Problem Statement

Receiving the right nutrition and hydration is a fundamental human right and requirement in the delivery of health care. The role of food and nutrition within the healing process cannot be underestimated, and must be considered an integral and fundamental component of a patient’s treatment plan.

Evidence shows that malnutrition is common in the hospital setting. Patients are frequently admitted to hospital malnourished and a significant number of patients are identified as being at risk of malnutrition during their stay. Patient malnutrition can result in higher treatment costs, longer length of stay, and increased risk of hospital readmission and mortality.

Providing patients with meals of an appropriate temperature and quality, providing appropriate mealtime assistance and minimising mealtime interruptions supports improved patient outcomes and helps ensure appropriate nutrition and hydration is provided.

In a pre-implementation audit of a pilot ward, before the Protected Mealtimes initiative was introduced, 14 out of 25 patients stated that they were interrupted at mealtimes, and four out of eight patients who were identified as requiring some assistance stated they did not get assistance, or the assistance was given too late.

What are we trying to achieve?

Our goals are to:

  • provide a patient-centred framework that recognises nutrition as an integral aspect of health improvement and patient care
  • support the rehabilitation of patients through good nutrition and hydration
  • reduce variation in the delivery of the fundamental aspects of care, specifically nutrition and hydration
  • support CM Health’s commitment to providing consistent, quality care, and ensuring all patients receive appropriate nutritional support to meet their needs
  • support best practice in Fundamentals of Care Standard 6 (Nutrition and Hydration)
  • improve patient experience and health outcomes
  • ensure health equity for all patients, especially those affected by disability, cognitive impairment, diabetes and obesity.

Below is the audit question from the Fundamentals of Care Programme.

What have we done?

The Fundamentals of Care Programme was introduced at CM Health in 2017 to ensure the provision of high quality, consistent patient/whaanau care. There are nine standards including nutrition and hydration. The standards are supported with an improvement and assurance framework.

The Protected Mealtimes initiative has been implemented in eight wards since June 2018, in response to Fundamentals of Care peer review results.

There has been variation in the consistency and continuity of how Protected Mealtimes has been implemented. Staff support and a systematic organisational approach are needed to promote the success of the initiative.

Results from the March 2019 Fundamentals of Care review identified those wards that scored 65% or less in the Nutrition and Hydration standard. Staff in these areas will be supported to introduce Protected Mealtimes as an improvement initiative.

A ward information resource package is also being developed to support staff and develop a consistent approach to implementation.

We have gathered data to evaluate the impact of Protected Mealtimes on stakeholders, such as ward staff, phlebotomists, Multi Disciplinary Team (MDT) and radiology. Phlebotomy staff have endeavoured to adapt their schedules around Protected Mealtimes. However, this may become more challenging as the initiative rolls out across the organisation.

Evaluation of the initiative’s impact on other stakeholders is in progress.

A Working Group has been established to support Protected Mealtime implementation and provide consistent approach.

What did we find?

Those wards that have implemented Protected Mealtimes report improvements in the efficiency of meal distribution. Before the Protected Mealtime implementation, meal distribution took 25 to 40 minutes. Post-implementation, meal distribution takes around 2.5 to 5 minutes. This means that patients receive food that is fresh and at an appropriate temperature, increasing the likelihood of them consuming their meal.

Preparing patients for their meals has given the healthcare team dedicated time to provide basic care, including toileting, handwashing and positioning of patients proactively rather than reactively.

Protected Mealtimes has also raised awareness of patients’ mobility and assistance needs, and staff report that patients have received timely, appropriate assistance to eat and drink.

Staff also report that there has been less incidence of patients missing meals, and that when problems have arisen, they have been rectified quickly due to efficient distribution.

Barriers to implementation and continuity have included staff finding it difficult to change traditional tasks and routines, and visiting staff interrupting patients during mealtimes. There is a very high need for charge nurse managers to drive the initiative; continuity is significantly compromised in the absence of a dedicated champion.

The impact of Protected Mealtimes on stakeholders and patient flow will need to be assessed and monitored as Protected Mealtimes are implemented across the organisation.

Guidelines and policy development will be required to support the continuation of Protected Mealtimes.

How did we make a difference?

The March 2019 Fundamentals of Care review showed that six out of eight Protected Mealtimes wards achieved an overall score of 80 percent or higher in Care Standard 6: Nutrition and Hydration since implementation. Five out of eight of these wards have improved their scores since July 2018.

Where to from here?

The aim is to implement Protected Mealtimes across the organisation over the next 6 months. Initially, this will be in wards identified as scoring below 65 percent the Fundamentals of Care March 2019 review in Care Standard 6: Nutrition and Hydration.

The Working Group will agree an approach to the Protected Mealtimes rollout, provide education, resource materials and promote the benefits of Protected Mealtimes. The Working Group will also monitor and evaluate the impact of Protected Mealtimes on patient and staff experience.

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