Mealtime interruptions, assistance and nutritional intake in subacute care
Judi Porter A B C , Anita Wilton B and Jorja Collins AA Monash University Department of Nutrition and Dietetics, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. Email: jorja.collins@monash.edu
B Eastern Health, 5 Arnold Street, Box Hill, Vic. 3128, Australia. Email: anita.wilton@easternhealth.org.au
C Corresponding author. Email: judi.porter@monash.edu
Australian Health Review 40(4) 415-419 https://doi.org/10.1071/AH15060
Submitted: 27 March 2015 Accepted: 13 August 2015 Published: 19 October 2015
Abstract
Protected mealtimes is an initiative to support increased nutritional intake for all hospitalised patients, particularly those who are malnourished. The increased focus on maximising independence of patients in the subacute setting may provide a supportive environment for implementing these strategies. The aim of the present study was to gain insight into subacute ward practices at mealtimes under usual conditions (i.e. at baseline) where no protected mealtimes policy was implemented. Participants were patients aged ≥65 years recruited from subacute care facilities at a large healthcare network in Victoria, Australia. Participants were observed at mealtimes and mid meals (i.e. morning tea, afternoon tea and supper) to determine daily energy and protein intake, provision of mealtime assistance and mealtime interruptions. Almost all participants received assistance when it was needed, with positive and negative interruptions experienced by 56.2% and 76.2% of participants, respectively. There was an energy deficit of approximately 2 MJ per day between average intake and estimated requirements. In conclusion, mealtime practices were suboptimal, with particularly high rates of negative interruptions. Protected mealtimes is one strategy that may improve the mealtime environment to support patients’ dietary intake. Prospective studies are needed to evaluate its implementation and effects.
What is known about this topic? The mealtime environment on a hospital ward may influence the nutritional intake of patients. Protected mealtimes is a systems approach that aims to minimise negative interruptions and promote positive interruptions to enhance the nutritional intake and nutritional status of patients. Whilst the approach has been widely implemented, further evaluation of its fidelity and effects is required.
What does this paper add? This observational research has determined the nutritional intake, provision of assistance and interruptions at mealtimes experienced by a cohort of subacute care patients under usual care conditions. An energy deficit of approximately 2MJ below estimated requirements was identified. Half of the participants received positive interruptions and the majority of participants requiring assistance received it, however the prevalence of negative interruptions was high. This pilot study has enabled a fully powered prospective study to be designed, exploring the implementation of protected mealtimes and its effects on nutritional intake of patients in the subacute setting.
What are the implications for practitioners? The energy deficit that exists for patients in subacute care may lead to nutritional decline, and longer lengths of stay. There are opportunities to improve ward practices at mealtimes in the subacute setting to focus on nutritional care.
Additional keywords: energy, hospitalisation, malnutrition, protected mealtimes.
References
[1] Hospital Caterers Association. Protected mealtimes policy. 2004. Available at: http://www.hospitalcaterers.org/documents/pmd.pdf [verified 30 August 2013].[2] NHS National Patient Safety Agency. Protected mealtimes review. Findings and recommendations report: V1. 2007. Available at: http://www.nrls.npsa.nhs.uk/resources/?entryid45=59806 [verified 13 August 2013].
[3] Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, Isenring E. Nutrition care practices in hospital wards: results from the Nutrition Care Day Survey 2010. Clin Nutr 2012; 31 995–1001.
| Nutrition care practices in hospital wards: results from the Nutrition Care Day Survey 2010.Crossref | GoogleScholarGoogle Scholar | 22717261PubMed |
[4] Charlton KE, Nichols C, Bowden S, Lambert K, Barone L, Mason M, Milosavljevic M. Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database. J Nutr Health Aging 2010; 14 622–8.
| Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cfntlarug%3D%3D&md5=a20e31cf515873aa38b3b242a54183d6CAS | 20922337PubMed |
[5] Walton K, Williams P, Tapsell LC, Batterham M. Rehabilitation inpatients are not meeting their energy and protein needs. Eur J Clin Nutr 2007; 2 e120–6.
