Presentation on theme: "Protected Mealtimes Helga Goutcher Palau de Congressos de Catalunya, Barcelona. 18th April 2007."— Presentation transcript:
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 Caring Accountable Ethical Respectful Dedicated Enabling
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 observation Residents 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 ResidentResident Direct Indirect
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 cant believe Mrs Ms 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
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