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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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Healthy non-therapeutic dietary
recommendations
Based on Life stages:
Kitten / puppy
Breed specific
Young adult
Adult
Mature
Distinguished
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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!!!
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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.
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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.
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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.
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 National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines
9/23/2010
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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
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.