[6] Neumann SA, Miller MD, Daniels L, Crotty M. Nutritional status and clinical outcomes of older patients in rehabilitation. J Hum Nutr Diet 2005; 18 129–36.
| Nutritional status and clinical outcomes of older patients in rehabilitation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M7lsFKitQ%3D%3D&md5=ae913d314013522fb52433d7d320cb57CAS | 15788022PubMed |
[7] Beck E, Carrie M, Lambert K, Mason S, Milosavljevic M, Patch C. Implementation of malnutrition screening and assessment by dietitians: malnutrition exists in acute and rehabilitation settings. Aust J Nutr Diet 2001; 58 92–7.
[8] Das AK, McDougall T, Smithson JA, West RM. Benefits of family mealtimes for nursing home residents: protecting mealtimes may similarly benefit elderly inpatients. BMJ 2006; 332 1334–5.
| Benefits of family mealtimes for nursing home residents: protecting mealtimes may similarly benefit elderly inpatients.Crossref | GoogleScholarGoogle Scholar | 16740570PubMed |
[9] Weekes CE. The effect of protected mealtimes on meal interruptions, feeding assistance, energy and protein intake and plate waste. Proc Nutr Soc 2008; 67 E119
| The effect of protected mealtimes on meal interruptions, feeding assistance, energy and protein intake and plate waste.Crossref | GoogleScholarGoogle Scholar |
[10] Hickson M, Connolly A, Whelan K. Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients. J Hum Nutr Diet 2011; 24 370–4.
| Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MnlsVSmsQ%3D%3D&md5=20c7e6b5efca02e41a0cff208b82817cCAS | 21585568PubMed |
[11] Huxtable S, Palmer M. The efficacy of protected mealtimes in reducing mealtime interruptions and improving mealtime assistance in adult inpatients in an Australian hospital. Eur J Clin Nutr 2013; 67 904–10.
| The efficacy of protected mealtimes in reducing mealtime interruptions and improving mealtime assistance in adult inpatients in an Australian hospital.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3sfhs1amsQ%3D%3D&md5=9e25e63c8061365f30b7dc91facd9495CAS | 23860001PubMed |
[12] Young AM, Mudge AM, Banks MD, Ross LJ, Daniels L. Encouraging, assisting and time to EAT: improved nutritional intake for older medical patients receiving protected mealtimes and/or additional nursing feeding assistance. Clin Nutr 2013; 32 543–9.
| Encouraging, assisting and time to EAT: improved nutritional intake for older medical patients receiving protected mealtimes and/or additional nursing feeding assistance.Crossref | GoogleScholarGoogle Scholar | 23211758PubMed |
[13] Department of Human Services, Metropolitan Health and Aged Care Services Division. Promoting health independence: a framework for better care. 2008. Available at: http://www.health.vic.gov.au/subacute/conf-211108/phi-framework-report.pdf [verified 10 September 2013].
[14] Australian Institute of Health and Welfare. Admitted patient care: sub-acute and non-acute care. Australian Government. 2010–2011. Available at: http://www.aihw.gov.au/haag10-11/admitted-patient-care-sub-acute-non-acute/ [verified 24 January 2013].
[15] Health & Social Care Information Centre (HSCIC). Hospital episode statistics, admitted patient care – England, 2011–12: main operations summaries. Leeds, UK: HSCIC. 2012. Available at: http://www.hscic.gov.uk/searchcatalogue?productid=9161&q=title%3a%22Hospital+Episode+Statistics%2c+Admitted+patient+care+-+England%22&sort=Relevance&size=10&page=1#top) [verified 16 April 2014].
[16] Health & Social Care Information Centre (HSCIC). Hospital episode statistics, admitted patient care – England, 2007–08: main operations summaries. Leeds, UK: HSCIC. 2009. Available at: http://www.hscic.gov.uk/searchcatalogue?productid=94&q=title%3a%22Hospital+Episode+Statistics%2c+Admitted+patient+care+-+England%22&sort=Relevance&size=10&page=1#top [verified 16 April 2014].
[17] LaChance PA. Simple research techniques for school foodservice. Part II. Measuring plate waste. Sch Foodserv J 1976; 30 68–72.
[18] Berrut G, Favreau AM, Dizo E, Tharreau B, Poupin C, Gueringuili M, Fressinaud P, Ritz P. Estimation of calorie and protein intake in aged patients: validation of a method based on meal portions consumed. J Gerontol A Biol Sci Med Sci 2002; 57 M52–6.
| Estimation of calorie and protein intake in aged patients: validation of a method based on meal portions consumed.Crossref | GoogleScholarGoogle Scholar | 11773213PubMed |
[19] Xyris. Foodworks 7 (version 3.02). Available at: http://www.xyris.com.au/ [verified 10 September 2013].
