Accuracy of patient care staff in estimating and documenting meal intake of nursing home residents

OBJECTIVES: To determine the accuracy of patient care staff estimates and documentation of food intake of residents in nursing homes. DESIGN: prospective, observed, unblinded cohort study. SETTING: Three urban nursing home facilities. SUBJECTS: Staff estimation and documentation of 27 nursing home residents' meal intake. MEASUREMENTS: Actual amount consumed by 27 nursing home residents was ascertained by weighing food and caloric fluids on resident trays before and after one lunch time meal. Staff estimates and documentation of percent of meal consumed was compared with actual intake. RESULTS: Patient care staff estimates differed from actual intake by approximately 20%, and in most instances intake was overestimated. Almost one-third of the residents at risk for nutritional problems were not identified correctly by staff. Chart documentation of meal intake frequently did not reflect either actual amount of meal consumed or the staff's estimation of what was eaten. CONCLUSION: Study findings indicate that the present system used to document nursing home residents' intake is inadequate and that a more accurate mechanism or an entirely different process for identifying residents at risk for nutritional problems should be developed and implemented.