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 ExercisesObservations CleaningMedication Dr’s roundsVisitors 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 bloodsDelayed 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?