Resident Weight Variance Tracking Log

Monthly inspection-style tracking log for skilled nursing facilities to document resident weights, calculate weight variance over 30 and 180 days, and flag clinically significant loss for dietitian review and care plan intervention.

Inspection Details

• Facility name
• Unit or neighborhood
• Inspection month
  Enter the month being reviewed for resident weight variance.
• Inspector name and title

Resident Weight Record

• Resident identifier
  Use resident ID or chart number; avoid full name if not required by policy.
• Current weight
• Weight date
• Weight 30 days ago
• Weight 180 days ago

Variance Calculation and Threshold Review

• Percent weight change over 30 days
  Document the calculated percentage change from the weight 30 days ago to the current weight.
• Percent weight change over 180 days
  Document the calculated percentage change from the weight 180 days ago to the current weight.
• 5% weight loss in 30 days threshold met
  Mark Yes if the resident has lost 5% or more of body weight in the last 30 days.
• 10% weight loss in 180 days threshold met
  Mark Yes if the resident has lost 10% or more of body weight in the last 180 days.

Clinical Review and Follow-Up

• Dietitian review completed
  Confirm the resident was referred to or reviewed by the dietitian when a threshold was met.
• Care plan updated for weight loss intervention
  Confirm care plan interventions were initiated or revised based on the weight variance findings.
• Contributing factors documented

Disposition and Sign-Off

• Resident requires ongoing monitoring
  Indicate whether the resident should remain on enhanced weight monitoring or follow-up review.
• Corrective actions and follow-up notes