Quality of care report 2012/13

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Red trays to improve nutrition for patients / Nutrition

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Patient John McCormick and nurse Catherine Kelly

GV Health has introduced red meal trays to alert staff when a patient requires additional assistance at meal time. 

The red tray program is part of an organisation-wide focus on improving nutrition for patients in hospital. Malnutrition in hospital is a serious medical concern affecting up to one in three patients in hospital and is directly related to increasing hospital length of stay, treatment costs and poor outcomes. Food and drink is only effective if it is consumed. 

Adequate food and fluids can help improve recovery.  When patients don’t eat or drink enough they have an increased risk of infection, slower wound healing, increased risk of things going wrong (complications), increased time in hospital and reduced quality of life. 

Unfortunately being unwell can make a person feel less like eating and drinking.  This can put them at risk of poor nutrition (malnutrition).  A person’s food and fluid intake can be affected by:

  • Poor appetite, nausea, vomiting, diarrhoea, constipation or reflux
  • Changed taste or being unable to feed yourself
  • Age, illness and feeling unwell.

n 2012, the GV Health dietetics department conducted an audit to review the potentially avoidable barriers to achieving the best mealtime environment for hospitalized patients in its general medical and rehabilitation. 

The results of the audit found that one third of patients who required assistance with their meals were not provided the assistance they required, which could lead to poor meal consumption. 

Factors such as patients being asleep and not woken up for meal time, insufficient staff time to assist, nursing staff not being aware that assistance is required for that particular patient, or the high turnover of nursing staff make it difficult for assistance with mealtimes messages to be communicated between staff.

In September 2012, the GV Health dietetic department, in association with the Nutrition Working Committee and the Consumer Consultative Committee, rolled out the Red Trays @ Mealtime Program to provide a visual prompt to staff to help prioritise assisting particular patients at mealtimes. Any staff member can commence a patient on a red tray and there is a checklist for staff to complete to help determine the level of assistance a patient with a red tray may require.

A repeat mealtime environment audit was conducted three months after introduction of the red trays. As shown in the table below, more patients in the repeat audit were sitting upright in bed at mealtime and the tray was reachable, post red-tray audit. Only 5% of patients requiring assistance did not receive it, which is an improvement on the previous audit. However, some of these patients were not provided adequate assistance, or had to wait until nursing staff were available to assist them, by which point their food had gone cold, or they were no longer hungry or too tired to eat the whole meal. Mealtime assistance was usually provided by nursing staff, though family members sometimes visited and assisted with feeding. In these instances, patients received more timely assistance.

Red trays provide a readily identifiable means of alerting staff that patients require additional assistance at meal times, and offer a cost effective method for reducing hospital malnutrition. However, provision of assistance is often limited by competing work demands on nursing staff. Innovative strategies such as volunteer-led meal time assistance have been explored at other sites and may be of value to consider at GV Health.

Red trays help improve patient nutrition video