Nutrition - protected mealtimes
Protected Mealtimes have been introduced across all four countries of the UK. The origin of the intervention was a scheme introduced by two ward managers at King's College Hospital, London in 2002 (Nursing Standard 2007). The scheme was designed to allow patients to eat their meals without disruption and enable staff to focus on providing assistance to those patients unable to eat independently.
The National Patient Safety Agency (NPSA) published a review of protected mealtimes in England and Wales in 2007. The NPSA found that implementation was variable between hospital trusts and between wards in hospitals. The main incursions were: ward rounds, diagnostic tests, visitors and other heathcare professionals. The report pointed to lack of "Board to Ward" level leadership and lack of education and training of all staff groups. The critical success factors were: trust policy, promotion, communication and leadership (NPSA 2007a).
An analysis by SSentif (2011) of data from two hundred trusts over a period of a year to March 2010 prompted further concern about patient nutrition and the implementation of the Protected Mealtimes Initiative. The analysis suggests that nine million hospital meals are being returned untouched, which equates to about eight per cent of all hospital meals and costing the health service more than 26 million pounds.
Implementing protected mealtimes
Protected Mealtimes remain an important element of safe and effective nutritional care and are promoted by national schemes in the United Kingdom (NPSA 2007b; Department of Health Social Services and Public Safety 2011; Health Improvement Scotland 2011a).
The documents from the NPSA and Healthcare Improvement Scotland provide guidance on how to implement Protected Mealtimes. The NPSA (2009) based on their work on protected mealtimes, describe key aspects of providing a conducive eating environment and protected mealtimes and offer tips for implementing sustainable eating environments. The NPSA have also put together an implementation checklist and guidance on carrying out an obervational audit of mealtimes (NPSA 2007).
In Scotland the Improving Nutritional Care Programme identified the improvement of mealtime processes as one of three priorities and developed a 'Making meals matter pack' which includes principles of protected mealtimes (Healthcare Improvement Scotland 2011a). The programme has also involved a pilot project to introduce volunteers at mealtimes and the report evaluating the project includes information about the processes used to recruit, train and support the volunteers (Healthcare Improvement Scotland 2011b).
See also the reference and resource lists below.
You can also see how others have implemented quality improvements to mealtime experiences in the section enhancing nutritional care.
References
These references were last accessed on 18 April 2012. Some of them are in PDF format - see how to access PDF files.
Department of Health Social Services and Public Safety (2011) Promoting good nutrition: a strategy for good nutritional care for adults in all care settings in Northern Ireland 2011-2016. Belfast: DHSSPS.
Healthcare Improvement Scotland (2011a) Making mealtimes matter pack. Healthcare Improvement Scotland website
Healthcare Improvement Scotland (2011b) Ward volunteers at mealtimes: evaluation report. Edinburgh: Healthcare Improvement Scotland.
NPSA (2007a) Protected mealtimes reviews: findings and recommendations report (PDF 235KB). London: NPSA.
NPSA (2007b) Protected mealtimes toolkit. NPSA website.
Nursing Standard (2007) Time to share. 21(38) May 30 pp.20-23 (you can access the full text of this article via the RCN e-Journals).
SSentif (2011) Protected mealtimes failing as nine million hospital meals go uneaten. (Press release October 2011). SSentif Intelligence website.
Resources
This list focuses on resources that are specifically about protected mealtimes. Please refer also to the list of core nutritional care resources.
The resources below were last accessed on 20 January 2012. Some of them are in PDF format - see how to access PDF files.
Department of Health (2010) Essence of Care: benchmarks for food and drink
The Essence of Care benchmarks aim to help practitioners take a structured approach to sharing and comparing practice. This section offers benchmarks for processes that can be used to support protected mealtimes.
Benchmark for food and drink (PDF 513KB)
FoNS Centre for Nursing Innovation (2011) Working in partnership with patients and families on a dementia assessment unit
This report describes a project in a Health and Social care Trust in Northern Ireland in which, as part of a series of improvements in response to feedback from relatives and carers an action plan and range of improvement developments were implemented in particular to make care more patient-centred. This included improving the mealtime experience through the provision of more visual cues and prompts to help people with dementia recognise that it is a mealtime and to minimise distractions protected mealtimes was introduced.
Foundation of Nursing Studies (FoNS) (2006) Improving health choices for older people: implementing patient-focused mealtime practice (PDF 109.98) FoNS Dissemination series Vol.3 no.10
The dissemination series contains reports about projects which have aimed to reflect improvements in care and changes in practice that are responsive to patient care. This project aimed to improve the experience of mealtimes in a discharge unit for older people resulting in greater choice for patients and the active involvement of all staff in mealtimes.
Healthcare Improvement Scotland (2012) Improving nutrition...improving care: Final report from the Improving Nutritional Care programme
This tells the story of the programme and national campaign detailing the priorities and describing key initiatives. The three priority areas focused on were: making meals matter including mealtime volunteers; self management in long term conditions; improving nutritional care during transition.
The report describes how the improvement work is being spread and how information about it is being disseminated. The next steps for ensuring the integration and alignment of nutritional care work across Scotland are published at the end of the report.
See also the interim report published in 2011 at Improving nutrition....improving care interim report.
Healthcare Improvement Scotland (2011) Making meals matter pack
These resources are one of the outcomes of the ‘Improving Nutritional Care Programme’ in Scotland and include ‘Principles of protected meal times’ which are organised under five headings: effective implementation; identify individuals; preparation; during meal times; documentation.
Healthcare Improvement Scotland (2011) Ward volunteers at mealtimes: evaluation report
The report looks at a pilot project to introduce volunteers at mealtimes led by NHS Ayrshire and Arran and describes the processes employed to recruit, train and support volunteers. The report evaluates the challenges and successes of the project and includes a variety of qualitative feedback from patients, staff and volunteers.
National Patient Safety Agency (2007) Protected mealtimes toolkit
Includes a review document which identifies critical success factors and barriers in the implementation of protected mealtimes across acute trusts in England and Wales; top tips; implementation checklist and guidance on carrying out an observational audit.
National Patient Safety Agency (2009) Nutrition factsheets. 10 key characteristics of good nutritional care: 02 protected mealtimes
This factsheet looks at key aspects of providing a conducive environment and protected mealtimes and lists twelve top tips for implementing sustainable eating environments.
Nursing Standard article
The full text of articles published in the Nursing Standard are available electronically approximately three months after publication. RCN members can access them via the RCN e-Library at RCN e-journals.
Sneddon J and Best C (2011) Introduction of mealtime volunteers in a district general hospital. Nursing Standard 26(15-17) 14 December pp.37-40.
This article describes the introduction of volunteers to help with mealtimes and the effect this has had on the patient experience. It discusses the issues that arose around implementing this initiative which it is planned to expand.
Welsh Assembly Government (2003) Fundamentals of care: Eating and drinking (PDF 577.04KB)
The guidance in this document aims to help improve the quality of twelve aspects of health and social care for adults and reduce inconsistencies in quality. Eating and drinking “includes the choice, presentation, and availability of food, as well as helping those who need assistance to eat and drink”. Practice indicators and examples of what the indicators mean in practice are provided.