APPENDIX 9 PROTECTED MEALTIMES 1. BACKGROUND Mealtimes are not only a vehicle to provide patients with adequate nutrition but also provide an opportunity to support social interaction amongst patients. The therapeutic role of food within the healing process cannot be underestimated. However, food, even if it is of the highest quality is only of any value if the patient actually eats it. A greater understanding in the importance of the meal experience and nutritional requirements is increasing within the wider healthcare team. Food and the service of food are now regarded by many as an essential part of treatment. The National Institute for Health and Clinical Excellence (NICE) guidelines for Nutrition Support in Adults (February 2006) underlines the concern that up to 40% of adults show signs of malnutrition on admission to Hospital and often their stay can exacerbate the condition. Certain patient groups, such as the elderly, have particular dietary and eating requirements that need to be met to prevent malnutrition and to aid recovery. The Ward environment, presentation of food and the timing and content of meals are important elements in encouraging patients to eat well. The importance of mealtimes must be emphasised with dedicated time set aside for the service of food, supporting Ward-based staff to focus on the nutritional requirements of patients at mealtimes. 2. STATEMENT The purpose of Protected Mealtimes is to protect mealtimes from unnecessary and avoidable interruptions, providing an environment conducive to eating, ensuring staff provide patients with support and assistance with meals, placing food first at mealtimes and promoting and educating patients and their visitors of the benefits and their responsibilities. 3. AIMS AND OBJECTIVES This statement on Protected Mealtimes sets out: To improve the meal experience and support the social aspects of eating, by allowing patients to eat meals free from avoidable and unnecessary interruptions To improve the nutritional care of patients by supporting the consumption of food. To support Ward-based teams in the delivery of both food and support for patients at mealtimes. To create a quiet and relaxed atmosphere in which patients are afforded time to enjoy meals, To support the rehabilitation of patients through food. To ensure the environment is conducive to eating and is welcoming, clean and tidy. To emphasise to staff, patients and visitors the importance of mealtimes as part of care and treatment for patients. To allow the nursing staff time to provide assistance and to monitor patients identified as at risk.
GOVERNANCE ARRANGEMENTS Food and Nutrition Steering Group The Food and Nutrition Steering Group leads on the provision of appropriate, effective and safe, food and nutritional care for patients. Chaired by the Deputy Director of Nursing, the Food and Nutritional Steering Group reports to the Clinical Management Board. The group is responsible for policy and service development, audit and education. 5. RESPONSIBILITIES OF STAFF In order to maximise the benefits to patients, of the mealtime experience, staff are required to prepare themselves, the environment and their patients prior to the service of food. The following principles must be adopted in all clinical areas where patients receive food, however, it is acknowledged that in a number of clinical settings patients manage their own mealtime preparations. Staff Member All Hospital Staff Ward Leaders Specific Responsibilities To support patients with meals and the social aspects of eating by ensuring mealtimes are free from avoidable and unnecessary interruptions. Protected Mealtimes must be established within the ward routine and structured day, avoiding appointments at mealtimes (where appropriate), for both Patients and Staff. The Trusts Protected Mealtime signage must be displayed outside the ward, to inform staff and visitors of the protected meal time period. Medical staff and other healthcare professionals such as Radiographers and Phlebotomists must be consulted in changes to Ward routines to ensure patient care is enhanced. The principles of Protected Mealtimes must be included in the induction training for Ward staff. Carers and visitors can support patients with food and must be encouraged and supported in this role. Emphasise the importance of teamwork and cooperation between Catering/Facilities staff and ward teams. Nursing/Ward Teams Nutrition Link Nurse Ward staff should discourage visitors during mealtimes unless their attendance is to support patients with meals. Ward staff must be aware of the Essence of Care, Food and Nutrition benchmark, the importance of patient nutrition and the impact of environmental factors on food consumption.
