EAT NOW:
Implementing a Sustainable
Patient Protected Mealtime
Program
Theresa Cividin, Practice Leader Clinical Nutrition, VA
Jacqueline Per, Director Quality & Patient Safety, Vancouver
Stephanie Yurchuk, BSN Student, Langara College
Quality Forum 16
February 25, 2016
Background
Summary of VGH Data
34 % subjects malnourished upon admission
29% subjects had intakes less than 50%
Intakes of greater than 50% are associated with early discharge
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“By removing non-essential staff interruptions
and pausing non-essential tasks, health care
staff can help clients with hand hygiene, meal
set-up, and provide extra assistance to those
in need.” (Agarwal et al, 2012)
Protected Mealtimes
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Baseline Audit – May 2014 (n=136)
• Pt hand hygiene – 0%
• Good positioning – 74%
• Bedside table – 80%
• Interruptions – 163
• <50% intake – 28%
Wave One:
Baseline and Education
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Wave One Outcomes Engage Stakeholders
• Unit Leadership
• All unit staff
• Support staff: Sodexo and Aramark
• Physicians/residents
Staff Education
• Introduce Protected Mealtime
• EAT NOW (Easy Access to Nutrition on Wards)
• Plan for patient hand hygiene
• Posters on unit and in patient rooms
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Wave Two: Implementation
• Pt hand hygiene – 0%
• Good positioning – 74%
• Bedside table – 80%
• Interruptions – 163
• <50% intake – 28%
• Pt hand hygiene – 56%
• Good positioning – 100%
• Bedside table – 99%
• Interruptions – 47
• <50% intake – 16%
Baseline - May 2014
(n=136)
Post - Oct 2014
(n=146)
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• To improve staff attitudes towards menu items
– Sample menu items and different food
textures from the patient menu
• Relationship building with the Food Services
Management team
Food Tasting Events
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Wave Three: Evaluation
Pt hand hygiene – 0%
Good positioning – 74%
Bedside table – 80%
Interruptions – 163
<50% intake – 28%
Pt hand hygiene – 56%
Good positioning – 100%
Bedside table – 99%
Interruptions – 47
<50% intake – 16%
Baseline - May 2014
(n=136)
Post - Oct 2014
(n=146)
Post – June 2015
(n=127)
Pt hand hygiene – 55%
Good positioning – 84%
Bedside table – 96%
Interruptions – 77
<50% intake – 12%
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Sustainability Phase
• Unit Orientation (patients, visitors, staff)
• Hand Hygiene: sani wipes provided on meal
trays
• Continued Food Tasting Events
10
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What the staff (n=12) said:
Interruptions:
- non-emergent tests and procedures, blood collection, doctor and family meetings
Barriers to PPM implementation:
- late diet orders, workload, testing and procedures, competing hospital resources
Nutrition in relation to patient’s health:
- extremely important
Further support:
- more staff, test times to change, staffing and organization
“Maybe we can include
the cleaning wipes with
the meal tray”
“I Feel that nutrition
is incredibly
undervalued”
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What the patients (n=22) said:
- received mealtime assistance
- received a menu to mark
- those who required assistance with menu selections received it
- Only one patient reported being distracted from eating (Pain)
“The nurse
always came
in to help me
eat”
“The staff was
very helpful
and kind”
“The food
was
delicious”
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Next Steps
• Incorporate PPM into VCH orientation
• Incorporate into the patient information packages
• Continue to improve compliance to patient hand hygiene
• Continue to explore diagnostic testing/phlebotomy options
• Expand to other units at VGH
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