Mealtime interruptions, assistance and nutritional intake in subacute care

Protected mealtimes is an initiative to support increased nutritional intake for all hospitalised patients, particularly those who are malnourished. The increased focus on maximising independence of patients in the subacute setting may provide a supportive environment for implementing these strategies. The aim of the present study was to gain insight into subacute ward practices at mealtimes under usual conditions (i.e. at baseline) where no protected mealtimes policy was implemented. Participants were patients aged ≥65 years recruited from subacute care facilities at a large healthcare network in Victoria, Australia. Participants were observed at mealtimes and mid meals (i.e. morning tea, afternoon tea and supper) to determine daily energy and protein intake, provision of mealtime assistance and mealtime interruptions. Almost all participants received assistance when it was needed, with positive and negative interruptions experienced by 56.2% and 76.2% of participants, respectively. There was an energy deficit of approximately 2 MJ per day between average intake and estimated requirements. In conclusion, mealtime practices were suboptimal, with particularly high rates of negative interruptions. Protected mealtimes is one strategy that may improve the mealtime environment to support patients’ dietary intake. Prospective studies are needed to evaluate its implementation and effects.

What is known about this topic?
The mealtime environment on a hospital ward may influence the nutritional intake of patients. Protected mealtimes is a systems approach that aims to minimise negative interruptions and promote positive interruptions to enhance the nutritional intake and nutritional status of patients. Whilst the approach has been widely implemented, further evaluation of its fidelity and effects is required.

What does this paper add?
This observational research has determined the nutritional intake, provision of assistance and interruptions at mealtimes experienced by a cohort of subacute care patients under usual care conditions. An energy deficit of approximately 2MJ below estimated requirements was identified. Half of the participants received positive interruptions and the majority of participants requiring assistance received it, however the prevalence of negative interruptions was high. This pilot study has enabled a fully powered prospective study to be designed, exploring the implementation of protected mealtimes and its effects on nutritional intake of patients in the subacute setting.

What are the implications for practitioners?
The energy deficit that exists for patients in subacute care may lead to nutritional decline, and longer lengths of stay. There are opportunities to improve ward practices at mealtimes in the subacute setting to focus on nutritional care.