Mealtime support practices: Improving patient experience

Julie Stephens Clinical Risk and Quality Manager St John of God Bendigo Hospital, Melbourne

Left to right: Lily Kloester ANUM; Alison Barrett RN; Brendon Key EN; Eliza Mayberry RN; Lisa Gellatly EN / DVA Coordinator --- all from the Medical Unit.

Background

The impetus for this project came from a patient’s daughter who expressed concern regarding her father’s nutritional and fluid intake due to a lack of assistance by hospital staff at mealtimes. The project was undertaken in a 28-bed medical unit in an acute-care private hospital.

Problem/Aim

The aim of this quality improvement project was to improve service delivery in a medical unit by providing the right assistance to patients at mealtime. This means that all patients (100%) receives the assistance and support they want or need on receipt of breakfast, lunch and dinner by 31 December 2017.

Measures

An investigation revealed that on average for every meal there were one or two patients who were not receiving the assistance they required at mealtime, resulting in decreased nutritional intake, poor patient experience and food wastage. Nurses were undertaking other nursing care activities and were providing insufficient mealtime support in a timely manner. Patients were reluctant to call for assistance as they did not wish to worry the nurses, who were very busy. Catering staff collecting the meal trays were not encouraged to identify patients who had not eaten their meals.

Design

A trial was undertaken implementing ‘protected’ mealtimes and the introduction of coloured meal trays, indicating the level of patient assistance required. These two initiatives have been successfully used in the United Kingdom and in other Australian healthcare facilities. The project team consisted of the catering manager, nurse unit manager, dietitian, medical unit ward clerk, and quality and clinical risk manager. Protected mealtimes became a priority rather than other non-urgent nursing activities, releasing staff to provide support and assistance. Patients were assessed on admission for the level of assistance needed at mealtime and assigned a coloured tray. The coloured trays became an easy visual for staff and volunteers to provide the right assistance by the most appropriately skilled person.

Results

There have been no complaints regarding lack of mealtime assistance since the beginning of the trial in the medical unit. The trial identified that food wastage occurred when ward staff did not update the patient management system.

In the first week, there were two untouched meals on consecutive days, both by the same patient and for the same reason, preparation for procedure. The patient was on a blue tray, and fasting had not been entered in the interventions and brief advice (IBA) system. In the second week, three meals were returned untouched. The two patients on the 3/5 were on lime-coloured trays. One patient was not hungry and did not need assistance, and the other should have been on a blue tray and was not assisted. On the 5/5, the patient was fasting, which should have prompted an entry in the IBA system. In the 17th week, there were no untouched meals returned. The catering staff informed the authors anecdotally that the nurses were much better at entering any changes in meals in the IBA system, which was an unplanned improvement!

Conclusion

The protected mealtime did not have the same impact on improving mealtime support as did the colouredtrays.

Next steps

Supported mealtime practices will be rolled out across the hospital, with the primary focus being on the provision of coloured meal trays to assist staff identify which patients require assistance with their meals.