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Engagingthepatient:Improvingoncologypatientmealexperiencethroughbedsideterminalmealordering.
VickiBarrington,APD
PeterMacCallum CancerCentre
Email:[email protected]
ThisSessionissupportedby:
J Hum Nutr Diet. 2018 Jul 2. doi: 10.1111/jhn.12573
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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
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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.
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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
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BedsideMealOrdering
ServiceandDeliverytimes• Canordermealsupto1hourpriortomeal
service• Canorder1mealaheaduptonextday’s
meals
• Enablepatientstoorderfewermealsinadvance
• Canordermeals24/7
MenuCommunication• DietCodedisplayed• Photosanddescriptionsofmeals• AssistCALDpatients
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MenuCommunication
MenuCommunication§ Patientsandstaffcanringmenucoordinators
directlytoaddressmenuissuesandconcerns
Nutritionalfactors• Enablepatienttohaveeasyaccesstonutritionalinformation• Nutrientcompositionfor everyfooditem
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Nutritionalfactors• Summaryofmealorderandnutrition
NutritionalFactors
RecipeingredientsonFSstaffiPads
MidMealoptions• Nomidmealdefaults• Improvedmidmealsafetyandfoodoptions• IncludedONS
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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
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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
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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?
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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
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Mobileintake
Foodallergymanagement
• Increaseinfoodallergiesandrange• CBORDisabettersystemformanagingfoodallergies• Implementedspecificfoodallergydietcodes,previously
alreadyhadglutenfree
Foodallergymanagement
• Increasingdifficultyinprovidingsafemealstopatientswithanunusualreportedfoodallergy
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Foodallergenmanagement
Policiesandprocedures•Whatiscurrentlyinplace?•Whatdoweneedtodevelop?•Disseminationofthese
Communication• Whatistheprocessforcommunicatingfoodallergies?
• Howdofoodservicesknowapatienthasanallergy?
Foodpreparation• Isitsafeenough?• Dofoodservicesstaffunderstandtheimportanceofthis?
Thankyou
