Abstract
Background: ‘IN REACH’ was established, having identified a significant need to improve nutrition for cognitively and physically frail hospital inpatients, admitted to the Complex Medical Units (CMU) at the John Radcliffe Hospital. The IN REACH team includes the CMU multi-disciplinary team (MDT), representatives from patient and volunteer groups, caterers and medical illustrators.
Introduction: IN REACH identified that food and drink is often unreachable by inpatients. The project’s aim is to ensure food and drink is always within patient reach, improving nutritional intake, avoiding dehydration, reducing weight loss, reducing family anxiety, promoting independence and improving health outcomes.
Method: MDT members, patients and their families were engaged in the design. Baseline observational data included whether both food and drink were in reach and whether the patient had cognitive impairment. Interventions to be evaluated by Plan-Do-Study-Act (PDSA) methodology include: raising awareness at daily MDT meetings; focussed education by presenting observational data to catering team; involvement of volunteers; the introduction of IN REACH champions; and prompting by signage, both physical and digital. Improved inpatient nutrition will be correlated with data on length of stay and health outcomes. Improved rates of return to baseline function and independence are anticipated, by keeping food and drink, in reach.
Results: Baseline data showed out of 319 inpatients, only 33% had both food and drink within reach. 67% had cognitive impairment and only 27% were able to reach food and drink. Following 4 initial PDSA cycles 58% of patients had food and drink within reach.
Conclusions: Most CMU patients have food and drink left out of reach. Patients with cognitive impairment are particularly at risk. Changing ward culture is challenging. Further and repeated interventions are necessary.