web conference: taking action with the aaha nutritional...

AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines

9/23/2010

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Taking Action With the AAHA Nutritional Assessment Guidelines

September 23, 2010By

Katherine Knutson, DVM&

Susan Thorson, DVM

The AAHA Nutritional Assessment Guidelines for Dogs and Cats were sponsored by a generous educational grant from Hill’s Pet Nutrition. Educational events are presented in collaboration with Hill’s Pet Nutrition.

AAHA Nutritional Assessment Guidelines for

Dogs and Cats

Kimberly Baldwin, CVT, VTS, ECC | Joe

Bartges, DVM, PhD, DACVIM, DACVN | Tony

Buffington, DVM, PhD, DACVN, Chair | Lisa M.

Freeman, DVM, PhD, DACVN | Mary Grabow,

DVM | Julie Legred, CVT | Donald Ostwald,

Jr., DVM, DABVP (Canine & Feline)

Extended EvaluationThe Circle of Nutrition

Animal factors

Diet factors

Feeding factors

Environmental factors

Interactions

™

Used with permission of the American College of Veterinary Nutrition, www.acvn.org

http://www.acvn.org/


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Body Condition Score

Muscle

Condition

Score

Basic Assessment

Nutritional Screening Risk Factor Check ()

if presentHistory

Altered gastrointestinal function (e.g., vomiting, diarrhea, nausea,

flatulence, constipation)

Previous or ongoing medical conditions / disease

Currently receiving medications and/or dietary supplements

Unconventional diet (e.g., raw, homemade, vegetarian, unfamiliar)

Snacks, treats, table food > 10% of total calories

Inadequate information about or inappropriate feeding management

Inadequate or inappropriate housing

Physical Examination

Body condition score

5-pt scale: any score other than a 3

9-pt scale: any score less than 4 or greater than 5

Muscle condition score: Mild, moderate, or marked muscle wasting

Unintended weight loss of > 10%

Dental abnormalities or disease

Poor skin or hair coat

New medical conditions / disease


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Extended EvaluationScreening Animal Diet Feeding Environment

History

Altered GI Function

Effect on FI?

Food intolerance

Spoiled foodOvereating, gorging

Barren or chaotic

environment

medical

conditions/disease

Correct diet for

disease?Effect on FI?

Effect on access or

compet. for food?

Meds ± diet suppl. Affecting diet

adequacy?

Effect on FI? Total

calorie intake?

Who is doing this? Are

others affected?

Unconventional diet

How is the pet

affected?

Is the diet

satisfactory?

Effect on FI?

Other

“unconventional”?

features

Snacks, treats, table

food > 10% Effect on diet

adequacy?

Other features

affected?

Inadequate or

inappropriate housing

Barren or chaotic;

competition

Physical Examination

BCS

Many diseases

Quality, suitability for

the situation

identified

Amount, frequency

Effect on access or

compet. for food?MCS

BW > 10%

Others with similar

problems?

dental dz or disorder

Effect on appetite or

food intake?Poor skin or hair coat

New disease

Establish Individual Patient

Action Plan

Implementing a nutrition service within your hospital

Between the different patient life stages

Between different disease states

Creating the same message between staff

Gaining compliance with your clients

Goals Today

Understand that nutrition is medicine

Evaluate your hospital’s approach on nutrition

Create ways to implement nutrition as a service

Design new protocols

Develop nutrition roles for each team member


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Traits of a Practice where Nutrition Is An

Integral Component of Excellent Medicine

Passionate and committed leadership to the importance of nutrition

Belief and culture that nutrition is an important component of medicine

Consistent Communication is the cornerstone of any successful program

Written protocols that establish your practice’s medical recommendations

Evaluation process for compliance and function

Nutritional medicine is dynamic

Continuous training of the entire veterinary healthcare team

Nutrition is Medicine


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Evaluate your hospital’s approach on

nutrition

Where to begin?

