1. Making a Meal of Health Samantha Cushen, BSc, M.I.N.D.I Research Dietitian, School of Food and Nutritional Sciences, University College Cork

3. Public Private

4. Operation Hospital Food James Martin

5. Malnutrition

7. Irish Examiner Nov 2011 Irish Daily Mirror Nov 2011 In comparison: the cost of overweight and obesity in Ireland =€1.13billion

9. The length of time a patient spends in hospital and the cost of that stay is linked to the patient’s nutritional status. Under-nutrition in sick patients is associated with: impairment of every system in the body: muscle weakness, particularly in respiratory muscles; reduction of the ability of the immune system to function; and alterations in the structure and function of the gut delayed wound healing apathy and depression reduction of appetite and the ability to eat higher rates of mortality

10. The Debilitating Effect of Poor Nutrition (Allison, 1999)

11. Causes of under-nutrition in Hospital The many causes of under-nutrition include: loss of appetite due to the disease difficulties in chewing or swallowing lack of assistance with feeding inappropriate utensils impaired cognitive function missed meals due to interruptions or investigations at mealtimes or excessive fasting Inadequate provision of food and physical disability can cause under-nutrition or aggravate an existing deficiency.

12. The aim for both the dietitian and the caterer is the same; that the patient consumes their food and gains nutritional benefit.

13. Hospital Catering Catering services in healthcare have a high public profile – benchmark by which patients, staff and the local community judge hospital services The nutritional value of food left uneaten is nil

16. Hydration Water is fundamental for life and health. The human right to water is indispensable for leading a healthy life in human dignity. It is a pre-requisite to the realisation of all other human rights’ United Nations Committee on Economic, Cultural and Social Rights - 27 November 2002 Improving hydration brings well-being, better quality of life and improved health outcomes for individuals. It can also reduce use of medication and prevent illness which will benefit all healthcare providers.

17. Food Waste Nutritional requirements cannot be met when people fail to eat their meals as served. Understanding the reasons for food waste on the ward is critical to understanding patients’ food consumption. Although waste is unavoidable it is beneficial to all involved in the food chain if it can be measured. Monitoring food waste is equally vital to the caterer, because of the cost implications Measurement of plate waste is an important indicator of food consumption.

18. Reasons for food waste... Over-production in excess of the need to provide choice Over-ordering of meals (such as ordering a meal for someone who is Nil By Mouth, just in case their dietary status changes) Poor communication systems Patient movements and discharges No suitable ‘special or personal diet choice'. Meal ordering too far in advance People may require assistance with eating Person was asleep, away from the bed, in an awkward position or interrupted Unpleasant procedures/incidents taking place nearby

19. Protected Mealtimes: provision of a patient- focussed meal service “Nothing shall be done on a ward whilst patients are having their meal” Florence Nightingale (1859)

20. Protected Mealtimes: An Irish Perspective St. Vincent’s University Hospital (SVUH) endorses the Protected Mealtime Policy as food comes first at mealtimes in SVUH. The policy ensures that patients will not be disturbed between 12 noon and 1.30 pm. This will allow patients to complete their meal and to receive encouragement and assistance if required.

21. Protected mealtimes are difficult to protect….

23. Summary Food service in hospitals must be given a higher Priority in Ireland Nutrition should be high on the agenda for a catering managers; every decision that is made is based on putting the patient first It is important that nutrition steering groups have representation from a multidisciplinary team including catering, dietetics, nursing and clinical staff. Hospitals are encouraged to have protected mealtimes to allow patients to eat undisturbed