1. The proof is in the pudding: clarity of menu options for diabetic patients Utku ALHUN, FY1 & Sophie HANINA, FY1

2. Index case 85M on Ward 20 –PMHx: T1DM, NSTEMI, PVD (L-toe amputation), L-femoral bypass, dementia –Wildly fluctuating BMs Persistent hypo- and hyperglycaemia despite numerous attempts to optimise medication (insulin) –Choice of food with high sugar content

3. Premise Are diabetic pts making poor food choices for their sugar control? Are the menus clear to enable them to make the right choices? Do staff know which options are suitable for such patients (in helping them make their choices?)

4. Menu

5. Perceived problem Lack of intuitive terms Writing too small

6. Audit design 1.Questionnaire –To assess whether people knew there were options suitable for diabetics –To determine if they know which symbol it is 2.Diet vs. BM –Collection of used menus to collate food choices to compare against pre- and post- lunch BMs

7. Patient cohort 50 patients –25 female, 25 male –Average age 69.6 ± 15.2 years –9 x T1DM, 41 x T2DM Over 10 weeks On wards 3, 15, 16, 20, 21, and 22

8. Questionnaire 1.Are you a health-care worker or patient? –104 people recruited in total 20 HCAs 20 nurses 14 doctors 50 patients

9. Questionnaire 2.Are you aware that there is a “suitable for diabetics” option on the food menu? DoctorsHCAs & nurses PatientsAggregate Yes77.8%72.5%50%63%

10. Questionnaire 3.Do you know which letter/symbol on the menu stands for “suitable for diabetics”?

11. Questionnaire 4.Do you know what the following letters stand for: ‘V’, ‘ED’, ‘BC’?

12. Questionnaire 5.Do you think the menus can/should be improved? [How?]

13. Diet vs BM Diet choice vs sugar control

14. No correlation

15. Summary Only 6% of patients knew which symbol represented the suitable for diabetics option Most nurses/HCAs think that ‘D’ is the symbol Most people know intuitive terms like ‘V’ 91% think menu should be changed

16. Future Major discussions with Cook Chill –Denise Clifford, Catering Manager –Can’t use D- discriminatory! –New symbol (e.g. use of ♥ to designate food suitable for diabetics) –Bigger font –Close audit cycle

18. Questionnaire 1.Are you a health-care worker or patient? 2.Are you aware that there is a “suitable for diabetics” option on the food menu? 3.Do you know which letter/symbol on the menu stands for “suitable for diabetics”? 4.Do you know what the following stand for: ‘V’, ‘ED’ and ‘BC’ 5.Do you think the menus can/should be improved?

20. HCAs & nursesPatientsAggregate Yes97.5%84%91.3% [Introduce ‘D’ as the new symbol] 36%47.5%43.3% [Introduce a separate menu for diabetics] 28%42.5%36.5%