4 month Piloted Protected Mealtime at Lunch An Evaluation of a Pilot Protected Mealtime Program in a Canadian Hospital 1,2Jan Chan, MRSc, RD, 3Christine Carpenter, PhD 1Clinical Nutrition, Fraser Health Authority, Burnaby, BC, Canada, 2Department of Rehabilitation Sciences, University of British Columbia, Vancouver, BC Canada, 3Faculty of Health and Life Sciences, Coventry University, Coventry, UK Pre-pilot Observational Mealtime Audit 4 month Piloted Protected Mealtime at Lunch February, 2013– June, 2013 - Protected mealtime policy developed Post-pilot Observational Mealtime Audit Staff Self Administered Questionnaire Background Figure 2: Methodology Figure 4: Top Sources and Reasons of Interruptions from the Audit Who Interrupted Pre-PM (n=31) Nurses (55%) Housekeeping (22%) Other (10%) Post-PM (n=13) Nurses (46%) Housekeeping (31%) Physicians (15%) Reasons for Interruption Pre-PM (n=31) Elective Procedures (16%) Drug Rounds (16%) Other (52%) Post-PM (n=13) Medical Review (23%) Elective Procedures (15%) Drug Rounds (15%) Other (46%) In Canada, 40-69% of hospitalized patients are malnourished1,2,3; increasing morbidity and mortality by impairing immune response, decreasing muscle strength, decreasing respiratory function, and delaying wound healing4. The prevalence of malnutrition leads to increased demands on the health care system. Hospitals in the UK and Australia have implemented a ‘protected mealtime’ (PM) to prevent malnutrition in their hospitals. A ‘protected mealtime’ is a patient-centred approach that ensures patients have the opportunity to eat without unnecessary interruptions to their meals while in hospital5 (See Figure 1). ‘Protected mealtimes’ also allocates time for nursing staff to effectively assist patients with their meals. No studies have evaluated the implementation of a ‘protected mealtime’ in Canadian hospitals.  Results Thirty-four patients were observed on the ACE ward during the pre and post mealtime observation audit. Twenty-three of 150 potential respondents who work on the ACE unit completed the staff questionnaire . A total of 18 questionnaires met the inclusion criteria. Figure 3: Results from the Pre and Post Mealtime Observational Audit Discussion Purpose This study has contributed to the literature discussing the provision of ‘protected mealtime’ programs in Canadian hospitals. Due to the small sample size we were unable to accurately reflect variability in our audit categories of interests and significance was not tested for all outcomes. A low questionnaire response rate may have led to non-response bias. Other survey methods, such as structured interviews could be used to improve response rates and reduce non-responses. A large-scale study is needed to determine the impact of a ‘protected mealtime’ on other acute care wards and patient groups, in Canadian hospitals. Research to assess the impact of a ‘protected mealtime’ on clinical outcomes of patients, such as, nutrition and functional status is needed. An investigation of the effects of a ‘protected mealtime’ on patient food intakes would be beneficial. The study evaluated the impact of a pilot ‘protected mealtime’ program on meal experience and care of hospitalized acute care patients. Methods A quasi-experimental design was used to implement a four-month pilot of a ‘protected mealtime’ for one meal (lunchtime) on a 35-bed, Acute Care for the Elderly (ACE) unit at Burnaby Hospital, BC, that admits patients 75 years and older. A ‘protected mealtime’ policy was developed for the unit. All staff members were formally oriented to the ‘protected mealtime’ policy which required staff to stop all non-urgent clinical interventions and therapies during the ‘protected mealtime’. Table 1: Results from the Stakeholder Questionnaire Questions Total Staff Responded % Felt patients had adequate time to eat Felt patients had the opportunity to get out of bed and eat Felt interruptions decreased PM encouraged visitors to assist with meals PM encouraged all staff to assist Improved mealtime environment PM decreased noise distractions PM decreased offending smells 12 11 16 13 10 92 100 94 67 77 81 83 60 Felt they had more time to: Assist with meals Feed patients Wash patient’s hands 70 50 With changes to their schedule during a PM, staff felt: Adequate time to give meds Adequate time to implement therapies Adequate time to implement medical intervention Same amount of time to do other work 6 9 7 15 71 86 PM allowed: More time to record intakes Less time to record intakes Same amount of time to record intakes 17 35 59 Conclusion The piloted ‘protected mealtime’ program improved patient mealtime environment and patient care; and is a reasonable approach to combating malnutrition in Canadian hospitals. From a staff perspective, the protected mealtime program had minimal impact on their workload. Successful implementation of a ‘protected mealtime’ program requires stakeholder support with adequate and ongoing education of all parties involved. Visitors at bedside unless visitor assists patients with meals PROTECTED MEALTIMES MEAL 12 to 1pm Routine Cleaning and Maintenance of patients and dining rooms Non-urgent tests & procedures Medical imagine, endoscopy etc Medication Rounds Checking temperature Patient Interviews Rehabilitation Assessment and therapies Messy Bedside Table An interruption CAN BE... Blood Pressure Figure 1: What is an Interruption? Physician Rounds References: 1.Babineau, J, Villalon, L, Laporte, M, & Payette, J. Outcome of screening and nutritional intervention amoung older adults in healthcare facilities. Can J Diet Pract Res. 2008; 69,2: 91-96. 2. Singh H, Watt K, Veitch R, Cantor M, Duerksen DR. Malnutrition is prevalent in hospitalized medical patients: Are house staff identifying the malnourished patient? Nutrition. 2006 Apr; 22(4):350-4. 3. Allard JP, Jeejeebhoy KN, Grämlich L, Duerksen D, Payette H, Bernier P, et al. lb010-sun malnutrition in Canadian hospitals: Preliminary results from the Canadian malnutrition task force (cmtf). Clinical Nutrition Supplements. 2011;6(1):208-9. 4. Baldwin C, Weekes EC. Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults. Cochrane Database of Systematic Reviews. 2012;7:1-139. 5. National Patient Safety Agency. Protected mealtime review: Findings and recommendations report. 2007: 1-19.