With patient nutrition a major concern at trusts up and down the country, nurses in Yorkshire decided they had to change hospital culture to radically improve mealtimes
For a hospital patient who is feeling sick and afraid, food is probably the last thing on their mind. Yet missing or failing to eat their meal can affect their health, wellbeing and recovery.
While the benefits of good hospital food are well documented, so are the failures to deliver it. In 2006, the National Patient Safety Agency (NPSA) found the practice of protected mealtimes was still ‘sporadic’ while national headlines regularly shout about how hospitals are ‘starving’ patients and point out the poor quality of NHS food.
Lack of staff and resources make it difficult to ensure patients get the most out of mealtimes. But Judith Connor, clinical matron for cardiothoracic services at South Tees Hospitals NHS Trust, feels the biggest challenge is overcoming the way hospitals ‘work to suit wards and departments, while patients have to fit into that process’.
‘We all know the rhetoric of putting the patient at the centre of everything. But we need to change the hospital culture, so the ward environment is conducive to making the patient’s eating experience the best it can be,’ she explains.
To do this, Ms Connor is championing three ways to encourage patients to eat and drink properly during their hospital stay: protected mealtimes, assisted feeding and a new meal service.
Last year, the trust was involved in a number of initiatives connected to nutrition. Working with the Institute for Innovation and Improvement, it took part in the Productive Ward initiative which reviews ward processes in an effort to release nurses’ time for direct patient care. The work revealed nurses should spend more time giving hands-on patient care, particularly at meal times. Feedback from the trust’s Private Finance Initiative partners also showed the quality of food for patients was an issue.
At the same time, Ms Connor, a matron on the trust’s Essence of Care steering group, was involved with the scheme’s nutrition benchmarking process. A patient questionnaire showed meals were being disrupted and that their quality varied because of the plated system, where food is heated up on a plate in a large cupboard or ‘hot lock’. ‘Warm salads and “brown soup” were common complaints,’ she recalls.
In response, a bulk ordering service was piloted on the cardiothoracic unit where Ms Connor works. The service involves food being tailored to patients’ needs and served on a trolley directly to their bedside. It was so successful that it has since been rolled out across the trust.
‘Patients can see what’s on the trolley, smell it and say if they want it,’ says Ms Connor. ‘And they can control their portions, down to the number of potatoes they want, depending on their appetite.’
Having to move a bulky trolley around the wards meant that from a health and safety point of view there was a need for fewer visitors while food was being served. This helped inspire protected mealtimes on the wards.
The Essence of Care nutrition benchmarking process also highlighted the disruptions associated with mealtimes, such as patients being taken for x-rays and visitors coming in.
Now there is a notice on all wards stating that patient mealtimes are protected between 5pm and 6pm – the time least likely to be disrupted by clinical procedures. Visitors are not allowed unless they are helping patients to eat their meals.
The Essence of Care nutrition benchmarking process revealed staff felt they needed more colleagues to assist them with feeding patients, particularly those on elderly care and stroke rehabilitation wards. Now nurses no longer go for breaks when patients are having their meals. And trays with red napkins on them show nurses which patients need assistance with feeding.
Ms Connor, along with other matrons at the trust, has pushed for these initiatives while carrying out her daily duties.
‘I wrote the policy, presented the papers and had the arguments with the clinicians!’ she says. ‘The challenge has been influencing people to realise that nutrition is an essential element of care.’
Support, she says, has come from the trust’s strong communication strategy and a non-executive director who has really championed the patient experience.
The focus on food has come at a price – including the recruitment of extra hostess staff and a new caterer – but pays for itself, she says. Savings on food wastage are ‘substantial’ and the visual evidence of just how much these schemes have benefited patients is captured on a ‘before and after’ DVD. This shows how the time it takes to serve meals to patients has been reduced from 40 to 15 minutes.
Patient feedback speaks volumes. ‘Patients are enjoying their food and mealtimes are calmer and quieter,’ Ms Connor says. ‘One older gentleman said to me “it’s more like it was in the old days” and patients are now saying to their relatives, “Why don’t you go for a cup of tea while I have my dinner”.’
Achieving these results is about persistence she believes. ‘Remember to put the patient at the centre of care and be passionate about what you’re trying to achieve – because sometimes you will have to put your head above the parapet.’