PAT/PA 16 v.4

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Protected Mealtimes Policy

This procedural document supersedes: PAT/PA 16 v.3 – Protected Mealtimes Policy

Did you print this document yourself? The Trust discourages the retention of hard copies of policies and can only guarantee that the policy on the Trust website is the most up-to-date version. If, for exceptional reasons, you need to print a policy off, it is only valid for 24 hours.

Author/reviewer: (this version) Joanne Pack – Matron, Specialty Services Care Group

Date written/revised September 2016

Approved by (Committee/Group) Nutrition Steering Committee – 15 September 2016 Policy Approval and Compliance Group – 21 September 2016

Date issued 28 September 2016

Next review date September 2019

Target Audience Trust-wide

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Amendment Form

Brief details of the changes made. If the policy/APD has been reviewed without change, this information will still need to be recorded although the version number will remain the same.

Version

Date Issued

Brief Summary of Changes

Author

Version 4

28 September 2016

Sections updated- Philosophy and Purpose combined.

Changes made to reflect the current Care Group structure in the Trust.

Page 6 – Intentional rounding wording removed. Red mat added.

Page 7 – PEAT assessment removed.

Section 5 – Essence of Care food and drink benchmark removed.

Section 7 – Changes made to audit requirements.

Section 9 – Policy information updated.

Additional minor changes made throughout.

Joanne Pack

Version 3

13 June 2013

Patient Nutrition and Hydration statement to commence policy added.

Section 2 - Aims of the policy expanded.

Section 4.1 - Recognition of the role of relatives, carers and visitors in supporting patients who are unable to eat their meal without assistance.

Section 4.4 - Preparing patients to eat their meal has been extended.

Section 6.1 - Ward accreditation has been added.

Section 6.2 - PLACE programme has been added.

Section 7 training and support added.

Vivienne Knight/ Joanne Pack

Version 2

March 2009

Contents page added

Sections numbered

Additional paragraph added to item 4.3 - Focusing on nutritional requirements at mealtimes

Additions made to item 4.6 - Assisting patients to eat their meals

Other relevant policies listed

Assistant Director of Nursing

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Contents

Section

Page No.

Patient Nutrition and Hydration 5

1 Introduction 6

2 Purpose 6

3 Duties and Responsibilities 7

4 General Principles Relating to Protected Mealtimes 4.1 Avoiding unnecessary interruptions 4.2 The ward environment 4.3 Focusing on nutritional requirement at mealtimes 4.4 Preparing patients to eat their meal 4.5 Presentation of food 4.6 Assisting patients to eat their meals

7 7 8 8 9 9 9

5 Communicating the Policy to Staff, Patients, Relatives and Carers.

10

6 Training and Support 10

7 Monitoring Compliance 7.1 Ward Accreditation 7.2 PLACE Programme

10 11 11

8 Equality Impact Assessment 11

9 Other Relevant Policies and Guidance 11

Appendices:

Appendix 1 Equality Impact Assessment Form 12

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“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health”

Hippocrates

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PATIENT NUTRITION AND HYDRATION:

Nutrition and hydration for individual patients are key areas, which need to be managed together, recognising the patient’s specific needs, and any impediments they have to achieving this alone, due to short or long-term health conditions which may present. The Registered Nurse and Healthcare Assistant at ward level are key to encouraging a satisfactory food and fluid intake for all patients. They need to always consider the following steps – enquiry on food and fluids taken so far, offer of a snack or presentation of a drink and encouragement to then sip the drink, the latter particularly applies to all patients at risk of poor hydration. It is never sufficient to simply check there is a glass of water to hand. Relatives, carers and visitors play a vital role in supplementing staff activities in both nutrition and hydration, and with patients who are unable to take responsibility for these areas themselves then a visitors’ contribution in supporting the patient must be welcomed and facilitated by ward staff. The concept of Protected Mealtimes refers to pausing routine ward activities to allow patients a quiet time to enjoy their meal. It is not to be used to exclude visitors to any patients unable to feed themselves where the visitor wishes to support and encourage the patient with their meal, supplement, snacks or fluids.

NUTRITION: Hydration Matters – HARMFREE CARE

Encourage patients to drink small amounts of water regularly throughout the day, particularly those worried about incontinence issues.

Assist patients by ensuring that they can reach – and lift – their cup or glass. Refresh water jugs regularly so that water is always available and appealing. Associate fluid intake with specific moments, such as meal times and medication rounds,

to ensure patients are drinking enough. Identify patients at particular risk of poor hydration. Monitor the hydration status of patients by using fluid charts. Review hydration status as a routine part of ward rounds and handovers. Fresh water with meals, every time, every meal!

