The Quality Measure for percent of residents with a Weight Loss is a long-stay measure, which impacts Care Compare. It measures the percentage of long-stay residents who have had a weight loss of 5% or more in the last month or 10% or more over the last 6 months.
Coding weight loss in K0300 on the MDS requires the facility to:
· Assess residents for a 5 percent weight loss in 30 days and/or 10 percent or more weight loss in 180 days
· Identify if a care plan or regimen was ordered by the physician with a goal for weight loss
Weight loss is calculated using the following formulas.
K0300 (0) is coded if there is no weight loss or it is unknown. K0300 (1) is coded if there has been weight loss AND the resident has a physician-prescribed weight-loss regimen. Finally, K0300 (2) is coded if there has been weight loss AND the resident is not on a physician-prescribed weight-loss regimen.
Other tips to keep in mind include:
· Variances in weight in between snapshot time periods are not captured on the MDS.
· Do not wait to address weight loss. If weight loss occurs, it should be promptly and thoroughly addressed.
· Code K0300 (1) if documentation supports an expressed goal for weight loss diet or an expected weight loss of edema with diuretics.
There are no covariates for risk adjustment for this measure.
There are exclusions for this measure based on the Target Assessment:
1. OBRA Admission Assessment OR a PPS 5-DayAssessment.
2. Prognosis of life expectancy is less than 6months OR Prognosis is missing on target assessment.
3. Receiving hospice care OR the item is missing.
4. Weight loss item is missing.
State Surveyors can use the Nutrition Critical Element Pathway when reviewing facility performance related to weight loss. Aspects reviewed include comprehensive assessments focused on Section C, D, GG, K, L, and O of the MDS, Physician orders, pertinent diagnoses, and care planning. Staff assistance and interventions are observed across shifts. Interviews are conducted across shifts with residents, their representatives, and family and with staff. Failure to comply can lead to various F-tags.
An Interdisciplinary Team approach should be utilized to address issues related to nutrition and hydration. Nursing, dietary, speech and occupational therapy should all work together with interventions focused on areas such as nutritional intake –type, percent, assessment of self-feeding with potential use of adaptive equipment, and swallow function.
To avoid the debility and adverse health, safety, and quality of life affect, it is important to continually assess and monitor a resident’s weight for overall health and quality of life.