Senior Clinical Nurse; PROTECTED MEALTIMES Does this improve the patient’s experience of hospital meals? Tracey McClelland, Senior Clinical Nurse; Marja Khalifa, Ward Manager.

(except emergency treatments) DEFINITION An uninterrupted lunch service with nurses focused on the delivery of food to patients for 1 hour (except emergency treatments) “Protected mealtimes are periods on a hospital ward when all non-urgent clinical activity stops. During these times, patients are able to eat their meals without interruption and staff are readily available to offer help to those who need it. Research shows that patients whose mealtimes are protected eat more and are better nourished, improving their chances of recovery” DoH, currently on website

A national initiative, initially backed by: - BACKGROUND A national initiative, initially backed by: - Hospital Caterers Association/RCN Department of Health NHS Estates NHS Plan Details of which documents: HCA wrote protected Mealtimes Policy, now endorsed by RCN. DoH/NHS Estates and NHS Plan: Better Hospital Food Doc in 2001

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 PMT can influence achievement of benchmarks including: conducive environment, assistance to eat and drink, obtaining food, food presentation, monitoring, and eating to promote health

BACKGROUND (3) Protected Mealtimes was recently recommended in: Hungry to be Heard: the scandal of malnourished older people in hospital (Age Concern August 2006) Statistics quoted in Hungry to be Heard: 4/10 older people admitted to hospital have malnutrition on arrival; 6/10 older people are at risk of becoming malnourished or their current nutritional state worsening in hospital

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 Lunchtime is when the patients hot/main meal served. Aim is to follow this with a 1 hour rest period

KEY PEOPLE INVOLVED Patients and Relatives Estates and Facilities team Nurses and Ward Assistants Medical staff AHPs Radiology Cleaning staff Visitors/relatives generally understanding and supportive. Estates: delivery time of trolley changed to allow drug rnd completion. Routines changed for all to avoid lunchtime patient activity- suggested drs take lunch break!

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 2 week pre audit, 2 week trial. Enough days to allow for changes in activity/staffing levels

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 Different patients, randomly selected- aimed for 5 per day on each ward

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%) 24% before, 7% after

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 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

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 Patient in this case was very disorientated and would call even if a nurse providing care to her

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 Medical staff moving rounds, radiology focusing lunchtime slots on other areas, nurse routine- nurses want to get everything done, junior staff reluctant to challenge visitors and staff

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 Surgical areas, considering how PMT will interact with theatre lists. Also must consider that more wards with PMT, will have greater impact on other depts. e.g. radiology

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 Audit to measure and review success in all areas of nutrition against E of C benchmarks

RECENT AUDIT TRENDS Wards without Protected Mealtimes: Examples of interruptions Bed making Exercises Observations Cleaning Medication Dr’s rounds Visitors Noise i.e. routine tasks, regular interruptions Low numbers of audit results analysed, but trends show that patients are routinely interrupted while eating on areas without PMT

RECENT AUDIT TRENDS (2) Wards with Protected Mealtimes Examples of interruptions Shortage of staff- need to complete duties Urgent bloods Delayed Dr’s rounds i.e. unplanned and emergency interventions We haven’t completely eliminated interruptions, but those above highlight that they are usually not routine and that generally ward routines have changed and staff have adapted their focus

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 Meeting to be arranged with new volunteer manager, to discuss role. If not feeding could be assisting, opening packets, cutting up food or general encouragement. Regional NPSA review will allow feedback and sharing of ideas

FUTURE PLANS (2) Consider implementation of related initiatives e.g. Red Tray Project Upcoming meetings with governor focus groups and members of the public Red tray to highlight patients that needs assistance with eating and drinking Feedback audit results, hear what patients and public have to say about Trust related to nutrition

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

Creating a calm and relaxing atmosphere ANY QUESTIONS? Protected Mealtimes Creating a calm and relaxing atmosphere