Mealtime matters

Protected (Pause in routine ward activities)

Prepared (Prepare patient and environment prior to meals)

Supported (Give assistance as required)

Reported (Ensure food and fluid record charts are completed) Red Apple/ Red Dot/ Red Tray/ Red Mat = Dependent patient … ‘don’t forget to help me’.

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1. INTRODUCTION

The NHS Plan published in 2000, set out a programme of action for the NHS to improve the patient experience. The Better Hospital Food programme is a key component of the plan and is designed to improve both the quality and availability of food in hospitals. Protected Mealtimes was one of six key modernisation aims of the programme and is included in the PLACE assessment (Patient led assessments of the care environment). The PLACE assessment is used by the Care Quality Commission (CQC) to monitor performance against one of the core Standards for Better Health relating to food, cleanliness and the patient environment. In order to support the requirements of the CQC, the Trust is required to have a Protected Mealtimes Policy. There is an increasing understanding of the importance of the patient meal experience and nutritional requirements within the wider healthcare team. The therapeutic role of food within the healing process cannot be underestimated. Food and the service of food are now regarded as an essential part of treatment.

The concept of Protected Mealtimes is supported by many organisations including the British Dietetic Association; The Patient’s Association; The Royal College of Nursing; The Royal College of Physicians and the Hospital Caterer’s Association.

2. PURPOSE

The aim of the policy is to:

Encourage all wards to create a calm atmosphere where the main focus is on serving appetising meals and drinks providing patients with uninterrupted time to eat and enjoy a vital part of their treatment – their food.

Improve the quality of the ‘meal experience’ for patients by enabling them to eat meals and have a drink with dignity and without disruption.

To ensure the nutritional care of patients is supported by the consumption of food and drink.

To ensure that ward based teams are focused in the delivery of food and drink at mealtimes.

To ensure that staff focus their attention on making the mealtime a success

To encourage anything that supports and assists patients to eat and drink.

To discourage anything that interferes with the meal and reduces the amount eaten.

As part of its development, this Policy and its impact on equality have been reviewed in line with the Trust’s Equality Impact Assessment Policy – CORP/EMP 27.

Reference to the Mental Capacity Act 2005 and the Privacy and Dignity Policy has been considered.

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3. DUTIES AND RESPONSIBILITIES

Each individual member of staff, volunteer or contracted worker within the Trust is responsible for complying with this policy. They need to be aware of their personal responsibilities in promoting a framework for mealtimes and place the patient at the centre of the mealtime experience. Mealtimes are not only a vehicle to provide patients with adequate nutrition but also an opportunity to support social interaction amongst patients. However, food, even if it is of the highest quality only has value if the patient actually eats it.

Care Groups: are responsible for monitoring the implementation of this policy and for ensuring action is taken when staff fail to comply with the policy.

Matrons: are responsible for ensuring implementation within their area by monitoring this on their ward rounds. Any deficits identified will be addressed.

Ward Managers: are responsible for ensuring implementation within their area, and for ensuring all staff who work within the area adhere to the principles at all times.

Nutrition Action Group: is responsible for monitoring compliance as part of the nutrition ward accreditation process.

4. GENERAL PRINCIPLES RELATING TO PROTECTED MEALTIMES

The purpose of a Protected Mealtimes Policy is to protect mealtimes from unnecessary and avoidable interruptions, predominantly arising from routine ward activities. The aim is to provide an environment conducive to eating; ensuring staff provide patients with support and assistance with meals, placing food and drink first at mealtimes.

4.1 Avoiding Unnecessary Interruptions

Mealtimes should be free from avoidable and unnecessary interruptions wherever possible. This will enable the team to focus ward activity on the service of food, and providing patients with support at mealtimes. However, some interruptions are unavoidable and a priority to patient care. All areas should collaborate with colleagues to identify such instances and agree local arrangements. Inappropriate enforcement of the ethos captured in this policy must be avoided, so that other aspects of patient care are not affected. An example of this might be in preventing the phlebotomist from taking necessary blood samples or preventing the pharmacist from checking prescriptions or in ensuring patients have an agreed window of opportunity for physiotherapy. The ward may consider restricting routine visiting during mealtimes, and each ward must agree an approach which is conducive to the needs of their patients generally. The patient and their relatives should be made aware of the mealtime arrangements as soon after admission as possible. Relatives should be informed in a sensitive manner of

