158 FIRST VISIT • Conduct nutrition screening per policy and procedure. • Provide direct education using Abbott handouts and document appropriately. SECOND VISIT • Obtain labs from PCP or draw labs if not available via PCP. • Is the patient at nutritional risk? Protocol Development Guidelines for Wound Care Does the patient present with 1 or more of the following? 1. Heavy exudates 1 2. VAC therapy 2 3. Involuntary weight loss 4. Diarrhea 5. Poor appetite 6. Recent surgery or infection Yes No No REASSESS WEEKLY PER POLICY REASSESS WEEKLY PER POLICY References: 1. Russell L. The importance of patients’ nutritional status in wound healing. British J of Nursing. 2001;10(6):S42-S44. 2. Haesler, E, et al. The 2014 International Pressure Ulcer Guideline: methods and development. J of Adv Nursing . 73(6):1515-1530. 3. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. 3rd ed. Haesler E, ed. 2019. 4. Demling RH, et al. Protein-energy malnutrition and wounds: Nutritional intervention. Treatment of Chronic Wounds Number 10. Hauppauge, NY: Curative Health Services, 2000. 5. Gomes F, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr . 2018;37(1):336-353.. Yes INITIAL INTERVENTION 1-3 Hydration: 30 mL /kg BW/day Calories: 30-35 kcal /kg BW/day Protein: 1.25-1.5 g /kg BW/day Oral supplements that can support calorie/protein needs: • Ensure COMPLETE • Ensure Plus • Ensure Plus High Protein TN • Glucerna Protein Smart (if patient has diabetes) • Glucerna Hunger Smart 10 fl oz (if patient has diabetes) • Nepro Add therapeutic multivitamin if not receiving recommended doses from diet and supplements. Follow up every 7-10 days. ADVANCED INTERVENTION 4,5 In addition: • Consider increasing protein to 1.5-2.0 g /kg BW/day. • Provide arginine, glutamine, zinc, HMB and antioxidants. Juven provides arginine, glutamine, HMB, hydrolyzed collagen, zinc, vitamins C, E & B 12 to support additional nutrient needs.