1 Peter Mac- a new oncology hospital in 2016 Opportunities with the - - PDF document

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1 Peter Mac- a new oncology hospital in 2016 Opportunities with the - - PDF document

Dec 04, 2022 320 likes •476 views

Engaging the patient: Improving oncology patient meal experience through bedside terminal meal ordering. Vicki Barrington, APD PeterMacCallum Cancer Centre Email:v.barrington@latrobe.edu.au This Session is supported by: J Hum Nutr Diet. 2018

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Engaging the patient: Improving

  • ncology patient meal experience

through bedside terminal meal

  • rdering.

Vicki Barrington, APD PeterMacCallum Cancer Centre

Email:v.barrington@latrobe.edu.au

This Session is supported by:

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

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Peter Mac- a new oncology hospital in 2016

Opportunities with the move

  • Improve patients meal

experience

  • Improve patients

nutritional intake

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

What’s new in the kitchen

v Better designed kitchen (1/3 size)

Ø Work flow Ø Under bench fridges Ø Temperature controlled area

v New equipment that works!

Ø Cooking Ø Plating Ø Dishwasher

v New Food and Nutrition Meal Management system

Ø Purchasing Ø Menu ordering Ø Patient nutrition

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Challenges

§ No increase in staff § No increase in budget- although some re-location spend § Smaller kitchen but bigger hospital footprint § No change to the menu § Limited input to type of food service and design

Ø layout, heat boost trolleys, equipment

Food Service Model Changes

East Melbourne

  • On site Cook fresh/cook chill hybrid
  • 4 week cycle menu
  • Paper menus- 3 meals
  • Lag time of a full day between ordering

and receiving a meal

  • Inefficient collection process
  • No nutrition information on menu
  • Limited mid meal service at point of

service

  • Poor diet safety
  • Lack of ONS

Parkville

  • On site Cook fresh/cook chill hybrid
  • No change
  • 4 week cycle menu
  • No change to menu
  • Bed side meal ordering ( CBORD)
  • Meal ordering up to 1 meal in advance
  • Order meals 24/7
  • Ability to order fewer meals at 1 time
  • Ability to order up to 1 hr minutes before a

meal

  • Nutrition information for each item
  • Daily nutrition intake summary
  • Mid meal ordering and increased mid meal
  • ptions

What has not changed: Malnutrition Prevalence

§ The oncology population is one of the highest risk groups for malnutrition § Oncology patients are 1.7 x more likely to be malnourished compared with other acute hospital admissions.1 § Barriers to adequate nutrition are multi-factorial Ø Barriers in the ward Ø Barriers in the kitchen

  • 1. 2009 DAA Practice guidelines for the nutritional management of malnutrition in Adult patients

MST<2 38% SGA-A 11% SGA-B 44% SGA-C 7%

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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Patients remember their food…..

Patients remember their food.

.......Ask the patient

Photo Credit:PeterMacCallum Cancer Center. www.petermac.org

Bedside Meal Ordering Project

  • Consumer engagement throughout the project
  • Consumers involved in the design of the Bedside Terminals screen look

and language

  • Consumer testing and feedback throughout project
  • Patient data gathered from previous surveys & feedback
  • 2015 Honors Student thesis “Oncology inpatients’ experiences with

meal ordering and intake"

  • Interviews addressed patients’

understanding of their nutritional needs and experiences with access and provision of food in hospital.

Patient Themes

Menu Communication Nutritional Factors Service & Delivery times Food quality Appetite

PATIENT

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Bedside Meal Ordering Service and Delivery times

  • Can order meals up to 1 hour prior to meal

service

  • Can order 1 meal ahead up to next day’s

meals

  • Enable patients to order fewer meals in

advance

  • Can order meals 24/7

Menu Communication

  • Diet Code displayed
  • Photos and descriptions of meals
  • Assist CALD patients
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Menu Communication Menu Communication

§ Patients and staff can ring menu coordinators directly to address menu issues and concerns

Nutritional factors

  • Enable patient to have easy access to nutritional information
  • Nutrient composition for every food item
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Nutritional factors

  • Summary of meal order and nutrition

Nutritional Factors

Recipe ingredients on FS staff iPads

Mid Meal options

  • No mid meal defaults
  • Improved mid meal safety and food options
  • Included ONS
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RESULTS Project Aims

