Protected Mealtimes Observational Audit

Transcription

1 1 Carrying out the Carrying out an observational audit is a simple process, but requires careful planning in order to be a success. Identify when you want to do the audit: in this instance, which mealtime(s) you wish to observe. Remember - you need two or more people to in order to carry out an observational audit fairly. Identify with whom you wish to carry out the observation. You may wish to be part of the audit team yourself, but any member of your team, including ward housekeepers, hostesses, healthcare assistants, nurses, or other healthcare professionals, can carry out the audit, with the right preparation and support. Before you begin the observation, make sure that you and your team are happy with what you are looking for and at. Familiarise yourself with the audit form included in this Toolkit, but bear in mind you may find it easier to carry out the audit using a blank piece of paper or a form of your own. The prompts below are there as a guide, but do not limit yourself to them. Think about where you will be best placed in order to carry out the observation. You need to be able to observe who is around and what they are doing and be able to pay particular attention to the environment (e.g. sounds, smells, clutter, etc.) You will need to position yourselves appropriately, so you are able to see and hear easily, but are not causing an obstruction. Think about your ground rules. Your observation should be interrupted only in an emergency, or where unacceptable practice, endangering the welfare of a patient, is observed. Staff on the ward need to be aware of what you are doing and why. Be clear with them about interruptions. Reassure them that you are not there to find fault with them, but simply to gauge a clearer picture of what happens during mealtimes, and that it is important that they carry on as normal. Think about how you are going to feed the results of the observation back to the team. This is especially important if it has been delegated to junior staff. Overall impressions, both positive and negative, can be fed back in a general way to the team, but some (perhaps more personal) issues should be dealt with on a one-to-one basis. Once the observation is complete, the observers need to compare notes and agree what information should go on the audit form. Sometimes it may take more than one observation in order to fully complete the form. If you have never carried out an observational audit before, think about who, in your organisation, you could ask for help. For example, the audit department, colleagues, practice development nurse, etc. Once you have completed your audit and discussed it with your team, the next step is to formulate your action plan, involving other teams and professionals as necessary. Remember - your action plan should be: Specific Measurable Achievable Realistic Time limited Evaluated Reviewed regularly The aim of this is to help you examine what happens in your area at mealtimes. This is important as a starting point to implementing. You may

2 2 want to complete an observation at each of the three main mealtimes in order to obtain a complete picture of what is happening. Under each heading, there are prompts and things to consider, but the list is by no means exhaustive. Remember - observation is simply a tool by which information can be obtained. Don t be put off by the process or the paperwork. Evelyn Prodger and Mhairi Donald, 2003 Brighton and Sussex University Hospitals NHS Trust Before You Start Ask yourself the following questions: Do staff organise themselves to take their meal breaks during patient mealtimes? Do mealtimes occur during visiting times? Are there planned activities that occur during mealtimes (e.g. teaching, ward rounds, handover, grand rounds, student visits)? Environment Space between and around beds. Can patients reach their tables, and are the tables clean and free from clutter? Are the patient areas free from clutter? Are there commodes in use? Is there a dining room or dining table for patients to use? Are there any off-putting smells on the ward, and if so, where are they coming from? What is the noise level and what is the cause of any noise? Is the ward atmosphere pleasant, relaxed and conducive to eating?

3 3 Activities What personnel are on the ward (e.g. doctors, phlebotomists, pharmacists, estates people, visitors, outside contractors, clergy, occupational therapists, physiotherapists, social workers, dieticians)? Do those people need to be on the ward (i.e. is it either an emergency, or are they involved with the mealtime)? What are the nursing staff, healthcare assistants and relatives doing? What are the housekeeping staff/hostesses doing? If you have a ward housekeeper, what are they doing? If you have any volunteers, what are they doing? Are the patients and staff aware that it is a mealtime?

4 4 Individuals Did the patients know that a meal was due to be served soon? Were patient asked whether they wanted to eat in the dining area, or at the dining table and were they given assistance to get there, if required? Was there an opportunity for patients to wash their hands before the meal was served? Were patients positioned in such a way as to enable them to eat safely and promote maximum independence? Did patients have appropriate cutlery, napkins, hand wipes, condiments, etc.? Were drinks within reach of patients? Were patients assisted with eating and drinking if they required help? If so, who helped them and how long did they wait to be fed? Was the dining area or table used, if available? Was there any socialisation during mealtime?

5 5 Monitoring Who was monitoring how much patients ate, and how was this fed back to the nurse looking after the patient? Was there evidence of documentation relating to nutrition and hydration being done either at the time or afterwards? Was an alternative offered, if a meal was not eaten? Do staff know what alternatives are available to patients? Do the staff serving the meal know of the patients dietary requirements adhered to? Were patients who had previously been identified as not eating well encouraged to eat? Were nursing staff available to observe patients eating in order to pick up specific problems? Who cleared away the meals?

6 6 Action Planning You should now have enough information for you team to examine what happens at mealtimes and start planning for the implementation of. We have included some Top Tips on how to get started. Please remember to share any good practice observed with colleagues. AREA: Date of Observation: Observer 1: Observer 2: