Improving Nutritional Care: Making meals matter

1. Improving Nutritional Care:Making meals matter The Plastic Surgery and Burns Unit Glasgow Royal Infirmary Journey with ‘Making Meals Matter’ Jackie Dunlop Practice Development Nurse

2. Following 1st day spread event • Discussion with GG&C team who attended event on how best to take the testing forward at local level. • Looked at all the quality improvement initiatives currently taken place in the ward area’s to see how the making meals matter could be integrated. • Found most areas had currently 22 audits taking place each week. • Mapped it against the Releasing Time to care, Meals module, to improve the process and production which would lead to improve safety and efficiency and thus more time spent with patients

3. Releasing Time to Care, MealsAims: • Improve safety • Improve patient and staff experience • Save time

4. 6 phases process

5. Prepared: • Who should be involved…SCN’s, link nurses, dietician, SALT, catering dept and PD support • We invited all staff to a meeting, providing information and looked for their suggestions on RTTC and testing of ‘making meals matter’ • Requested any current available data to evidence current practice…complaints, datix incidents, Better together questionnaire, CQI’s, tracking results and waste walk from RTTC, knowing how we are doing module.

6. Assessed Nutrition champion and PD nurse performed base line observations using the CQI and ‘making meals matter’ tool • Observation of meal time • Patient questionnaire • Staff questionnaire Link nurses then performed further observations using the same tools for a 3 week period which was • Observational tool (3 times a week) • Staff questionnaire (5 times a week) • Patient questionnaire (5 times a week)

7. Diagnose:The PD nurse collated all the results from all 4 wards, then attempted to place them into highlights and lowlights used in the unit for the Better Together programme for staff knowledge consistency • Plan: • Collectively after a brain storming session and agreement from all the SCN’s, each lowlight was addressed using The Model for Improvement, PDSA cycle. • The link nurses assisted in the implementation of change

8. Highlights and Lowlights

9. PDSA – Food (improving quality of meals, including choice, in 4 weeks)

10. PDSA –Improving the quality of meals, including choice, in 4 weeks Fresh fruit to our ward

11. PDSA- process identificationImprove the process to identify the patients at meal times, especially the ones with specific needs to 95% compliance within a four week period. PDSA sheet Process Guidance Note

12. PDSA- hand washing prior meal Safety Brief PDSA sheet

13. Treat: • Currently in the process of testing the new processes after the changes we have made. This is another 4 weeks data on all 3 tools (on the units Better together results, no negative comments have been made regarding food) • We will evaluate the processes after this period

14. Challenges: • Difficult using 3 tools • Subjectivity on the results • No run charts • Can lead to confusion for staff with various models of improvement and quality initiatives, especially with all the audits being undertaken • Comments from patients and staff were about the quality of food rather then the process • Some of the processes/ patient experience are already being audited through other data, duplication of work…CQI, Better together, staff questionnaires • Economic climate making it difficult to staff areas, hence competing demands for staff

15. Thank you for listening Any questions ?