This Session is supported by - Dietitian Connection

1

Engagingthepatient:Improvingoncologypatientmealexperiencethroughbedsideterminalmealordering.

VickiBarrington,APD

PeterMacCallum CancerCentre

Email:v.barrington@latrobe.edu.au

ThisSessionissupportedby:

J Hum Nutr Diet. 2018 Jul 2. doi: 10.1111/jhn.12573

2

PeterMac- anewoncologyhospitalin2016

Opportunitieswiththemoveo Improvepatientsmeal

experienceo Improvepatients

nutritionalintake

PhotoCredit:Peter MacCallum CancerCenter.www.petermac.org

Photo Credit: Peter MacCallum Cancer Center. www.petermac.org

What’snewinthekitchen

v Betterdesignedkitchen(1/3size)Ø WorkflowØ UnderbenchfridgesØ Temperaturecontrolledarea

v Newequipmentthatworks!Ø CookingØ PlatingØ Dishwasher

v NewFoodandNutritionMealManagementsystemØ PurchasingØ MenuorderingØ Patientnutrition

3

Challenges

§ Noincreaseinstaff§ Noincreaseinbudget- althoughsomere-location

spend§ Smallerkitchenbutbiggerhospitalfootprint§ Nochangetothemenu§ Limitedinputtotypeoffoodserviceanddesign

Ø layout,heatboosttrolleys,equipment

FoodServiceModelChangesEastMelbourneo OnsiteCookfresh/cookchillhybrid

o 4weekcyclemenu

o Papermenus- 3mealso Lagtimeofafulldaybetweenordering

andreceivingameal

o Inefficientcollectionprocess

o Nonutritioninformationonmenu

o Limitedmidmealserviceatpointofserviceo Poordietsafetyo LackofONS

Parkvilleo OnsiteCookfresh/cookchillhybrid

o Nochangeo 4weekcyclemenu

o Nochangetomenu

o Bedsidemealordering(CBORD)

o Mealorderingupto1mealinadvance

o Ordermeals24/7

o Abilitytoorderfewermealsat1time

o Abilitytoorderupto1hr minutesbeforeameal

o Nutritioninformationforeachitem

o Dailynutritionintakesummary

o Midmealorderingandincreasedmidmealoptions

Whathasnotchanged:MalnutritionPrevalence§ Theoncologypopulationisoneofthehighestriskgroupsfor

malnutrition§ Oncologypatientsare1.7xmorelikelytobemalnourished

comparedwithotheracutehospitaladmissions.1§ Barrierstoadequatenutritionaremulti-factorial

Ø BarriersinthewardØ Barriersinthekitchen

1.2009DAAPracticeguidelinesforthenutritionalmanagementofmalnutritioninAdultpatients

MST<238%

SGA-A11%

SGA-B44%

SGA-C7%

Overall Nutritional Status(Inpatients):Well nourished 49%Malnourished 51%

Source: Loeliger J, Kiss N. Phase II Malnutrition in Victorian Cancer Services: summary report. Department of Health and Human Services, State Government of Victoria, Melbourne.

4

Patientsremembertheirfood…..

Patientsremembertheirfood.

.......Ask the patientPhoto Credit:PeterMacCallum Cancer Center. www.petermac.org

BedsideMealOrderingProject- Consumerengagementthroughouttheprojecto ConsumersinvolvedinthedesignoftheBedsideTerminalsscreenlook

andlanguageo Consumertestingandfeedbackthroughoutprojecto Patientdatagatheredfromprevioussurveys&feedbacko 2015HonorsStudentthesis“Oncologyinpatients’experienceswith

mealorderingandintake"o Interviewsaddressedpatients’understandingoftheirnutritionalneedsandexperienceswithaccessandprovisionoffoodinhospital.

PatientThemes

MenuCommunication

NutritionalFactors

Service &DeliverytimesFoodquality

Appetite

PATIENT

5

BedsideMealOrdering

ServiceandDeliverytimes• Canordermealsupto1hourpriortomeal

service• Canorder1mealaheaduptonextday’s

meals

• Enablepatientstoorderfewermealsinadvance

• Canordermeals24/7

MenuCommunication• DietCodedisplayed• Photosanddescriptionsofmeals• AssistCALDpatients

6

MenuCommunication

MenuCommunication§ Patientsandstaffcanringmenucoordinators

directlytoaddressmenuissuesandconcerns

Nutritionalfactors• Enablepatienttohaveeasyaccesstonutritionalinformation• Nutrientcompositionfor everyfooditem

7

Nutritionalfactors• Summaryofmealorderandnutrition

NutritionalFactors

RecipeingredientsonFSstaffiPads

MidMealoptions• Nomidmealdefaults• Improvedmidmealsafetyandfoodoptions• IncludedONS

8

RESULTS

ProjectAims

1.Determineifthenewbedsidemenuorderingsystemenhancesoverallmealexperienceandimprovesnutrientintake