Patients and their relatives must be made aware of the Protected Mealtime policy as soon after admission as is reasonably possible. Information on Protected Mealtimes must be included in booklets/leaflets provided for patients and relatives. Mealtime interruptions e.g. ward Rounds, Drug rounds, GP visits, cleaning, documentation and therapy should only occur when clinically appropriate. Staff must seek to create a quiet and relaxed atmosphere in which patients are afforded time to enjoy meals, limiting unwanted traffic through the Ward during mealtimes, e.g. cleaning, maintenance/repair work and linen deliveries. Staff must ensure at mealtimes, Ward activities are focused into the service of food and providing patients with support with meals. Patients requiring assistance with food must be identified prior to the service of meals. Providing assistance and encouraging patients to eat, being aware of how much food is eaten and identifying patients nutritionally at risk. Prior to the service of food all patients must be given the opportunity to wash/clean their hands. Where appropriate, staff must ensure patients are supported to use the toilet prior to the service of food. Staff must ensure that the Ward environment is conducive to eating (at mealtimes), welcoming, clean and tidy. Consideration must be given to where patients sit to eat their meals, supporting the social aspects of mealtimes whilst respecting the preferences of the individual. Whenever possible staff must support the rehabilitation of patients prior to discharge, by providing the opportunity and assistance to eat at a table. Bed tables and eating areas must be cleared (prior to the service of food) of items not conducive to mealtimes, e.g. urine bottles and used dressings. Each table must be clean and suitably prepared prior to the service of food and beverages, with appropriate tablecloths, place mats, cutlery, crockery and condiments. Patients must be made comfortable prior to the service of meals, with food served within a
comfortable reach and patients supported by an appropriate eating position. Staff must organise their own mealtimes to maximise the number of staff available to deliver and assist patients with food. Patients must be able to eat their food in a relaxed environment, at their own pace and rest afterwards. Menu cards and diet food requests must be checked for accuracy to avoid delays at mealtimes. Ward Clerks Where appropriate, divert telephones during meal times to support an environment free from unnecessary interruptions. Where clinically appropriate, schedule patient s appointments and other non-urgent tasks outside of the patient s mealtime. Ensure that Mealtime interruptions, e.g. Ward rounds, Drug rounds, GP visits, cleaning, documentation and therapy, only occur when clinically appropriate. Medical Staff Limit Ward-based activities, i.e. visiting patients, to those that are relevant to mealtimes or essential to undertake at that time. Mealtime interruptions e.g. Ward rounds, Drug rounds, GP visits, treatment, documentation and therapy, should only occur when clinically appropriate. Cleaning Staff Allied Health Professionals To support patients with meals by providing an environment that is, welcoming, clean and tidy. To limit cleaning tasks to those that are relevant to mealtimes or essential to undertake whilst patients are eating. Limit Ward-based activities, i.e. visiting patients, to those that are relevant to mealtimes or essential to undertake at that time. Mealtime interruptions, e.g. Ward rounds, documentation and therapy should only occur when clinically appropriate. Where clinically appropriate, schedule patient s appointments and other non-urgent tasks outside of the patient s mealtime. Facilities Staff To create a quiet and relaxed atmosphere in which patients are afforded time to enjoy meals, limiting unwanted traffic through the Ward during mealtimes, scheduling Ward-based activities, e.g. cleaning, non urgent maintenance or repair work and linen deliveries, outside of mealtimes.
