Food Service & Nutrition - Volume 1 No.2 - 8
All of these barriers can be addressed,
however, it is not without significant
change management! It requires a cooperative effort by all departments and levels within a facility and a commitment
to becoming Food Aware.
It has been frequently identified that
culture is very difficult to change and
this is what is required to develop a Food
Aware philosophy in a health care facility.
CMTF has identified through best practice
research and the results of the Nutrition
Care in Canada Study a number of practices that need to be put into place to
* Educate hospital management of the
effect nutrition status has on length
of stay, risk of readmission and cost
to the facility. Malnutrition typically
increases length of stay on average
by two days. Malnourished patients
are also much more likely to be
* Use of knowledge translation/implementation framework's to develop and
implement policies and protocols for
enhanced nutrition care.
* Put into place benchmarking and
progress tracking for nutrition related
goals. Make it part of the facility and/
or organizational strategic or action
plan. Data is very persuasive and
can influence decision makers significantly. Key performance indicators
should be developed to illustrate the
significance of the issue. KPI's can
also serve to measure the success of
* Effective communication between
departments; nursing; food services and health care professionals.
Research has indicated a lack of recognition regarding the prevalence
of malnutrition and/or the significance of poor nutrition on patient
outcomes. Use of in-house websites;
newsletters and online communication
tools to highlight the initiative should
* Focus on all aspects of nutrition care
process including screening, referral,
assessment, intervention and monitoring. Establishment of standard
protocols and processes to ensure
consistency. Involvement of all partners in the development of the protocols will assist in ensuring buy in to
* Interventions to promote intake:
1. Colour-coded trays for patients
requiring feeding assistance. This
is a subtle way to identify those
patients who require extra assistance and support.
2. Use of med pass - standard practice
based on the care plan and physician order of providing identified
high risk patients with 60-90 cc of
a high calorie, high protein nutritional supplement to the patient as
part of the medication regime. The
med pass protocols have been found
to ensure adequate intake of the
required supplement is more evenly
space throughout the day and does
not interfere with intake of food.
This practice is used in many facilities across the country at present
with good results.
3. Smaller portions with regular
snacks instead of just three big
meals. Large portions can overwhelm patients particularly those
that have a compromised appetite
or are nauseous.
4. Nutrient dense foods with a focus
on higher protein. Foods that are
only higher in calories, such as
sweet baked desserts, need to be
5. Liberalized or wellness diets - use
of very restrictive diets should be
monitored and need to be assessed.
The ability for the patient to make
food choices is important and
should be encouraged as appropriate. Patients may not always make
well balanced choices, however, if
they eat the foods they receive that
is a positive step.
CA N A D I A N S O C I E T Y O F N U T R I T I O N M A N AG E M E N T
6. Use of smaller plates and a smaller
spoon for feeding.
* Food services able to respond quickly
to diet changes and allow food access
outside of meal times (i.e., snack
carts). Snacks are typically a challenge for health care as it is difficult
and labour intensive to ensure they
are delivered to patients appropriately
and then whether they are consumed.
Many acute care facilities that had
processes in place to deliver snacks
in bulk to the nursing station on a
unit to have nursing distribute them
later have found that is not working.
Delivery to the bedside by food services
is the preferred option as it ensures
the patient is given the nourishment.
The food service staff member can
also provide feedback on whether the
patient wanted and/or intended to consume the snack or if they would have
preferred something different. This is
the most "Food Aware" approach and
should be considered as appropriate.
* Clarification of staff roles and responsibilities in nutrition care. It is important that all staff understand that
food and nutrition are a key element
of high quality patient care and can
impact recovery significantly.
* Staff education and training on how
to perform roles. Staff can be reluctant to assist with feeding if they are
not trained properly. Programs that
support proper feeding techniques
will provide that support to those
designated to assist with feeding.
Sometimes, it is not feeding that is
required. Instead, it may simply be
activities such as opening of packages
and cutting up of food.
* Individual actions to promote nutrition (such as, avoiding interruptions
at mealtimes; providing feeding
assistance if needed). Ensuring that
patients are ready for meals with overbed tables cleared and close to the
patient. If patient can eat in a chair