Authors (including presenting author) :
Liu YP(1), Wong NC(1), Wong CK(1), Tsang WY(1), Lo WK(2), Au LF(3), Sze WC(4), Wong HM(4), Lee SW(1)
Affiliation :
(1) Department of Medicine & Geriatrics, Tai Po Hospital, (2) Department of Dietetics, Tai Po Hospital, (3) Speech Therapy, Tai Po Hospital, (4) Hospital Catering Service, Tai Po Hospital
Introduction :
Dehydration which commonly occurs among elderly induces their mental and physical impairment. Hospitalization of them for hydration and re-condition is unavoidable. Re-hydration of them in M&G by snack as a key opened their appetite effectively. It was designed a program named Frail Elderly Eating & Drinking (FEED) with interdisciplinary involvement within the department of Dietetics, Speech Therapy, Catering and M&G. Each department shared its expert input into the program to facilitate a patient-care centred approach for re-hydration. It was evidenced that an improvement of oral intake and a shorten of length of stay (LOS) were achieved.
A snack menu was designed for patient choice. Snack round was introduced in ward practice.
Objectives :
1. To stimulate patient appetite with various snacks as a key
2. To improve patient oral intake
3. To shorten the length of stay
Methodology :
FEED program is developed into 3 phases. The various kinds of snacks were reviewed and allocated to medical wards periodically. Meetings were hold in every phase. Nurse provided favourite snacks to patient before or with every meal to stimulate patients’ appetite, record patient’s oral intake accurately in Input & Output (I/O) and FEED program record. Set up the ‘Snacks Bank’ and frequency water rounds in eight medical wards.
Phase I was piloted in two medical wards from November to December 2020.
Inclusive criteria: oral intake less than 500ml daily. Evaluation and meetings were conducted.
Phase II was implemented in more two medical wards from December 2020 to January 2021.
Inclusive criteria: oral intake less than 500ml daily. Evaluation and meetings were conducted.
Phase III started in all eight medical wards since February 2021 as CQI program.
Inclusive criteria for potential patient: daily portion of meals intake less than 75% or daily oral intake less than 600ml for two days long. The patients were excluded serious or deteriorated general condition.
1. Team members and core team members were recruited. Program was evaluated and refined according to feedback and outcome.
2. 96 nurses and 66 supporting staff (SS) were assessed the perception with pre-questionnaire before starting phase III. 93% of nurse and 89% of SS agreement to this program.
3. Inter-Rater Reliability Assessment had been applied to ensure the accuracy of the proportion of meal tray consumption in 0%, 25%, 50%, 75% and 100% according to the ‘New Territories East Cluster - Meal Quality & Category Supply Standards’. 10 sample meals trays were randomly selected to two raters (staff) for their judgement independently. The result of Inter-Rater Reliability Assessment was 98%.
4. Catering service promoted new diets in different kinds for patients in Q3 2022, such as Soup Schedule. The DCMS system was updated for patients’ needs.
5. New easy swallowing thickener with good taste was promoted for patients in Q1 2021
Result & Outcome :
In phase I and II (Pilot Period), there were 20 patients recruited. 14 patients were selected. 6 patients were not selected due to their serious condition. 78% of patients achieved oral intake more than 800ml. (> 800ml in 45%, > 900 ml in 22% and > 1000ml in 11%). 93% of patients shortened their LOS less than 15 days. (< 5 days in 50%, 6-10 days in 22% and 11-15days in 21%).
In Phase III, there were 66 of patients recruited. Their age ranged from 80 to 99 years old. 80 % of patients achieved oral intake more than 800ml or portion of meal tray more than 75%. It shortened LOS to 14.8 days compared with LOS 19.2 days in the past 13 months (< 5 days in 17%, 6-10 days in 26% and 11-15days in 20%). 4.4 days of bed days were gained. The most popular snack was Chinese tea (27.4%), Sesame Puree (13.2%), Sauce (12 %). It was found that nutritional drink (12.4%) was not popular for stimulating their appetite. 54% of patients was able to wean off nocturnal fluid infusion.
