Meal time should be a protected time

Malnutrition in hospitals could be slashed and Australia’s health bill cut if hospital staff help elderly patients to eat.

Nothing shall be done in the ward while the patients are having their meals. These words were spoken by Florence Nightingale in 1859. Yet today, 150 years later, nearly one in three elderly patients in hospitals are malnourished, and a further 60 per cent are at risk of malnutrition.
This is partly the result of patients not always receiving the help they need to eat their meals. Dietitians say the supply of hospital food to these patients could be improved, but assistance for elderly people at meal times should be a priority.

Many patients are already malnourished when they are admitted to hospital, but they are at risk of getting worse during their stay so staff need to pay more attention to what they eat, says Adrienne Young, researcher from the Queensland University of Technology.

“The food often comes in fiddly portion packs that can be hard to open, or the patient can’t sit up out of bed making it difficult to cut up their food,” says Young.

“Half an hour later the tray is taken away – and the patient hasn’t touched the food.”

Adding to the problem, she says hospital meal times are often interrupted by drug rounds, non-urgent visits from health staff and cleaning.

This led Young and her colleagues at the Royal Brisbane and Women’s Hospital to trial the introduction of protected meal times. At these times routine ward activities are scaled back.

“Protected meal times allow patients to eat their meals in peace, give staff more time to focus on patients who need help to eat, and help staff keep track of a patient’s food intake,” says Young.

Studies using feeding assistants at meal times have shown this to improve the level of nutritional care provided to patients, she says.

A study by the University of Wollongong found kilojoule and protein intake increased in elderly hospital patients at Sutherland Hospital when volunteers and nurses helped patients to eat.

In the study, researcher Kerri Harris, says energy and protein intakes at lunch time increased by almost 500kJ and 4g protein. And daily protein intake increased significantly, by around 9g per day.

“For an older person that’s a huge amount – 10g of protein to a 70 year old woman represents almost 20 per cent of her daily protein needs, or the amount of protein in two eggs,” says Harris.

Over and above improvements to patient’s nutritional intakes, Young says there can also be cost benefits for hospitals with increased feeding assistance at meal times.

“We know from previous research that properly nourished patients are less likely to need long hospital stays or follow-up treatment after they’ve been discharged. A nutritious diet aids recovery and can help prevent infections and medical complications,” says Young.

One study in Queensland public hospitals found the cost of treating pressure ulcers attributable to malnutrition was almost $13 million alone.

“Imagine the money that could be saved by preventing and treating malnutrition,” says Young.

Placing food first
• Allow patients to eat their meals without unnecessary interruption
• Provide and environment conductive to eating
• Assist staff to provide patients with support and assistance with meals

Protected mealtimes
• Ward-based teams will organise their own mealtimes to maximise the number of staff available to deliver and assist patients with food.
• Prior to the service of food: provide patients with assistance to use the toilet and the opportunity to wash their hands.
• Patients will be made comfortable prior to the service with food served within reach and supported by an appropriate eating position.
• Patients requiring assistance with food to be indentified to the ward team prior to the service of meals.
• Bed tables and eating areas to be cleared of items not conductive to mealtimes. For example, urine bottles.
• Consider closing the ward to visitors during mealtimes, except those assisting with meals.
• Interruptions will only occur when clinically appropriate. Undesirable interruptions include ward rounds, medication rounds, GP visits, cleaning and documentation.
• Staff directly involved with patients at mealtimes to avoid answering the phone.

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