Form MA39

Acorn Aged Care

NUTRITION AND HYDRATION AUDIT TOOL

The purpose of this audit is to evaluate whether the nutrition and hydration needs of residents are being met.

The Care Manager is responsible for ensuring any action required is carried out.

The completed audit form and Survey/Audit Report (Form MA5) are to be presented to the next Quality Committee meeting. The Quality Committee will decide if an Improvement Project Log (Form MA1) is to be completed.

This audit is to be completed at least once a year as per the Audit and Improvement Plan (Form MA3).

Date of Audit: ................................................................................................ Carried out by: ...........................

Number of records reviewed

Audit Notes/Further Comments:....................................................................................................................................

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Documentation	Yes	No	N/A	Action Required
l Initial Assessment/Interim Care Plan (RC3) nutrition section completed.
l Diet – eating and drinking section of Care Plan (RC7) completed.
l Referral to speech therapist/dietician completed and documented.
l Specific Care Plan (RC6) completed.
l Evidence of evaluation and review of nutrition and hydration management in progress notes (RC11).
l Allergies noted in Initial Assessment/Interim Care Plan, Resident Admission, Care Plan and Medication Signing Sheet (RC3, RC5, RC7).
l Weight chart completed, with weights recorded at least three monthly.
l A Fluid Balance Chart (RC32) is completed for two days following admission.
l Dietary Preference Form (RC15) completed and available in the kitchen.
l Dietary preferences on whiteboard in kitchen match the preferences on the dietary preference forms.
l Case Conference Checklist (RC25) demonstrates discussion with resident and/or family regarding dietary preferences.
l Cultural preferences requested by resident are included in menu.

Documentation	Yes	No	N/A	Action Required
l Menu is reviewed by dietician at least yearly (sight documentary evidence).
l Resident meeting minutes reflect discussions regarding the menu and food service.
l Aids are provided to residents requiring them, as described in the care plan including feeding assistance.
l Meals are provided at the times specified (refer page 7.2 Policy and Procedures Manual 3: Resident Care).
l A Resident Survey – Meals (MA19) has been completed within the last six months.
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l
l

Survey /Audit Report Completed: Actions Completed:

q Yes (ref no: SU________ / ___________ ) Date:...........

Improvement Project Log Completed:

q Yes (ref no: IP________ / ___________ ) q N/A