Malnutrition in Hospitals: Are Protected Mealtimes the Answer?
A real and prominent problem exists within our hospital system (and it may not be what you expect); malnutrition. Today, Australia’s malnutrition prevalence rates sit at approximately 40% [1]. This is a worrying trend, especially amongst patients requiring the highest of care in our hospitals.
To resolve this issue, Protected Mealtimes (an intervention method aimed at improving patient eating time) was developed. But there’s a caveat. Due to the lack of high quality evidence, the intervention’s effectiveness has been questioned, particularly by Associate Professor Judi Porter, a researcher and Advanced Accredited Practising Dietitian at Monash University.
Publishing their recent paper [2]; Judi and her team undertook a novel study (funded by the NHMRC) to measure the effect of implementing Protected Mealtimes.
Protected Mealtimes is a complex healthcare intervention designed to allow patients to consume food freely and uninterrupted by the typical day-to-day functionalities of hospitals. Examples of this include interruption for routine consumption of medicine or delivery of medicines.
With the debilitating symptoms of malnutrition (such as a depressed immune system, weakness and increased risk of mortality) there is a lot to be gained by introducing an intervention that prevents malnutrition. A huge benefit can be seen economically. In the UK alone, malnutrition in hospitals is estimated to cause up to 15% of the health and social care expenditure (£19.6 billion) [3].
However, implementing such an intervention is no easy feat. Given the complexity and variation within hospital settings (and the effect it has on staff routines), the overall success of the program has been limited [4].
This lack of success is not unsurprising, considering institutions have not addressed the elephant in the room; in that the effectiveness of Protected Mealtimes remains unproven. Thus if such an intervention were to come to Australia, it is imperative we understand its effectiveness.
The result? Energy intake (kJ/day) was not much different between the use of Protected Mealtimes and normal conditions. Similarly, changes to protein intake (g/day) were insignificant.
“Given that the programme is recommended in a variety of national and charitable organisation nutritional guidelines, it was unexpected that it was not more successful in increasing nutritional intake.” commented Porter. “However, it has enabled the team to re-focus their energies on other possible solutions. This, ultimately, is the whole point of running these trials; determining what works in addressing a particular issue, and what doesn’t.”
With this newly revealed information, the immediate implications become clear. More research should be focused on other approaches that also have potential to improve nutritional outcomes, not just Protected Mealtimes. An example of this is positive interruptions, such as assisted eating (e.g. assistance for a stroke patient who struggles to lift their arms to eat and drink).
For Porter, this new information shows that ”success from the intervention will come in the form of having organisations who are looking to implement approaches to manage inpatient malnutrition to choose other evidence-based strategies. However, for those wishing to implement Protected Mealtimes in the future, utilising principles of implementation science did prove successful.” [5]
More Information
Associate Professor Judi Porter is a researcher at the Monash University Department of Nutrition, Dietetics and Food. She specialises in systematic reviews, clinical nutrition and foodservice management. Her recent research explores the effect of implementing Protected Mealtimes on patient nutritional outcomes in the subacute setting. Judi is an Accredited Practising Dietitian and a Fellow of the Dietitians Association of Australia. You can follow Judi on Twitter via @JudiPorter.
Stay up to date with the Monash University Department of Nutrition, Dietetics and Food on Twitter via @MonashNutrition.
Image credit: rawpixel via Unsplash
References:
1. Barker LA, Gout BS, Crowe TC. Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. International Journal of Environmental Research and Public Health. 2011;8(2):514-27.
2. Porter J, Haines TP, Truby H. The Efficacy Of Protected Mealtimes In Hospitalised Patients: A Stepped Wedge Cluster Randomised Controlled Trial. BMC Medicine. 2017;15(1):25.
3. Elia M. The Cost Of Malnutrition In England And The Potential Cost Savings From Nutritional Interventions. NIHR Southampton Biomedical Research Centre; 2015.
4. Porter J, Ottrey E, Huggins CE. Protected Mealtimes In Hospitals And Nutritional Intake: Systematic Review And Meta-Analyses. International Journal of Nursing Studies. 2017;65:62-9.
5. Porter J, Ottrey E. Process Evaluation Of Implementing Protected Mealtimes Under Clinical Trial Conditions. Journal of Advanced Nursing. 2018.