[20] Department of Human Services (Victoria). Nutrition standards for menu items in Victorian Hospitals and residential aged care facilities. 2009. Available at: http://www.health.vic.gov.au/archive/archive2011/patientfood/nutrition_standards.pdf [verified 20 August 2013].
[21] Detsky AS, Smalley PS, Chang J. The rational clinical examination. Is this patient malnourished? JAMA 1994; 271 54–8.
| The rational clinical examination. Is this patient malnourished?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c%2FotFGlsw%3D%3D&md5=246a1cf39d02e275e2791b9ead8eaa4cCAS | 8258889PubMed |
[22] Alix E, Berrut G, Bore M, Bouthier-Quintard F, Buia JM, Chlala A, Cledat Y, d’Orsay G, Lavidne C, Levasseur R, Mouzet J, Ombredanne M, Salle A, Gaillard C, Ritz P. Energy requirements in hospitalized elderly people. J Am Geriatr Soc 2007; 55 1085–9.
| Energy requirements in hospitalized elderly people.Crossref | GoogleScholarGoogle Scholar | 17608883PubMed |
[23] Gaillard C, Alix E, Boirie Y, Berrut G, Ritz P. Are elderly hospitalised patients getting enough protein? J Am Geriatr Soc 2008; 56 1045–9.
| Are elderly hospitalised patients getting enough protein?Crossref | GoogleScholarGoogle Scholar | 18554362PubMed |
[24] Manning F, Harris K, Duncan R, Walton K, Bracks J, Larby L, Vari L, Jukkola K, Bell J, Chan M, Batterham M. Additional feeding assistance improves the energy and protein intakes of hospitalised elderly patients. A health services evaluation. Appetite 2012; 59 471–7.
| Additional feeding assistance improves the energy and protein intakes of hospitalised elderly patients. A health services evaluation.Crossref | GoogleScholarGoogle Scholar | 22735333PubMed |
[25] Wright L, Hickson M, Frost G. Eating together is important. Using a dining room in an acute elderly medical ward increases energy intake. J Hum Nutr Diet 2006; 19 23–6.
| Eating together is important. Using a dining room in an acute elderly medical ward increases energy intake.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28%2FmsFSiug%3D%3D&md5=081e41108c5adde8729083ecb694f1e9CAS | 16448471PubMed |
[26] Stratton RJ, van Binsbergen J, Volkert D, Hebuterne X, Elia M. Systematic review and meta-analysis of the effects of oral nutritional supplements on hospital admissions. Clin Nutr Suppl 2011; 6 16
| Systematic review and meta-analysis of the effects of oral nutritional supplements on hospital admissions.Crossref | GoogleScholarGoogle Scholar |
[27] Collins J, Porter J. The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: a systematic review with meta-analysis. J Hum Nutr Diet 2015; 28 1–15.
| The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: a systematic review with meta-analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2cjhtVGrtg%3D%3D&md5=47117b3ddb984cee3341f33ca05ba883CAS | 24811842PubMed |
[28] Francke AL, Smit M, de Veer AJE, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak 2008; 8 38
| Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.Crossref | GoogleScholarGoogle Scholar | 18789150PubMed |
[29] Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362 1225–30.
| From best evidence to best practice: effective implementation of change in patients’ care.Crossref | GoogleScholarGoogle Scholar | 14568747PubMed |
[30] Mudge AM, Ross LJ, Young AM, Isenring EA, Banks M. Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients. Clin Nutr 2011; 30 320–5.
| Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients.Crossref | GoogleScholarGoogle Scholar | 21262553PubMed |
[31] Reeves A, White H, Sosnowski K, Tran K, Jones M, Palmer M. Energy and protein intakes of hospitalised patients with acute respiratory failure receiving non-invasive ventilation. Clin Nutr 2014; 33 1068–73.
| Energy and protein intakes of hospitalised patients with acute respiratory failure receiving non-invasive ventilation.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhvF2rsbnK&md5=797181499bfb0ead6267e9d9eac60748CAS | 24321188PubMed |
