Protected Mealtimes Helga Goutcher Palau de Congressos de Catalunya, Barcelona. 18th April 2007.
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Transcript of Protected Mealtimes Helga Goutcher Palau de Congressos de Catalunya, Barcelona. 18th April 2007.
Protected Mealtimes
Helga Goutcher Palau de Congressos de Catalunya, Barcelona. 18th April
2007
Opportunity
Nutrition in the elderly has been a focal point of media attention. St Nicholas’ nursing home (a UK 176 bedded nursing home) looked at enhancing the nutritional health of clients with dementia by improving the dining experience.
• BUPA & BUPA Care Homes• St Nicholas’ care home• Protected mealtimes• How we got started• Actions taken• Outcomes• Advice: How to implement in your own home
Overview of Presentation
BUPA - Our Vision and Values
Vision
“Taking care of the lives in our hands” Values
CaringAccountableEthicalRespectfulDedicatedEnabling
BUPA Care Homes• Provident company – all profits returned to the
business, no shareholders• Established 1948• Approx. 300 care homes in the UK• Employs 27,000 people• 70% public (state) funded residents• 30% private funded residents• 19227 Residents in May 2006 (census 2006)• 5179 (30%) Dementia Clients (census 2006)• 77% of all residents show some sign of confusion,
challenging behaviour or depression.
St Nicholas’ Care Home• Multi-site.• 176 beds• 6 units• 4 frail elderly• 1 learning
disability• 1 dementia unit
(Gladstone House)• 208 staff• 88% Occupancy• Local authority
funded residents
Protected Mealtimes
• What are protected mealtimes?• External drivers
– Primary Care Trust– NHS hospital examples– No funding available
• Internal drivers– Already identified difficulties in dementia unit– Pre-admission assessments were identifying
malnutrition
How we got started
• Observational Audit– Random– Unannounced– Over two week period– Two people– Independent findings– All mealtimes covered– Nil intervention during audit– Conferred at end
Audit - Results from observationResident’s
perspective• Stressed• Challenging
behaviours• Anxiety• Aggression• Voted with their
feet• Poor food/fluid
intake
Environment
• Excessive noise levels
• Telephone interruptions
• Door bells ringing• Staff voice levels
Staff perspective
• Disorganised• No leadership• Haphazard• High level of
people traffic• Task orientated
High level of activity resulting in stressed residents and distraction from eating
Actions Taken
• Internal feedback to all staff• External feedback to agencies• Full involvement of families• Action plan developed
Action Plan Details
• Only people actively involved in mealtimes present
• Environmental-table presentation• Hostess service• Seating plans developed• Doors to lounge closed about 15-20 min
prior to mealtimes• TV turned off• Telephones redirected to admin
(cont…)
Action Plan Details (cont…)
• All care staff available and dedicated to groups of residents
• Gentle prompting of residents who may leave their seat
• Promote interaction between care staff and residents
• No housekeeping duties undertaken• Reduced voice levels• GPs, etc. visits rescheduled to more convenient
times• Changed times of administration of medicine
Outcome/Benefits
Privacy& Dignity
Weight increase
Calmer environment
Reduction in food supplements
More interested in activities
Reduction in challenging behaviour
Less food wastage
Highly motivated staff
Improved partnerships
Improved staff retention
Improved rapport with relatives
Enhanced reputation
R
e
s
i
d
e
n
t
Direct Indirect
Outcomes (3 months later)
(cont…)
Gladstone House Resident Weights1 0.
65 1 0.6
0
0.25
6.5
2.5
1.7
3.3 1.
2 1.5
2.55 3.
55
0
3.05 4.
1 0.45
4.8 4.73
-3.0
5
-1.3
5
-1.7
5
-1.5
5
40
50
60
70
80
90
Individual Residents
Wei
gh
t (k
g)
Pre protected meal times Post Prot-meal (gained weight) Post Prot-meal (lost weight)
Outcomes (3 months later) (cont…)
• Out of 24 residents, 20 showed an increase in weight with only 4 (17%) having weight loss
• The average resident's weight increased by 3%
• Some residents are not included:– 3 Residents have died in the intervening
period– 2 Residents have been transferred to frail
elderly– 1 Resident refused to be weighed
Comments by GPs , Nurses Relatives, etc
“We got our mum
back”
“Breathtaking innovation”
“Are these really people
with dementia?”
“We need to
buy bigger clothes”
“When are you
introducing exercise?”
“I can’t believe Mrs M’s weight
gain”
“I seem to be visiting this unit
less”
Advice: Doing this in your own home
• Start with a planned observational audit• Ensure you have the support and
cooperation of visiting professionals• Involve the residents and relatives in the
process• Have the hearts and minds of your staff
involved to make sure they are engaged
Thank you, any Thank you, any questions?questions?
Helga Goutcher, contact details
• Email: [email protected]
• Phone: (+44) 0113 381 6265
• Address: BUPA Care Services, Bridge House, Outwood Lane, Horsforth, Leeds. LS18 4UP