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Resource Manual For Quality Indicators In - Department of Health

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<strong>In</strong>dicator 5: Prevalence <strong>of</strong> unplanned weight loss<br />

Data Recording Sheet<br />

Name <strong>of</strong> service:<br />

Reporting quarter end<br />

date:<br />

Table: Number <strong>of</strong> residents who experienced unplanned weight loss<br />

Number <strong>of</strong> residents<br />

whose weight was monitored<br />

Number <strong>of</strong> residents who experienced a<br />

significant total unplanned weight loss (ie<br />

equal to or greater than 3 kg)<br />

Number <strong>of</strong> residents<br />

whose weight was monitored<br />

Number <strong>of</strong> residents who experienced an<br />

unplanned weight loss over three<br />

consecutive months<br />

Comments:<br />

• REQUIRED if applicable - Explain any difference between total residents and<br />

number <strong>of</strong> residents whose weight was monitored<br />

for example, 2 residents died, 1 in hospital on 2 weigh day<br />

• REQUIRED if applicable - <strong>In</strong>dicate number <strong>of</strong> residents who appeared in both<br />

parts <strong>of</strong> the indicator, ie they lost more than 3kg and lost weight for 3<br />

consecutive months<br />

for example, 4 residents lost more than 3kg AND lost weight every month<br />

• OPTIONAL – any other comments<br />

20

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