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omputers—love them or hate them, they are used every day in long-term care facilities. Most of the time, when providers think about computer systems for their nursing homes, they automatically think about ways to improve the facility’s operations and management. There are a multitude of vendors that offer complete billing and clinical solutions. These programs can help a facility by providing anything from staffing and case mix reports to managing the general ledger. For example, all of the larger food suppliers now offer online purchasing systems to streamline the food procurement process. In years gone by, the food-service manager would analyze the upcoming menus and determine which food items needed to be purchased for the week. He or she would then make a handwritten list and call in an order over the telephone.
       Nowadays, though, all of this is done online. One can track an order, manage an inventory, and keep tabs on food costs with a few clicks. It is easy to see that such a system is a vast improvement, allowing for a much more efficient food purchasing system. At a minimum, computers are used to transmit Minimum Data Set (MDS) information and manage the facility’s financial records. At the maximum point of usage, the facility may have an electronic health record (EHR) system, ushering in a complete shift from paper to computers. In reality, most facilities are somewhere in between in the computer revolution. But how many facilities have thought about using computers to improve the nutritional care of their residents and upgrade the food and nutrition services offered? Here are some easy-to-implement, everyday ideas to get started.

1,001 Ways to Cook Chicken

       The Internet is chock full of recipes and menu ideas. If your menus have gotten stale, just look to your computer for a bevy of ideas. The holidays are almost upon us. You can find Christmas, Hanukkah, and Kwanzaa menus instantly. Do you have a resident who loves a particular food? Almost every branded food item has its own website with dozens of recipes. There are sites specializing in low-salt and low-fat recipes and many more focused on meals suitable for diabetic patients. LifeScan, the makers of OneTouch^® blood glucose meters, boasts more than 1,000 diabetic-friendly recipes at www.onetouchgold.com.

Nutrition Products Galore

       Most facilities can purchase and store a limited number of medical nutrition products. Many vendors have minimum case orders and/or a minimum dollar level for delivery. Because of these restrictions, some facilities might get in the routine of serving the same few supplements and not trying new products as they become available. Online, one can research and purchase dozens of supplemental products. One-stop sources like www.4webmed.com offer instant access to hundreds of medical nutrition products from almost every manufacturer. They allow customers to mix products, flavors, manufacturers, and even frozen and non-frozen products, helping a facility to combat unintended weight loss by allowing greater flexibility and personalization of medical nutrition products.

Food-Drug Interactions

       Should I give that pill with food? Can I crush that tablet in applesauce? Could that pill cause anorexia? Medication questions arise every day, especially with most residents taking multiple drugs daily. Consultant pharmacists are a great resource, but if they are not on site, turn to your computer to find out all you need to know about food-drug interactions. Be sure to use a credible site like www.epocrates.com, which allows healthcare providers to register for free and access a database of more than 3,300 brand and generic drug monographs, including on- and off-label dosing, adverse reactions, contraindications, drug interactions, pricing, and mechanism of action. One can even download the database to handheld computers, such as Palm (Palm, Inc.) or Pocket PC (Microsoft) devices.

“I Need an In-service, Fast!”

       Everyone in healthcare today is pressed for time. How many times have you thought to yourself, “If only there were 25 hours in every day”? Your computer can provide countless resources to help you do your job. For example, imagine you have to do an in-service for your staff on fiber and constipation but you just do not have time to put it all together. You can get a free in-service, including objectives, an outline, quick links to brush up on the topic, and a pre/post test, with one click. Visit www.RD411.com, sponsored by Ensure (Ross Products), for free nutrition resources, including policies, forms, continuing education (CE) modules, and in-services through a peer-to-peer concept.

Diet Manuals at Your Fingertips

       Every facility’s nutritional care adheres to a diet manual. These manuals describe the foods that are allowed and avoided on every conceivable diet prescription. A reliable diet manual should thoroughly explain basic nutritional care, specific needs throughout the lifespan, and therapeutic protocols. It should also describe a variety of disease conditions along with the proper nutritional regimen for each condition. Typically, diet manuals are 500 or more pages, which makes carrying one burdensome. Now you do not have to—manuals are available in online formats. One popular one, produced since 1978 by the Florida Dietetic Association, is available at www.floridadietmanual.org.

Comparing Tube-Feeding Products

       Each of the major medical nutrition companies prints and distributes a product handbook. These handbooks describe each of their products and provide the basis for calculating the nutritional content of supplements and tube feedings. Products change faster than new editions are printed, however, and you probably do not keep every company’s book handy. For example, a new resident might arrive with an order for a product your facility does not carry and you need to find an appropriate substitute. Just look online for the most current information for every product from every company. One company, Nestlé Nutrition, allows users to download its entire product guide to a handheld computer at www.nestle-nutrition.com.

“I Never Was Good at Math!”

       Whether it is computing a resident’s body mass index (BMI) or converting milligrams to milliequivalents, a good medical calculator can help save time and ensure accuracy. There are many free ones available, including several that can be downloaded to a handheld device. MedMath, available free at www.pdacortex.com, offers 28 formulas, including BMI and basal energy expenditure (BEE). MedCalc offers 68 formulas and is also available free at www.freewarepalm.com/medical/medcalc.shtml.

Counting Calories

       When a resident is not eating well, his or her physician might order a 3-day calorie count. This requires a nutritional team member to calculate the calorie and, often, protein values of each item consumed over a 3-day period, usually with standard dietary exchanges. The exchange system provides a quick way to estimate energy and calories in any given food. For example, each fruit is counted as 60 calories, and each vegetable 25 calories. While this is good for a quick estimate, you can be much more precise with a nutrient database. The United States Department of Agriculture (USDA) provides access to its database, officially called the USDA National Nutrient Database for Standard Reference (SR), free online. One can look up the nutritional content of any food quickly and easily just by typing in its name at www.nal.usda.gov/fnic/foodcomp/search/.

End Telephone Tag

       Many residents have relatives who live far away and cannot visit often. Even those family members who live nearby might only visit on the weekends or at times when you are not present. Free-flowing communication can go a long way toward making the entire nursing home experience better for concerned family members (who can be a great source of nutrition information, from weight history to food preferences). Instead of leaving countless voicemail messages, use e-mail to gather information and keep families informed of their loved ones’ nutritional status.

Adaptive Technology

       Did you know there are companies that specialize in adaptive technology that allows residents to use computers themselves? Using touch screens and other adaptive technology with a committed and engaged staff, residents can have a rewarding online experience. Imagine how delighted a resident would be to receive an e-mail with a photograph of his or her grandchildren and how connected the family members would feel if they received a reply. Companies like It’s Never Too Late (IN2L) at www.IN2L.com are making this a reality. Indeed, it is never too late for residents—and it is certainly never too late for long-term care facilities to learn how to make the most of the vast array of nutritional software, websites, and services just a few clicks away.