Jump Start? Blow Up?

AAHA Nutritional Assessment Guidelines for

Dogs and CatsKimberly Baldwin, CVT, VTS, ECC | Joe Bartges, DVM, PhD, DACVIM,

DACVN | Tony Buffington, DVM, PhD, DACVN, Chair | Lisa M.

Freeman, DVM, PhD, DACVN | Mary Grabow, DVM | Julie Legred, CVT

| Donald Ostwald, Jr., DVM, DABVP (Canine & Feline)

Nutritional Assessment – Quick Reference

Guide. The resource guide is available in the links box and on the web

page for this event.

Implementation Action Item #1

All Hospital Staff Needs to Read


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Welcome

Finally Friday Meeting

When doing strategic

implementation always be able to

answer the following:

Who

What

When

Where

Why

How

Today’s Agenda

General Update 8-8:45

Review of AAHA Nutritional Assessment Guidelines

for dogs and cats 8:45-9:45

What are we doing? 9:45-9:55

What are we not doing? 9:55-10:15

Rank items to be implemented 10:15-10:45

Determine who will implement 10:45-11:30

Who is in charge of follow up?11:30-12:00


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Welcome

Finally Friday Meeting Part Two:

Nutritional Guidelines

Today’s Agenda

Discussion of healthy non-therapeutic dietary

recommendations along with therapeutic

recommendations using evidence based medicine

We need to give consideration to our patient’s

nutritional status in both wellness and sick exams


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Healthy non-therapeutic dietary

recommendations

Based on Life stages:

Kitten / puppy

Breed specific

Young adult

Adult

Mature

Distinguished


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Therapeutic Guidelines

Obesity

Arthritis

Kidney Disease

Liver Disease

Heart Disease

Breed specific

requirements

FLUTD

Diabetes

Cancer

Critical Care

Starvation

Post surgery

Dental

Senility


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Design new protocols

Protocol name: Obesity/weight reduction

Basic Idea: Successfully establish a protocol for patients that need weight reduction

Rationale: Obesity and morbid obesity carries significant health risks which reduce both the quality and longevity of our patients lives.

How it will work: All staff members will promote a healthy BCS at all times. Each will have a script that respectfully allows them to discuss weight.

Who needs to do what:

Client service- BCS, MCS, weight tracking, calorie requirements, send out congrats cards, be versed on health risks

CVT – CS plus dietary recommendations

CVTA’s – same as CVT’s

Volunteers – BCS, MCS, support for dietary recommendations

Management - same as CS

Doctors – all of above along with recent evidence based medicine on obesity

Body condition score

9/9

Needs weight loss of 5

pounds

Can eat ½ cup of r/d

daily

Environmental

stimulation

Weigh every two

weeks

Nutrition is Medicine

Your clients know that NUTRITION for their pets is

very important

They are going to follow someone’s advice- let it be

a medical recommendation

Make certain that your hospital knows more than

the pet store clerk

Educate your clients so they make the right

nutritional choices for their pets


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YOUR NUTRITION EDUCATION

AAHA Nutritional Guidelines - lists many excellent

websites as references

Veterinary Conferences

Veterinary Journals

Ask the pet food representative for your clinic for

abstracts and journal articles relating to nutrition in

pets, along with any courses they offer

Learn about levels of research – Evidence Based

Medicine

Team Education

Nutritional CE at staff meetings

Provide information on the science of nutrition & the tools to communicate it to your clients.

Remove the translational barriers – Present this in everyday language as opposed to the language of medicine

Make these talks short and concise

Address the client perspective

Needs to be ongoing conversations

Add a bit of humor and have FUN!!!


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Mini CE Subjects

The role of nutrition in puppy and kitten growth.

What’s the big deal about large breed puppy formulations?

How important is salt or omega fatty acids in diets for cats with urinary tract disease?

How can a food help a cat with chronic kidney disease?

Why on earth does this food cost so much?

