Accuracy of minimum data set in identifying residents at risk for undernutrition: oral intake and food complaints

to evaluate the accuracy of nursing home (NH) staff in documenting two Minimum Data Set (MDS) items that are used to identify residents at risk for undernutrition, low oral intake and food complaints, using standardized observation and interview assessment protocols implemented by research staff.

MDS information related to low oral intake (item K4c: <75% of most meals) and complaints about the taste of food (item K4a) was compared to independent evaluations of low oral intake and food complaints for a random sample of 75 residents in two proprietary NHs within the same month that a complete MDS assessment was due for each participant. Direct observations were conducted by research staff during nine mealtime periods for 3 consecutive days according to a standardized mealtime observational protocol to estimate low oral intake; and, two one-on-one interviews with residents were conducted on two consecutive days using standardized questions to assess the stability of food complaints.

Research staff documentation based on direct observation and resident interviews showed a significantly larger number of residents being identified as potentially at risk for undernutrition due to low oral intake (73%) and/or stable complaints about the taste of food (32%) as compared with NH staff documentation of MDS items K4c (44%) and K4a (0%), respectively, within the same month. A total of 47% of the participants expressed stable complaints about some aspect of the NH food service (eg, variety, appearance, temperature).

The documentation of low oral intake and food complaints on the MDS was inaccurate and resulted in a significant underestimate of residents with either of these risk factors for undernutrition.