A pilot study at an orthopedic ward The aim was to test and evaluate working methods around the nutritional care process and how person-centered meals can be a part of personal-centered care, before introducing person-centered meals at hospitals in the region of Kronoberg. Background. Since 2017 there are new national guidelines for hospital meals saying that the meals should be individually tailored and adapted to the different wards target groups. Implementation of person-centered care is ongoing in health care. Person-centered care means that patients become co-creators in their own care. That the patient’s and caregiver’s knowledge forms the basis for deciding and establishing an individual plan, a plan that can then be shared with others through the patient’s care process. Tackling with malnutrition, food waste, working hours for health care professionals, food safety, patient safety and nutrition, awareness of gaps in the nutrition care process.
Actions The hospital kitchen changed the menu and offered several small-sized starters and desserts for lunch and dinner. The energy and protein content was standard, eg. starters 150 kcal, 5-6 g protein, main course 400 kcal, 17-20 g protein and desserts 50-150 kcal. The main courses are changes every lunch/dinner, starters and desserts are offered every lunch/dinner and are changed every week. The structure of the meal work in the care department was changed. All patients were given the menu and could choose freely among the different dishes. When needed, the staff provided support on what would be best for the patient to eat. The structure for serving changed, from the food being served from the food cart in the corridor, the food cart and serving were now moved to the department kitchen. A new method “Green Cross” for systematic work with malnutrition, pressure ulcers and cases were introduced in the care department. Every morning, all the healthcare staff gathered around the “Green Cross” to inform about risks, measures and follow-up
Main results Effects and added value for patients The patients appreciated being able to participate and were very satisfied with the meals. Patients ate more when they got involved. Food waste decreased by 60 g per patient and meal. None of the patients identified as at risk for malnutrition reached more than 40% of their recommended protein requirement. Effects and added value for health care professionals at the ward The new serving structure provided more efficient work and saved time, the healthcare staff saved 90 minutes per lunch dinner. Food safety improved as the food was able to maintain the right temperature and handled more hygienically. Patient safety was improved when the patient’s food was not discussed in the corridor. Staff became more aware of the nutritional intake of patients at risk of malnutrition. Costs The extra costs for the pilot project were the costs for starters and desserts at lunch/dinner, a total of 7 kr (0,7 EUR) per patient per day. Identified development areas, gaps in the nutrition care process Structure for Dietician Involvement in Patients at Risk of Malnutrition. Systematics for over-reporting of nutrition to the next healthcare provider The nutrition care process needs to be supplemented with governing documents, routines and tools and included in the healthcare quality work. It is necessary to develop a training package prior to a broader introduction to the concept. Continued development work and product development of new dishes, starters and desserts aimed at increasing the consumption of vegetable protein, vegetables and whole grains for sustainable and healthy consumption in all patients. Development of digital support such as where the patient and healthcare staff can see the menu and order food Conclusion The concept of person-centered meals provides high benefit to the patient at low cost and contributes to the development of a structured quality work around nutrition. Prior to implementing the concept, identified development areas need to be taken care of, and there needs to be an “owner” to implement, operate and develop the nutrition care process and person-centered meals as part of person-centered care.