Is table food OK to combine with an allergy diet?

How is JD different from glucosamine supplements?

How to take the “weird” out of explaining Brain Diet.

Nutritionists and Nutrition/Food companies

representatives often will visit your staff meetings

to provide education. This brings a fresh

perspective and new means of presentation along

with up to date research information.

There are many web based nutrition curriculum

opportunities available for staff. These are

motivational with milestones and prizes.

Interactive Learning Techniques

See one, Do One, Teach One

Interactional Learning Transmission Type Education


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Interactive Learning Activities

Role playing

Nutritional jeopardy

Body Condition Scoring lab

Exam Room Implementation

Goals – efficient, convenient, part of the rest of the

process, effective & interactive communication with

your client

Include prompts & resource materials in the exam

room

Report Cards / SOAPS Examination Record

These must have a space to record the following:

Life stage or age equivalent

Weight and Previous Weight

BCS & MWS

Current Diet & Snacks & Supplements

Your nutritional recommendations

Picture of the BCS you utilize and circle what the patient is at that exam

Writing down this information validates it in your clients eyes


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Involving your Client

Have a Body Condition Scoring Diagram

accessible

Have client friendly anatomic models & diagrams

available

Have Caloric Requirement Charts available

You now have your client involved and engaged in

an interactive conversation about their pet’s

health.


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You have become your client’s GUIDE

to their pet’s nutritional health They have been shown pertinent aspects of their pets’

nutrition during the physical examination.

They have seen and felt their pets’ body & muscle condition score.

They will receive an individualized nutritional plan based on the nutritional assessment and the physical examination.

Interactive conversations are far more effective in gaining client acceptance and support of your medical recommendation plan.

The pet has a greater potential for receiving the care and support they need. The client is happier. You are happier with this method of medical relationship.

Pet Nutrition Events

Local Events

AmeriCanine Idol

Paws In The Park

Grand Opening of the Dog

Park

Community Events

Duck Race

Kids Safe at the Local Hospital

Fall –a- Palooza – fun run

event

Pet Health and Fitness Fair

Summary You will assess the nutritional status of your practice with the traits of

a practice that embraces nutrition as an important component of excellent medicine, and with the AAHA Nutritional Assessment –Quick Guide .

You can access a number of resources for learning about nutrition.

You will work with your team to develop your nutritional protocols.

The exam form &/or report card will be structured with the prompts for pertinent information.

Body Condition and Muscle Condition Scoring will be used in the exam process to draw in client participation.

Nutrition will be included with the other components of excellent medical care such as diagnostics, procedures, and pharmaceuticals.

Education of your team will become an ongoing process. The subjects will be presented in “client language”. The points to be remembered will be few & concise. You will make the learning interactive and bring in an element of fun.


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Questions?

1. To complete the evaluation, please go to the following website:

2. After completing the evaluation, you will automatically be linked to the Continuing Education Certificate. The CE certificate can only be accessed after the evaluation is completed.

3. Download the CE Certificate (in pdf format) to your computer and print enough copies for those persons viewing the web conference with you.

Your input is very important! We take feedback seriously in order to provide you with the highest quality experience possible.

If you have any questions about completing the evaluation or accessing your CE certificate, please email us at [email protected] or call 800/252-2242.

http://www.keysurvey.com/survey/329075/d818/

Questions to the Speaker

Please email your questions to [email protected] by Thursday, September 30, 2010.

Dr. Knutson and Dr. Thorson will provide written responses to all of the questions and they will be posted on AAHA’s website by Tuesday, October 12, 2010.


http://www.keysurvey.com/survey/329075/d818/


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Tough Talk: Communicating Nutrition With Difficult and Not-So-Difficult Clients webcast, October 4 – 17, 2010.

Nutrifluent: Speak the Clients’ Language workshops, beginning October 2010.

Please visit www.aahanet.org/nutrition


http://www.aahanet.org/nutrition

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