  • 1. Determine if the new bedside menu ordering system enhances overall

meal experience and improves nutrient intake

  • 2. Compare data to previous baseline meal service audits conducted in

2014 and 2015

  • Patient meal experience
  • Ordering patterns
  • Plate waste
  • Energy and Nutrients consumed

Meal Experience Survey Demographics

2015 2016

No Pts 59 50 Gender Female 44% Male 55% Female 54% Male 46% LOS Mean = 10d Range = 2-52d Mean = 6d Range = 2-33d Age Mean = 59y Range =19-90 y Mean= 65y Range = 23-90y CALD 29% CALD 33% CALD

Results

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Patient Ordering Patterns

  • 60% patients use Bedside meal ordering terminals

independently

  • 33% CALD,
  • 49% > 65years
  • 25% patients have assistance by menu co-ordinators/staff
  • Unwell patients still have individual assistance
  • Allocate time to patients who need assistance
  • Photo. Credit:CBORD

www.cbord.org.

Patient Ordering Patterns

Decrease of 10% in patients receiving default meals

  • More likely to eat what

you choose

  • Less wastage

25 15 5 10 15 20 25 30

2015 2016

Perrcent Patient

Default Meals

33 66 10 20 30 40 50 60 70

2015 2016

Percent Patients

Mid Meal Orders

Increase of 100% in patients ordering mid meals

  • Availability of nutrient

dense snack and fluids

  • Less wastage as no

defaults

Meal Experience Survey results

Effects of Meal Ordering

2015 2016 P value I understand how to fill in the menu 38(65%) 33(66%) Not sig Choosing the right food is difficult, there isn’t enough nutrition information 35(61%) 16(32%) P=0.002* When the food arrives I always want what I’ve ordered 32(55%) 43(87%) P=0.0005* I did not receive the food I ordered 26(45%) 6(13%) P=0.0002*

*P<0.05

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6997 4663 9500 8940 6517 9500

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000

Ordered Consumed EER

Kilojoule

AVERAGE ENERGY INTAKE

2014 2016

P = 0.004 P = 0.00001

82 55 70 98 68 70

20 40 60 80 100 120

Ordered Consumed EPR

Grams

Average Protein Intake

2014 2016

P = 0.0017 P = 0.02

Average Plate Waste

32.2 36.3 37.5 35.3 28.1 35.2 41 34.3 BREAKFAST LUNCH DINNER DAILY TOTAL A% Plate Waste 2015 (n=96) 2016 (n=85)

P=0.3 P=0.47 P=0.82

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Summary

Bedside meal ordering is a success

1. Improving access to ordering and meal timing can improve oral intake for both meals and mid meals independent of food service cooking/preparation model. 2. Patients of all ages are ready to adopt technology and have embraced Bedside meal ordering. 3. Patients’ want to actively participate in their healthcare at all stages. 4. Bedside meal ordering empowers patients’ to feel engaged about their nutritional care and meal experience whilst in hospital.

Thankyou!

  • Peter Mac Patients and Consumers
  • Latrobe University and Monash University students

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

Update from Jacq Black

  • Current situation at

PeterMac, 2 years on

  • Where to from here

Where is Peter Mac now?

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Background

  • 2.5 years post move to new facilities and implementation of

CBORD food service system

  • Understand CBORD system better but still a lot more we can

do with it

  • It’s time for change and improvements

Patient ordered on the bedside terminal Patient ordered via menu coordinators Patient is nil by mouth

Menu review Menu review

No change to menu in >7 years Existing 28-day menu cycle Plus short

  • rder and

mid meals Day therapy chairs increased four-fold! Kitchen is ⅓ size!

Food wastage / patient consumption data

Mobile intake

  • Not currently being used at Peter Mac
  • Brings many benefits

Calculated food wastage

  • No more student projects taking photos and

watching plating lines!

Calculated protein and energy intake

  • Potential improvement to food charts
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Mobile intake Food allergy management

  • Increase in food allergies and range
  • CBORD is a better system for managing food allergies
  • Implemented specific food allergy diet codes, previously

already had gluten free

Food allergy management

  • Increasing difficulty in providing safe meals to patients with

an unusual reported food allergy

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Food allergen management

Policies and procedures

  • What is currently in

place?

  • What do we need to

develop?

  • Dissemination of these

Communication

  • What is the process

for communicating food allergies?

  • How do food services

know a patient has an allergy?

Food preparation

  • Is it safe enough?
  • Do food services staff

understand the importance of this?

Thank you

Jacq Black Jacqueline.black@petermac.org