Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
LIU YP(1), WONG CK(1), WONG NC(1), TSANG WY(1), LO WK(2), AU LF(3), SZE WC(4), WONG HM (5), LEE SW(1)
Affiliation :
(1) Department of Medicine & Geriatrics (M&G), Tai Po Hospital, (2) Department of Dietetics, Tai Po Hospital, (3) Department of Speech Therapy, Tai Po Hospital, (4) Department of Catering, Tai Po Hospital, (5) Department of Administration, Tai Po Hospital (TPH)
Introduction :
Eating and drinking are important in the recovery from illness. Unfortunately, many elderly patients tend to eat less due to their illness and this delays their recovery. The ‘Frail Elderly Eating and Drinking (FEED) Program’ has been designed to arouse interest to eat among hospitalized patients to improve nutrition, facilitate recovery and minimize the length of hospital stay in medical wards of Tai Po Hospital, and been running since November, 2020. Though the programme, nursing staff are empowered to recruit suitable patients. Prior to implementation, staff training, survey for staff’s readiness and evaluation of staff performance in food portions charting were carried out. On going periodic audits have been conducted for evaluating the effectiveness and efficiency of the programme.
Objectives :
1. To improve older patients’ appetite with various snacks in order to reduce reliance on artificial fluids supplementation. 2. To empower staff on feeding knowledge and skills
Methodology :
Lean Six Sigma model is driven by a DMAIC concept: DEFINE Q4, 2020 1st multidisciplinary meeting Pilot in 1 ward Patient selection: daily oral intake ≤ 500ml for consecutive 2 days MEASURE Q4, 2020-Q1, 2021 Evaluate outcome 2nd review meeting Promote to 3 other wards Q1, 2021 Implement in all 8 wards. Transfer knowledge and skills to ward staff Promote new thickener to dysphagic patients ANALYSE Q2, 2021 Evaluate of staff’s perception Conduct CNE talk Assess the ability of ward staff to record uneaten meal portions after training. Evaluate outcome of Phase II IMPROVE Q2, 2021-Q4, 2022 Patient selection: daily oral intake ≤ 600ml or < 75% of daily portion of meals taken for two consecutive days Modify the snacks supply with periodic meetings according to their popularity among patients. Introduce new diets for patients, such as the Soup Schedule Update DCMS for patients’ needs CONTROL Q4, 2023 3rd evaluation to access the outcome between Nov 2022 – Nov 2023
Result & Outcome :
96 nursing staff and 66 supporting staff took part in the questionnaire, in which 93% nurse and 89% SS showed understanding and willingness to participate in the program. A 98% of Inter-Rater Reliability Agreement showed that most of the nursing and supporting staff could correctly rate the eaten percentage of 10 meal trays as 0%, 25%, 50%, 75% and 100%, according to the ‘New Territories East Cluster - Meal Quality & Category Supply Standards’. From Nov, 2022 to Nov, 2023, 164 patients were recruited. On average, daily fluid intake had increased by 230%, with 26% of patients taking >1000ml more, and another 41% taking ≥ 800ml more per day. For solid foods, the average increase in intake was 34%, with 16% of patients able to finish 100% and another 53% of patients, ≥75% of meal trays. A total of 46% of patients were able to wean off intravenous fluid as a result. The outcome reflects the value of the FEED program.
