t have a current system in place and would like to establish one. Sit down with your boss and ask if it’s possible for you to work one extra day or two to get a system in place. Most bosses are comfortable allowing you to work an extra day or two to kick start a new system that will benefit your facility.
Step 1: Establishing Your Wound Care Dietitian System
Find out if there is a list of the residents with current wounds. Some facilities are really great with tracking, you want to have your own list (again, put it in your one stop shop binder!)
For example:
Room 129 – Margaret Smith – Stage 3 Wound to the Coccyx – Current interventions: TwoCalHN 125 mL TID with Medpass, Next follow up date: 2-3 weeks.
You want to keep this up to date, know the progress.
You should have ALL your high risk patients in a spreadsheet that details the nutrition diagnosis, nutrition interventions, and nutrition goals in one place. If you don’t have a spreadsheet, check out our free Resource page. You can find free spreadsheets to implement in your practice. Click here.
Step 2: Join the Wound Care Team
Be a part of the wound care team if possible. If not possible due to scheduling conflict, ask for a summary sheet of the wound care for residents.
Check in at minimum every 2-4 weeks for updates on current wounds. You will use your clinical judgement as to how often you need to follow up with each patient.
Ensure that your list weekly is up to date with the progress of all of your patients with wounds.
Once you have your list compiled, read on to discover how to practically treat them!
Step 3: Treating Patients with Wounds
- Evaluate the type, stage, and location of each wound.
Skin tears do not necessarily need nutrition interventions, I typically ask that I not be consulted over skin tears unless they are severe.
Ensure first that they are getting adequate nutrition.
Check the amount of protein per KG of body weight.
Are they getting at minimum 1.0 grams – 1.2 grams/KG body weight per day?
Determine their food and fluid intake levels on average weekly.
Find out where improvements in their intake can occur. - For Stage 1 and 2 Pressure Wounds/Injuries:
Ensure that Protein Intake is 1.25 grams – 1.50 grams/KG of body weight per day.
Add up what they are getting throughout their meals, snacks and supplements to see what the base is.
If you have been consulted on a wound, make sure that you CHART your response.
You need documentation proof that you have acknowledged the consult.
If your resident is getting adequate protein, look at approximate calorie intake and fluid intake. - For Stage 3 and 4 Pressure Wounds/Injuries:
Increase the amount of Protein to 2.0 grams/KG of body weight per day.
It is important though that you are not only prescribing that amount of protein, but ensure that it is realistic.
It doesn’t matter if you give them 2.0 grams/KG BW per day, if they aren’t going to eat a massive piece of chicken.
Speak with the resident or designated family member about the issue, and check if there are high protein items that they enjoy. Increasing protein at times where they are more likely to eat during the day, some residents don’t eat breakfast but enjoy larger suppers so you can increase the portion of their protein at supper.
Nutrition supplements are useful as well, 2.0 grams/KG of body weight protein is a lot for some residents.
Implement MedPass start at 60 mL QID. If you don’t see results, continue to increase the amount daily.
Adding protein with the use of protein powders can be an effective strategy as well.
You can add it to soups, oatmeal, potatoes, etc. It’s important to find a realistic option.
For caloric intake they should be increased to 30-40 kcal/KG body weight per day. You want a higher Carbohydrate and Fat diet so that the body breaks down Carbohydrate and Fats instead of Protein.
For increased fluids it’s important they are getting adequate fluids to maintain skin integrity. - Document, Document, Document.
It’s important that you chart what you have done, and write a PES statement. If you need help writing out PES Statements, check this article and this article!
Make sure you document when you’re going to follow up as well. Write it in a calendar and make sure you follow up and see the progression.
Once you have covered your bases, work with the team of how they are working on improving wound healing as well. Whatever each team member can do to help, the better off your resident will be.
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.
