Monitoring progress

Monitoring nutritional status is important, and setting goals with patients and then linking the nutritional care to these can help with motivation to comply. Achievement of such a goal is also a way of monitoring improvements.

The aims for monitoring nutritional status

• Meet all nutrient requirements, particularly protein and vitamin D (for those spending a lot of time indoors) (Barazzoni et al., 2020)
• Ensure a varied and balanced diet (Barazzoni et al., 2020)
• Manage symptoms through eating adjustments (Barazzoni et al., 2020)
• Use Oral Nutritional Supplements when necessary (complies with Advisory Committee on Borderline Substances criteria), consulting a dietitian or speech and language therapist where there are swallowing difficulties (Malnutrition Pathway, 2020 [PDF])

Setting goals

Healthcare professionals should discuss goals with patients. It is advisable that goals are SMART. i.e. “specific, measurable, attainable, relevant and time based.” Some examples that patients could report are:

• being strong enough to flush the toilet on her own
• have the strength to open the milk carton

Goals should be based on what matters to the person and what they see as their priorities.

It is nonetheless important to prevent muscle mass loss and provide support for patients to improve stamina, resume normal hobbies, achieve functional independence and reach a desirable weight (Malnutrition Pathway, 2020 [PDF]).

This should be combined with a gradual increase of physical activity.

Discussion with a physiotherapist and/or GP should occur to ensure a suitable approach for patients.

For patients who have been hospitalised, it is important to assess for sarcopenia, respiratory support, cognitive status and dysphagia, addition to weight loss, to improve functional status and quality of life (Brugliera et al., 2021).

Guidance recommends that healthcare professionals think about remote rehabilitation care from hospital and conditions at home, ask about symptoms, specific diagnostic tests, using open questions.

Monitoring of pre-existing comorbid conditions in COVID-19 survivors during rehabilitation is warranted to guarantee safety of the rehabilitative interventions, and to optimise health of these patients.

This may require availability of a multidisciplinary team of medical specialists (B Balbi et al., 2020).

People who suffered more severely from COVID-19 (e.g. ICU patients) need regular review and monitoring (Barazzoni et al., 2020; Cawood et al., 2020; Malnutrition Pathway, 2020 [PDF]).

It is recommended that general monitoring plans last to up to 2 years. For nutritional care, please refer to local guidance or service level agreements.

Following dietetic assessment, if the patient is undernourished or has a poor quality diet, it is important to determine if supplements of A, C, D, E, B6 and B12, Zinc and Selenium and high fibre should be included in the diet (Chen et al., 2020).

A dietitian can also explain the importance of a varied and nutritionally adequate diet and discuss the frequency to assess vitamin levels how to monitor this.

For a prolonged home stay due to quarantine (for those at risk or who have COVID-19), maintenance of indoor physical activity is crucial. See our section on General Symptoms for useful links for physical activity and exercise.

Value of support and communication

A clear nutrition support plan should be designed to last up to two years post discharge from hospital and when patients have ongoing or post-COVID syndrome (NIHR, 2021). Nutritional screening should be used (Cawood et al., 2020) to identify those at risk of nutritional problems.

The dietitian's role is highly relevant and referral for assessment and monitoring should be made where required. This is an example of a dietetic assessment [Word.doc], along with steps to establish a monitoring plan (which can be performed by non-dietitians). The grey boxes contain a standard letter format to the GP or other health professionals to support communication of assessment and plan.

The Patient Association Nutrition Checklist included is adapted to virtual consultations. This format was designed by the Lambeth and Southwark Action on Malnutrition Project (LAMP) Nutrition and Dietetics Department.

A holistic, patient-centred approach with multi-disciplinary input is recommended (Cawood et al., 2020; NHS, 2020). If people are fatigued, due to post-COVID syndrome and having difficulty preparing meals, then a referral to occupational therapy for coping strategies may enable them.

The healthcare professional leading patient care should consider individual values, needs and preferences, and setting realistic goals. Physiotherapists, occupational therapists, social workers and GPs are most likely to signpost patients to sources of advice and support (support groups, social prescribing, online apps), explaining how to get support from social care, housing and employment, and advice about financial support (NHS, 2020; NICE, 2020).

Patients reporting symptoms of chronic fatigue should be fully assessed by a specialist clinician before advising graded increases in exercise/activity, as this may exacerbate symptoms.

It is suggested to give people a copy of their care plans, clinical records, rehabilitation plans, letters and prescriptions (NICE, 2020).

Interdisciplinary communication is vital. Planning care entails considering local and clinical care pathways and shared decision making to establish which healthcare professionals need to be involved (NICE, 2020); patient centred goals are preferred (Cawood et al., 2020). 

It is vital to ensure strong links between acute and community settings (Cawood et al., 2020) so patients are not lost to follow-up when they move from hospital (or other setting) to home. 

For more information see our Identifying who needs nutritional care during COVID-19 recovery

Consensus statements

To improve patient-centred care and follow up, self-monitoring tools should be accessible for patients to use at home.

Professionals should use a range of strategies (pointed below) to ensure nutritional issues that concern patients are identified and followed up.