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the importance of nutrition, and they should not be made to feel unwelcome at mealtimes. However, it is also necessary to recognise the role of relatives, carers and visitors in supporting patients who are unable to eat their meal without assistance. For patients who are unable to eat their meal without assistance, always enquire from their next of kin or if appropriate their wider visitors, if they have been previously assisting the patient with this activity and if they wish to do so whilst they are on the ward. Whilst encouraging those visitors who are going to assist their relative to eat, dependent on the circumstances, others may be asked to leave to promote the dignity of those patients needing assistance. The assistance of relatives or visitors with meals and any other activities for the patient should be welcomed and incorporated into the ward routine as a positive support for the patient, and acknowledged as such by the staff. John’s Campaign - All the wards within the Trust have signed up to supporting the national campaign. http://www.goldstandardsframework.org.uk/john-s-campaign-dementia

4.2. The Ward Environment

Clinical staff should ensure that the environment is conducive to eating a meal prior to the service of food. Wherever possible patients should be able to eat their food in a relaxed environment, at their own pace and rest afterwards should they choose to. Consideration should be given to where patients sit to eat their meals, supporting the social aspects of mealtimes whilst respecting the preferences of the individual. Each table should be clean and suitably prepared prior to the service of food and beverages, with appropriate place mats, cutlery, crockery and condiments to meet each patient’s individual needs (e.g. specialist cutlery, non-slip place mats). Bed tables and eating areas should be cleared (prior to the service of food) of items not conducive to mealtimes.

4.3 Focusing on Nutritional Requirements at Mealtimes

Mealtimes are a time for nursing staff to observe and record the nutritional intake of patients. Food records should be maintained for all patients who are identified as being at medium or high risk of malnutrition. Patients, who are able to, may wish to record their own intake of food and drink. The ward team must ensure that the right patient receives the right meal or supplement, (ensuring the correct texture food is provided) at the right time and with the right amount of support to consume this.

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4.4 Preparing Patients to Eat their Meal

In order to maximise the benefits to patients of the mealtime experience, clinical staff are required to prepare the patient prior to the service of food as follows:-

Staff must wash their hands prior to handling or serving of food in accordance with Hand Hygiene Policy and Procedure PAT/IC 5.

Staff are expected to help patients to wash/clean their hands before eating. Bedfast patients, who are unable to wash their hands, must be offered a hand wipe before each meal or snack.

Patients must be made comfortable prior to the service of meals in an appropriate eating position and with food placed within comfortable reach.

Patients who require adapted cutlery should be highlighted so that the cutlery can be made available.

Patients requiring assistance with food or requiring a special diet (including textured diets) will be identified by the ward team prior to the service of meals and appropriate assistance given.

Ensure that the patient has a drink available during their meal or with a snack, this can help with both eating and the overall consumption of fluids across the day.

4.5 Presentation of Food

The presentation of the meal served is important and staff should work together to ensure that the meal served to each patient is presented in a manner that is pleasing to the eye.

4.6 Assisting Patients to Eat their Meals

Nursing staff should use the ‘Red Apple/ Red Dot/ Red Tray/ Red Mat’ system to identify which patients require assistance with their meals and for those patients who are at medium/high nutritional risk and those who have visual impairment. Nursing staff should make food a priority during mealtimes. Staff have a responsibility to ensure that food and drink is within reach. They should identify patients nutritionally at risk and provide assistance for those who require it. Those patients who would benefit from using adapted cutlery should be highlighted so that this can be provided. Patients should be encouraged to eat and their food and fluid intake monitored. The input of a visitor to assist the patient should be welcomed and incorporated in this. Nursing staff must organise their own mealtimes to maximise the number of staff available to deliver and assist patients/clients with food.

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Consideration should be given to where patients sit to eat their meals, supporting the social aspects of mealtimes whilst respecting the preferences of the individual and maintaining privacy and dignity at all times.

Patients must be allowed the time and place to eat and drink at their own pace without feeling rushed.

5. COMMUNICATING THE POLICY TO STAFF, PATIENTS, RELATIVES

AND CARERS

The principle of a Protected Mealtime policy needs to be established within the ward routine and structured day. Appropriate signage should be displayed outside the ward, to inform staff and visitors of the protected mealtime period. Visitors should be made aware of the ethos of the policy and where appropriate relatives should be welcomed to assist a patient at mealtimes. Communicating the principles of protected mealtimes to visitors and carers should not be overlooked. Carers and visitors can, if they wish, support patients with food and fluids and should be supported in this role. Medical staff and other healthcare professionals such as Radiographers and Phlebotomists should be informed about changes to ward routines to ensure patient care is appropriately managed.

