PROTECTED MEALTIMES

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					PROTECTED MEALTIMES


Does this improve the patient’s
 experience of hospital meals?


             Tracey McClelland,
            Senior Clinical Nurse;
               Marja Khalifa,
               Ward Manager.
DEFINITION


 An uninterrupted lunch service with
 nurses focused on the delivery of food
         to patients for 1 hour
   (except emergency treatments)
BACKGROUND


 A national initiative, initially backed by: -
   •Hospital Caterers Association/RCN
   •Department of Health
   •NHS Estates
   •NHS Plan
BACKGROUND (2)

• Potential to assist in the achievement
  of Essence of Care benchmarks for food
  and nutrition
     (NHS Modernisation Agency 2003)

• Addenbrooke’s Hospital has developed
  its own standards based on these
BACKGROUND (3)

Protected Mealtimes was recently
  recommended in:


• Hungry to be Heard: the scandal of
 malnourished older people in hospital
            (Age Concern August 2006)
AIM

To protect the patient’s mealtime, making their
    nutritional intake the top priority of care
                 during this period
METHOD

• Drug round 12-12.30
• All interventions stop at 12.30
• All nursing staff assist with preparing
  patients for eating, hand washing,
  toileting, serving of food and feeding of
  patients
• No visiting unless relatives are to assist
  with meal
KEY PEOPLE INVOLVED

•   Patients and Relatives
•   Estates and Facilities team
•   Nurses and Ward Assistants
•   Medical staff
•   AHPs
•   Radiology
•   Cleaning staff
IMPLEMENTATION

• Trial on 2 medical wards May 2005
• Pre audit of mealtime experience
• Audit of mealtime experience during
  Protected Mealtime
• If successful planned to continue, and
  increase number of wards involved in
  initiative
AUDIT

  Both trial wards were included in the audit:

  In total: -

  • 45 Patients were given a questionnaire prior to
    the Protected Mealtimes

  • 61 Patients were given the same questionnaire
    during the Protected Mealtimes
SUMMARY OF RESULTS (1)
Q: Were you disturbed during your meal?

    Prior to Protected Mealtimes

    YES = 11/45      (24%)

    During the Protected
     Mealtimes

    YES = 4/61       (7%)
SUMMARY OF RESULTS (2)
Q: If you were disturbed during your meal, could you
indicate who disturbed you and why you were disturbed?

         PRIOR TO PROTECTED MEALTIMES
 WHO DISTURBED YOU?                                   REASON FOR DISTURBING YOU?
 4 = Nursing Staff                                    •Drugs
                                                      •Temperature
                                                      •To make bed and take blood pressure
                                                      •No reason given
 1 = Doctors & Other Patient’s Visitors               •Doctors – To talk to me, Other Patient’s Visitors –
                                                      Too Loud
 1 = Physiotherapist                                  •Walking

 1 = Other Patient’s Visitors                         •No reason given

 2 = Nursing Staff, Doctors and Person taking blood   •Doctors – to talk, Person taking blood – to take
                                                      blood
                                                      •Nursing staff – Routine tests. Doctors –
                                                      examination & Test Results, Person taking blood –
                                                      blood sugar & Test samples
 2 – No answer given                                  •Had to have scans
                                                      •No reason given
SUMMARY OF RESULTS (3)
Q: If you were disturbed during your meal, could you
indicate who disturbed you and why you were disturbed?

      DURING THE PROTECTED MEALTIMES


   WHO DISTURBED YOU?     REASON FOR DISTURBING
                          YOU?
   1 = Doctor             •Examination
   1 = Another patient    •A patient calling ‘Nurse’ all the
                          time
   2 = No answer given    •No reason given
SOME PROBLEMS

• Embedding change in routines
• Lack of support from some staff groups
  and departments
• Difficult to sustain focus when ward is
  busy or short staffed
• Consistency in challenging people
  attending the ward during the
  Protected Mealtime
SINCE 2005

• Original 2 wards have continued with
  Protected Mealtimes
• 8 more wards in Medicine also have
  adopted Protected Mealtimes
• Other wards in the Trust are
  considering implementation
• Visit from RCN senior nurse for older
  people- positively reviewed Protected
  Mealtimes
SINCE 2005 (2)

• Visits from head of National Patient
  Safety Agency
• Following her observation of Protected
  Mealtimes, visit from NPSA
  representative for food and nutrition
• Audit of Essence of Care Food and
  Nutrition Standards in 2006
  incorporating wards with Protected
  Mealtimes
RECENT AUDIT TRENDS

Wards without Protected Mealtimes:
• Examples of interruptions

            Bed making         Exercises
            Observations       Cleaning
            Medication         Dr’s rounds
            Visitors           Noise


i.e. routine tasks, regular interruptions
RECENT AUDIT TRENDS (2)

Wards with Protected Mealtimes
• Examples of interruptions
         Shortage of staff- need to
         complete duties
         Urgent bloods
         Delayed Dr’s rounds

i.e. unplanned and emergency interventions
FUTURE PLANS

• Increase number of wards in Trust with
  a Protected Mealtime
• Consider use of trained volunteers for
  feeding and assisting with preparation
• Attendance at regional NPSA Protected
  Mealtimes review October 2006
FUTURE PLANS (2)




• Consider implementation of related initiatives
  e.g. Red Tray Project

• Upcoming meetings with governor focus
  groups and members of the public
REFERENCES/FURTHER READING

• Age Concern (2006) Hungry to be Heard: The
  scandal of malnourished older people in hospital
  www.ageconcern.org.uk
• Hospital Caterers Association (2004) Protected
  Mealtimes Policy. www.hospitalcaterers.org
• Davidson A, Scholefield H (2005) Protecting
  mealtimes. Nursing Management September;
  12(5):32-36
• NHS Modernisation Agency (2003) Essence of Care
  Benchmark for Food & Nutrition. www.doh.gov.uk
ANY QUESTIONS?

				
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