The effect of a protected mealtime policy on the energy intake and frequency of non-urgent interruptions during mealtimes at the Royal Bournemouth Hospital

Abstract

Malnutrition is both a cause and consequence of disease effecting up to 30% of patients admitted to hospital (1) and the public cost has been estimated at £13 billion a year (2) . The protected mealtime initiative (PMI), currently under the care of the national patient safety agency, aims to allow patients to eat their meals without unnecessary interruption and enable staff to assist those who are unable to eat independently (3) . Two years ago the PMI was introduced onto one ward at the Royal Bournemouth Hospital. Results of an audit showed a positive impact on the number of interruptions during the mealtime and the energy intake of patients (4) . Following this, protected mealtimes were introduced across the whole hospital. This audit, 6 months later, shows the effect on patients' mealtime experience and their energy intake.Over a 2 week period all patients in one 6-bedded bay in each ward were observed at a lunchtime by a dietitian. The number and reason for all non-urgent interruptions was recorded. The menu choices of each patient and amount consumed was recorded and the energy content of the meal estimated using a standardised tool. Patients nil-by-mouth or on clear fluids only were excluded. The data were compared with data collected in the previous year before protected mealtimes was introduced.Ninety seven patients were included in the baseline audit and 102 patients were included following the introduction of the PMI. At baseline, 45 % of patients experienced one or more non-urgent interruptions during the mealtime. This decreased to 29 % of patients after the PMI. The reason for interruptions can be seen below and a similar pattern was seen at baseline. The mean energy intake was 1907.904 kJ v. 2125.472 kJ (456 kcal v. 508 kcal) before and after PMI respectively. There was no difference in the intake of patients who were interrupted compared to those that were not.

Aspects of protected mealtimes are associated with improved mealtime energy and protein intakes in hospitalized adult patients on medical and surgical wards over 2 years

“…As patient interruptions were negatively associated with intake when all mealtime observations were analyzed, this may explain why protected mealtimes implementation was not associated with intake. Other studies have shown that interruptions can be reduced post implementation of protected mealtimes, 9,10 or remained unchanged. 7 Some components of protected mealtimes did improve after program implementation though.…”

“…An Australian study in elderly inpatients showed no differences in energy and protein intakes after implementation of protected mealtimes and/or mealtime assistance; however, inpatients were more likely to meet daily energy requirements post implementation (pre:8% vs post: 20-31%, P o 0.01). 5 Other studies [6][7][8][9][10] have not checked whether protected mealtimes was successfully implemented, and used a variety of strategies to implement the program (such as staff inservicing, signage on wards). Thus no conclusion can be drawn from their results that show no changes in energy and protein intake.…”