Catering Staff To agree food service times with Ward teams and deliver meals in accordance with this timetable. 6 RESPONSIBILITIES FOR PATIENTS AND THE PUBLIC It is the patient s and public s responsibility to read any information leaflets given and ask questions if necessary. Patients can also play an important role in reminding visitors and staff of the need to protect mealtimes from avoidable interruptions. To observe Protected Mealtimes by arranging visiting times away from the patient s mealtime and to be present on the Ward at mealtimes only when they are supporting patients with food. 7 TRUST PRIORITIES 7.1 Patient Involvement The Food and Nutrition Steering Group promotes food and nutrition through education and support of patients. The group will actively promote food and nutrition by providing information in a range of appropriate methods, presentations and representation. Food and Beverage services are developed with patients and members of the public. 7.2 Education and Learning Education is provided to all staff through awareness sessions, Nutrition link professionals, departmental induction programmes and information leaflets, educational packages and audit. Links to the Knowledge and Skills Framework (KSF) Core Dimension 4: Service Improvement Levels 1 Make changes in own practice and offer suggestions for improving services. 2 Contribute to the improvement of services. 3 Appraise, interpret and apply suggestions, recommendations and directives to improve services. 4 Work in partnership with others to develop, take forward and evaluate direction, policies and strategies. Core Dimension 5: Quality Levels 1 Maintain the quality of own work. 2 Maintain the quality in own work and encourage others to do so. 3 Contribute to improving quality. 4 Develop a culture that improves quality. Dimension HWB 1: Promotion of Health and Well-being and Prevention of Adverse Effects on Health and Well-being Levels 1 Contribute to promoting health and well-being and preventing adverse effects on health and Well-being 2 Plan, develop and implement approaches to promote health and well-being and prevent adverse effects on health and well-being.
3 Plan, develop, implement and evaluate programmes to promote health and well-being and prevent adverse effects on health and well-being. 4 Promote health and well-being and prevent adverse effects on health and well-being through contributing to the development, implementation and evaluation of related policies. Dimension HWB 2: Assessment and care planning to meet Health and Wellbeing needs. Levels 1 Assist in the assessment of people s health and well-being needs. 2 Contribute to assessing health and well-being needs and planning how to meet those needs. 3 Assess health and well-being needs and develop, monitor and review care plans to meet specific needs. 4 Assess complex health and well-being needs and develop, monitor and review care plans to meet those needs. Dimension HWB 4: Enablement to address Health and Well-being needs. Levels 1 Help people meet daily health and well-being needs. 2 Enable people to meet ongoing health and well-being needs. 3 Enable people to address specific needs in relation to health and well-being. 4 Empower people to realise and maintain their full potential in relation to health and well-being. Dimension HWB 5: Provision of care to meet health and Well-being needs. Levels 1 Undertake care activities to meet individuals health and well-being needs. 2 Undertake care activities to meet the health and well-being needs of individuals with a greater degree of dependency. 3 Plan, deliver and evaluate care to meet peoples health and wellbeing needs. 4 Plan, deliver and evaluate care to address peoples complex health and well-being needs. Links to Modernising Medical Careers (MMC) In the foundation programme curriculum section 1.3 covers quality and patient safety. 1.3 i) quality and patient safety Seeks to ensure (wherever appropriate) that patients are cared for in a way that's he/she or his/her family would want to be cared for. Always seeking opportunities to make care better. Welcome feedback from patients and professional colleagues. Endeavour to understand what a patient would feel like and what their needs and wants are likely to be. 8 SUPPORTING EVIDENCE Department of Health, Essence of Care, Food and Nutrition benchmark. The Health Service should be organised around the needs of patients rather than the needs of professionals. Therefore, all non-urgent activity such as ward and drug rounds, tests, etc, - should not be allowed to happen during mealtimes. This allows patients to eat their meals without being interrupted by other activity and gives ward staff the time needed to help those who need help eating. Age Concern, Hungry to be Heard (August 2006)
Missing meals, or experiencing interruptions during the mealtimes, can compromise a patient s nutritional intake, which could have a negative impact on their health and well-being. As health professionals, we need to work together to ensure that patients have a calm, uninterrupted period of time to eat. The British Dietetic Association (BDA) Doctors can help to promote more satisfactory nutrition for patients by making sure that as far as possible: The service and consumption of meals is not interrupted by ward rounds or routine tasks that could take place at other times. Procedures, such as x-rays, are scheduled to ensure, whenever possible, that patient s do not miss meals Nutritional care depends on teamwork between health care workers in different disciplines, the scope and contribution of whose work should be recognised Royal College of Physicians, A doctor s responsibility 2002 Interruption of patients meal times by ward rounds and procedures should be minimised, and each ward should have a clear policy in this respect. The environment at meal times should be made as conducive to eating as possible. British Association for Parenteral and Enteral Nutrition (BAPEN), Hospital Food as Treatment 1999