PROTECTED MEALTIMES

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PROTECTED MEALTIMES

• Does this improve the patients experience of
  hospital meals?

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

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

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BACKGROUND

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

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BACKGROUND (2)

• Potential to assist in the achievement of Essence
  of Care benchmarks for food and nutrition
• (NHS Modernisation Agency 2003)
• Addenbrookes Hospital has developed its own
  standards based on these

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BACKGROUND (3)

• Protected Mealtimes was recently recommended in
• Hungry to be Heard the scandal of malnourished
  older people in hospital
• (Age Concern August 2006)

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AIM

• To protect the patients mealtime, making their
  nutritional intake the top priority of care
  during this period

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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

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KEY PEOPLE INVOLVED

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

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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

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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

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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)

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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 Patients Visitors Doctors To talk to me, Other Patients Visitors Too Loud
1 Physiotherapist Walking
1 Other Patients 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
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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
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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

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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

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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

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RECENT AUDIT TRENDS

• Wards without Protected Mealtimes
• Examples of interruptions
• Bed making Exercises
• Observations Cleaning
• Medication Drs rounds
• Visitors Noise
• i.e. routine tasks, regular interruptions

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RECENT AUDIT TRENDS (2)

• Wards with Protected Mealtimes
• Examples of interruptions
• Shortage of staff- need to complete duties
• Urgent bloods
• Delayed Drs rounds
• i.e. unplanned and emergency interventions

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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

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FUTURE PLANS (2)

• Consider implementation of related initiatives
  e.g. Red Tray Project
• Upcoming meetings with governor focus groups and
  members of the public

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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

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ANY QUESTIONS?