6. TRAINING AND SUPPORT

Role specific training programmes will be delivered for staff identified through a training needs analysis. Ward and department managers have a responsibility to ensure that staff are released to attend the relevant session.

7. MONITORING COMPLIANCE

Protected Mealtimes audits will be undertaken on wards participating in the nutrition ward accreditation process to monitor compliance. The PLACE programme will also monitor compliance.

What is being Monitored

Who will carry out

the Monitoring

How often

How Reviewed/

Where Reported to

Protected Mealtimes

All wards as part of Nutrition Ward Accreditation. PLACE Team

Twice yearly Once a year

Will be collated on the Nursing Metrics. Data shared with the Nutrition Action Group and actions directed to Ward Managers. PLACE Programme

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7.1 Ward Accreditation

Ward accreditation relates to the nutritional management of patients, and Protected Mealtimes is included in one of the standards that need to be met. Twice yearly information will be collated on the nutrition metrics and this data then shared twice yearly with the Nutrition Action Group (NAG) and actions directed to ward managers.

The ward accreditation system has been developed as a process that allows wards to demonstrate how they are continually working towards improving the nutritional care of their patients.

The criteria to be met for the ward accreditation system relate to those standards that should form the framework for the wards activities concerning the nutritional care and management of their patients. These nutritional standards should also be seen as an integral part of the wards quality management system.

7.2 PLACE Programme (Patient – Led Assessments of the Care Environment)

Adherence to Protected Mealtimes is also assessed as part of the Food Assessment part of the PLACE Programme, in particular reference to whether it was clear that all unnecessary activity was ceased during the meal time.

8. EQUALITY IMPACT ASSESSMENT

An Equality Impact Assessment (EIA) has been conducted on this procedural document in line with the principles of the Equality Analysis Policy (CORP/EMP 27) and the Fair Treatment For All Policy (CORP/EMP 4).

The purpose of the EIA is to minimise and if possible remove any disproportionate impact on employees on the grounds of race, sex, disability, age, sexual orientation or religious belief. No detriment was identified. (See Appendix 1).

9. OTHER RELEVANT POLICIES AND GUIDANCE

PAT/T 43 – Nutrition and Hydration Policy for Adults in Hospital

PAT/T 35 - A Practical Guide to Nutrition Support for Adults

PAT/IC 5 - Hand Hygiene

PAT/PA 19 - Mental Capacity Act 2005

PAT/PA 28 - Privacy and Dignity Policy

Red Tray Guidance (available on clinical nutrition intranet resources).

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APPENDIX 1 – EQUALITY IMPACT ASSESSMENT - PART 1 INITIAL SCREENING

Service/Function/Policy/Project/Strategy

Care Group/Executive Directorate and Department

Assessor (s) New or Existing Service or Policy?

Date of Assessment

Protected Mealtimes Policy All Wards in The Trust Joanne Pack - Matron Existing 15 September 2016

1) Who is responsible for this policy? Name of Care Group/Directorate: - Joanne Pack – Matron – On behalf of the Nutrition Steering Committee

2) Describe the purpose of the service / function / policy / project/ strategy? - All patients. To provide a framework for mealtimes and places the patient at the centre of the mealtime experience.

3) Are there any associated objectives? CQC Registration. PLACE

4) What factors contribute or detract from achieving intended outcomes? - None

5) Does the policy have an impact in terms of age, race, disability, gender, gender reassignment, sexual orientation, marriage/civil partnership, maternity/pregnancy and religion/belief? - No

If yes, please describe current or planned activities to address the impact [e.g. Monitoring, consultation]

6) Is there any scope for new measures which would promote equality? [any actions to be taken

7) Are any of the following groups adversely affected by the policy? - N/A

Protected Characteristics Affected? Impact

a) Age No

b) Disability No

c) Gender No

d) Gender Reassignment No

e) Marriage/Civil Partnership No

f) Maternity/Pregnancy No

g) Race No

h) Religion/Belief No

i) Sexual Orientation No

8) Provide the Equality Rating of the service / function /policy / project / strategy – tick () outcome box

Outcome 1 Outcome 2 Outcome 3 Outcome 4 *If you have rated the policy as having an outcome of 2, 3 or 4, it is necessary to carry out a detailed assessment and complete a Detailed Equality Analysis form in Appendix 4 Date for next review: September 2019

Checked by: Joanne Pack - Matron Date: 15 September 2016