Questions and Answers
1. Can patients from Non-English Speaking Backgrounds (NESB) participate in the study if there is an
interpreter or carer to provide responses?
Yes, patients from NESB can be included in the survey as long as an interpreter or carer is available to
provide all the responses in the English language.
The interpreter or carer is also required to sign the statement of consent form on behalf of the participant.
2. What if we do not have 60 patients to meet the participant numbers required? Can we still
Sites that do not include at least 60 patients in the survey are still welcome to participate. However 60
patients is the minimum suggested number of patients for data quality.
3. Since ours is a small hospital, can we conduct the survey on all the 3 days made available so we can
collect data from at least 60 patients?
In such a case we recommend that you collect data from different sections/wards of the hospital over the 3
days made available.
4. Are we able to cover a large hospital and a district hospital within the same health district over the 3
days made available?
Yes. You could collect data at different sites (within the same health district) over the three days. The data
must be collected from different wards on each of the three days.
5. Clarification on terms in the Exclusion Criteria (terminally ill, palliative care, subacute):
Patients that have been classed as
Receiving end-of-life care;
Receiving palliative care;
must be excluded from the survey.
Sub-Acute patients include patients admitted for non-acute reasons such as rehabilitation, geriatric
evaluation and management, organ procurement, palliative care and must be excluded from the survey. Sub-
acute wards (also referred to as Interim wards/ Intermediate wards) must be excluded from the survey.
To avoid confusion and ensure that sub-acute, terminally ill, palliative care patients are excluded from the
survey, we recommend that dietitians involved with data collection discuss and confirm the admission type
of potential participants with the Nurse Unit Manager/ Ward-In Charge Nurse on the day of the survey.
6. Why are we not including Rehab wards?
As this is the first year of conducting the survey we wanted to focus only on one setting and we have chose
the acute care setting.
7. We will need more information on how to collect dietary intake data.
We are interested in the proportion of meal consumed by the patient in comparison to what was available on
their tray. In-depth training will be provided to participating sites through a formal teleseminar-based
8. Are we able to use the help of nursing staff to observe and collect dietary data?
Only Dietitians must be involved with data collection. We will be conducting training sessions on collecting
dietary data eventually. These sessions will be held via teleseminars and it is recommended that all staff
members involved with data collection attend the training session.
9. How should the other clinical workload be managed on the data collection day?
It is expected that ward dietitians from participating sites will inform their ward- nursing and medical staff
about the survey. It is recommended that clinical workload is managed on a priority basis. Dietitians not
directly involved with data collection could also help manage the clinical workload.
10. Can patient meals be photographed for analysis at a later time?
Patient meals can be photographed for analysis at a later time only after a detailed methodology has been
provided to and approved by the research team. The following points must be made a note of:
We are interested only in the percentage consumption of meals at a gross level and not by each
individual food item;
The approved methodology must be included in the ethics application;
Photographs will need to be taken prior to meal consumption and after meal consumption for
Appropriate patient identification will be required for each photograph;
Patients will still need to be asked if they have consumed any of the meal items at a later time.
11. What if a patient is in ICU or other “excluded” ward of the hospital for part of the day but then
comes out to a ward that is included in the survey- would they be included / excluded?
In such a scenario you would exclude the person because
You will not have their informed consent
You will have missed their intake data from the initial part of the 24-hour period
However, if they were included in the survey in one ward and then got transferred to another ward (also
included in the survey), you could continue to capture their data as
You would have their informed consent
Another dietitian would have captured their intake data in the initial part of the 24-hour period.
12. What happens if the patient is fasting for part of the day only but has provided informed consent and
will be allowed to eat in the later part of the 24-hour period?
For the meals/mid-meals that they have missed because of the fasting, you can tick the “nil by mouth”
13. What if the diet type changes during the day?
You can tick more than one option in the diet codes section of form 2.
14. What do you mean by the term additional nutritional supplements?
We are referring to commercial nutritional supplements (eg Resource/Ensure/etc.) and other high-energy
high-protein products (such as yoghurt/custard/ice-cream/Breakas etc) that have been recommended by the
dietitian in addition to patients meals/mid-meals.
15. What happens about other foods consumed (eg takeaways, food from home, vending machines, etc).
They may not be consumed at the same time (eg as lunch) but would account for why hospital food
was not consumed
This reason can be mentioned as “other” in the reason for not consuming all the meal section of Form 3a.
We are interested in capturing only the proportion of meals provided by the hospitals.
16. If patients are receiving supplements at meal times would this be included as part of their meal
Yes. We are not capturing different components of the meal. We are interested in evaluating the proportion
of meal consumed out of that available to the patient at each meal and mid-meal during the 24-hour survey
17. Can we use trained dietetic students to collect dietary intake data to overcome a resource issue?
In order to maintain uniformity with data collection methods we would like only dietitians to be involved
with capturing all the data. Dietitians from participating sites will be provided with training on completing
data collection forms through future teleseminars.
18. Does the data need to be sent via hard copies or is there an online program that we can enter data
Data collected on forms 1, 2, 3a and 3b will have to be sent to Ekta Agarwal in a hard copy format. Data
collection form 4 will be sent electronically.
19. How can one quantify the FTE other staff members (doctors/ nurses/ other) spend on nutrition care?
This question is aimed at other staff members who are particularly involved with nutrition care in certain
wards. This can be captured by asking them roughly how many hours per week they spend on nutrition
Ethics, Patient Consent:
20. Ethics Application for New Zealand
One common application can be made for all the participating New Zealand sites. We are in the process of
preparing that application at the moment.
21. What is involved with obtaining patient consent and how long it takes for each patient?
Participating sites will be provided with a detailed patient information sheet. Participating sites will
also be provided with a written paragraph summarising the details of the survey that can be orally
communicated to the patients.
Ethically, it is required that potential participants have a clear understanding of the survey.
Therefore, staff members involved with the consent process could negotiate a time with the patients
at which they return and obtain written consent from the patients. We recommend that patients are
provided with the information sheets early on Monday June 21st 2010.
Please note, as per the NHMRC guidelines, participating sites are required to obtain signatures from
a witness on the consent form (usually a nursing staff).
22. Are we able to use the help of students/nutrition assistants/dietetic assistants for obtaining consent
Sites could use the help of trained students/nutrition assistants/dietetic assistants to hand out the patient
information sheets and consent forms as long as they have made this clear in their ethics applications and
have received approval for the same.
23. Will participating hospitals be acknowledged in the study?
Yes, all participating hospitals will be acknowledged in my thesis and publications.
24. Has Nutrition Screening become mandatory in the EQuIP standards?
Please accept my apologies for answering this question incorrectly during the teleseminar. Nutrition
Screening has been included in the draft version of the EQuIP standards and is not mandatory.
25. The decision to participate form is a commitment or an expression of interest? We will need to seek
approval from our CEO before we put in an ethics application.
The Decision to participate form is intended as a commitment from participating sites. However, sites are
not legally bound to participate if they confirm participation first and withdraw later.
Based on your experience if you think that the CEO is likely to grant approval to participate, we
recommend you complete and submit the decision to participate form so your staff members can commence
with the training.