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High Risk Nutrition Care Plan Guidelines 2

Women categories with Hemoglobin <9.9 g/dl, Hematocrit <29.9% Children with Hemoglobin <9.3 g/dl, Hematocrit <27.9% Infants with Hemoglobin <9.5 g/dl, Hematocrit <29%

Assessment, counseling, and referral guidelines: • Complete nutritional assessment according to WIC protocol. Especially note information that may affect hemoglobin/hematocrit level such as blood loss, sickle cell, thalessemia, pica, etc. • Investigate the availability of food or food security. • Counsel on a high iron diet. • Inquire about iron supplement (other than prenatal multivitamin/mineral supplement). • Refer to physician. Complete Referral form (WIC 104) and give to participant or send to HCP.

NOTE: Hemoglobin/hematocrit should be rechecked by the health care provider since anemia is a medical, rather than solely a nutritional concern. However, one follow-up hgb/HCT test in the WIC clinic is allowed during a certification period.

Documentation: • Check “High Risk Education” on the Nutrition Education screen under Nutrition Education Topics and enter “high iron diet” under Topic Status. • Document any specific details regarding the nutritional assessment and the nutrition care plan in the Nutrition Assessment field on the Care Plan Summary. This may include documentation of an iron supplement. • Document date and “HR hemoglobin referral/Referral form” in the Nutrition Assessment field on the Care Plan Summary. • For Hospital Certification: Document “Hospital Cert. – WIC 104 not required under care of MD” in the Nutrition Assessment field on the Care Plan Summary. Create an alert for CPA to follow up at next food benefit issuance.

Recommendations for the WIC CPA: • Learn about and reinforce the health care team’s plan of care and encourage participants/caregivers to keep all appointments and take iron supplements as directed. • Emphasize infant feeding guidance such as providing iron-fortified infant formula for infants not breastfed or partially breastfed for the first year of life and offering iron-rich or iron-fortified complementary foods around 6 months of age. • For breastfed infants under 6 months old, refer to the healthcare provider to determine if iron supplementation is needed. • Encourage consumption of iron-rich foods, such as lentils and beans, fortified cereals, red meats, fish, and poultry. • Encourage consumption of foods rich in vitamin C to aid in iron absorption, such as citrus fruits, tomatoes, and other fruits and vegetables.