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

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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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Acknowledgements

A special thank you to the Langara College Nursing students

for their leadership and hard work with the project:

• Carly Irons

• Erica Dovan

• Kalin Li

• Vivian Dinh

• Raluca Antonovici

• Stephanie Yurchuk

• Dr. Veryl Tipliski, Nurse Educator, Langara School of

Nursing

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