2.Comparedatatopreviousbaselinemealserviceauditsconductedin2014and2015o Patientmealexperienceo Orderingpatternso Platewasteo EnergyandNutrientsconsumed

MealExperienceSurvey Demographics

2015 2016NoPts 59 50

Gender Female44%Male55%

Female54%Male46%

LOS Mean =10d Range=2-52d Mean=6d Range=2-33d

Age Mean =59yRange=19-90y Mean= 65yRange=23-90y

CALD 29%CALD 33%CALD

Results

9

PatientOrderingPatterns

• 60%patientsuseBedsidemealorderingterminalsindependentlyo 33%CALD,o 49%>65years

• 25%patientshaveassistancebymenuco-ordinators/staffo Unwellpatientsstillhaveindividualassistanceo Allocatetimetopatientswhoneedassistance

Photo. Credit:CBORDwww.cbord.org.

PatientOrderingPatterns

Decreaseof10%inpatientsreceivingdefaultmealso Morelikelytoeatwhat

youchooseo Lesswastage

25

15

0

5

10

15

20

25

30

2015 2016

PerrcentPatient

DefaultMeals

33

66

0

10

20

30

40

50

60

70

2015 2016

Percen

tPatients

MidMealOrdersIncreaseof100%inpatientsorderingmidmealso Availabilityofnutrient

densesnackandfluidso Lesswastageasno

defaults

MealExperienceSurveyresultsEffectsofMealOrdering

2015 2016 Pvalue

I understandhowtofillinthemenu 38(65%) 33(66%) Notsig

Choosing therightfoodisdifficult,thereisn’tenoughnutritioninformation

35(61%) 16(32%) P=0.002*

When thefoodarrivesIalwayswantwhatI’veordered

32(55%) 43(87%) P=0.0005*

IdidnotreceivethefoodI ordered 26(45%) 6(13%) P=0.0002*

*P<0.05

10

6997

4663

95008940

6517

9500

0100020003000400050006000700080009000

10000

Ordered Consumed EER

Kilojoule

AVERAGEENERGYINTAKE2014 2016

P = 0.004 P = 0.00001

82

55

70

98

68 70

0

20

40

60

80

100

120

Ordered Consumed EPR

Grams

AverageProteinIntake2014 2016

P = 0.0017

P = 0.02

AveragePlateWaste

32.2

36.3 37.535.3

28.1

35.2

41

34.3

BREAKFAST LUNCH DINNER DAILYTOTAL

A%PlateW

aste

2015 (n=96) 2016 (n=85)

P=0.3P=0.47

P=0.82

11

Summary

Bedsidemealorderingisasuccess1. Improvingaccesstoorderingandmealtimingcanimproveoral

intakeforbothmealsandmidmealsindependentoffoodservicecooking/preparationmodel.

2. PatientsofallagesarereadytoadopttechnologyandhaveembracedBedsidemealordering.

3. Patients’wanttoactivelyparticipateintheirhealthcareatallstages.

4. Bedsidemealorderingempowerspatients’tofeelengagedabouttheirnutritionalcareandmealexperiencewhilstinhospital.

Thankyou!o PeterMacPatientsandConsumerso LatrobeUniversityandMonashUniversitystudents

Photo Credit:Peter MacCallum Cancer Center. www.petermac.org

UpdatefromJacqBlacko Currentsituationat

PeterMac,2yearsono Wheretofromhere

WhereisPeterMacnow?

12

Background

• 2.5yearspostmovetonewfacilitiesandimplementationofCBORDfoodservicesystem

• UnderstandCBORDsystembetterbutstillalotmorewecandowithit

• It’stimeforchangeandimprovements

Patient ordered on the bedside terminal

Patient ordered via menu coordinators

Patient is nil by mouth

Menureview

Menureview

Nochangetomenuin>7years

Existing28-daymenucycle

Plusshortorderandmidmeals

Daytherapychairs

increasedfour-fold!

Kitchenis⅓size!

Foodwastage/patientconsumptiondata

Mobileintake

• NotcurrentlybeingusedatPeterMac• Bringsmanybenefits

Calculatedfoodwastage

• Nomorestudentprojectstakingphotosandwatchingplatinglines!

Calculatedproteinandenergyintake

• Potentialimprovementtofoodcharts

13

Mobileintake

Foodallergymanagement

• Increaseinfoodallergiesandrange• CBORDisabettersystemformanagingfoodallergies• Implementedspecificfoodallergydietcodes,previously

alreadyhadglutenfree

Foodallergymanagement

• Increasingdifficultyinprovidingsafemealstopatientswithanunusualreportedfoodallergy

14

Foodallergenmanagement

Policiesandprocedures•Whatiscurrentlyinplace?•Whatdoweneedtodevelop?•Disseminationofthese

Communication• Whatistheprocessforcommunicatingfoodallergies?

• Howdofoodservicesknowapatienthasanallergy?

Foodpreparation• Isitsafeenough?• Dofoodservicesstaffunderstandtheimportanceofthis?

Thankyou

JacqBlackJacqueline.black@petermac.org