Overcoming barriers to protected mealtimes implementation to prevent and treat malnutrition

Protected mealtimes aims to protect mealtimes from unnecessary and avoidable interruptions, through providing a supportive environment for eating. It supports staff to provide patients with support and assistance with meals, and is therefore a systems approach to address the vast problem of in-hospital malnutrition. This study will compare the implementation of a protected mealtimes intervention with usual care in the subacute setting. The study aims to positively improve food intake at mealtimes, therefore treating and preventing malnutrition developing. The implementation will have three steps: 1. Pre-implementation - decreasing barriers to implementation through engagement of key stakeholders, staff training, planning the implementation etc. The study has support from the Eastern Health Executive team, with the absence of support throughout the organisation known as a barrier from previous studies of protected mealtimes. The study will fall under the auspices of the Nutrition Expert Advisory Committee. Senior staff training and engagement will commence in July 2015. Training of nursing staff and other treating team members will occur in the week prior to the intervention so as not to affect baseline data collection. There will be three group training sessions on each ward during this pre-intervention week, all administered by the lead researcher. These training sessions will be multidisciplinary. The study will run for four weeks, including one week of baseline data collection (usual care) then the intervention introduced in one ward per week. 2. Implementation of protected mealtimes through the planned study design Protected mealtimes will be implemented consistent with the British Caterer's Association Protected Mealtimes Policy 2004, available at: www.hospitalcaterers.org/documents/pmd.pdf The intervention period will be 1-3 weeks. 3. Evaluation of the intervention will be two fold - compliance with the protected mealtimes implementation will be evaluated by the dietetic team who will assess compliance using the checklist from Hickson M, Connolly A, Whelan K. Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients. J Hum Nut Diet 2011; 24:370-374. Further, the nutritional intake of patients will be evaluated using the nutritional analysis software, Foodworks.