Standard Care

INPAC & the INPAC Toolkit

Standard care refers to the minimum level of care that should be received by all patients, regardless of their nutritional status.

The following are a variety of strategies to promote food intake for all patients:

Increase awareness about the importance of nutrition (expand +/-)

Increasing awareness across departments about the importance of mealtimes encourage staff to respond and change their behaviour. This could include, decreasing mealtime interruptions, or arranging to finish their assessment just before a meal so they can help to get a patient ready for the meal.
Posters can be used to increase awareness.
Brief education sessions about nutrition can be held during huddles or a Lunch and Learn.

Involve volunteers (expand +/-)

Develop a volunteer mealtime program.
Volunteers can help to clear the bedside table, open packages, encourage patients to eat and visit those who need social interaction.
Volunteers, when interacting with patients, can communicate food preferences to the dietitian through a communication book.
Volunteers do not have to provide eating assistance (feeding).
Involve the volunteer coordinators for recruitment and training of volunteers.
Recruit existing volunteers, interns, students, etc. to help out during mealtimes. This is an excellent way for students/interns to gain experience and interact with patients.
A sample volunteer role description, education material, and other tools are available below.

Provide positive encouragement to eat (expand +/-)

All staff can provide positive encouragement about the food.
During meal delivery, food service staff can encourage food intake by providing positive feedback about the meal.
If staff opinion regarding food is low, provide the opportunity for staff to taste the food, or provide more information about where it is sourced (i.e. locally) etc.
Encourage family to bring in nutritious preferred foods from home to stimulate appetite.
Encourage family to visit at mealtime for companionship as well as supporting the patient to eat. They can bring their own meal so that they both benefit nutritionally.

Treat food as medicine (expand +/-)

Reminders can be posted in patients' rooms that identify challenges affecting eating (e.g. laminated poster at the head of the bed). Photo reminders can include the need of glasses, hearing aid, dentures, etc.
Unit fridges could be stocked with food and beverages that staff and patients identify as nutritious and acceptable. This extra supply allows food to be provided outside of mealtime, particularly at night.
In hospitals with selective menus, increased communication can be provided to staff about how to submit meal preferences if a patient is unable to complete their menu.
Aim to have a meal delivered at a consistent time so that when family comes to help, the meal will arrive at the expected time and family is able to assist.
When a patient is not eating enough, allow and accommodate for family or friends to bring in food that will be eaten by the patient. Have a system of labelling and storing outside food.
Try to decrease the number of staff on break during patient mealtime to increase the numbers available to assist patients to get ready for their meal and when necessary, provide eating assistance.
Tray delivery for isolation patients is an issue in some hospitals. Try out some different strategies to ensure isolation patients receive a hot meal. For example, trays can be left at the nurses' station for distribution in a timely way.

Tools

Involving Volunteers

Eating Matters Assistance Program Volunteer Training Video (2022): a one hour training video with 7 modules that provides general information and guidance for volunteers, staff and students interested in safely assisting hospitalized patients with meals. Created by Diala Chayab, RD, MPH, CDE and the interdisciplinary team at the Joseph Brant Hospital. Partially supported by the Canadian Nutrition Society & The Canadian Malnutrition TaskForce.

More-2-Eat volunteer tools

Models of Volunteer Involvement: Examples of how volunteers can be involved during mealtimes.
Volunteer Role Description: A template for creating a volunteer mealtime assistant role.
Volunteer Training Manual: An example of a volunteer training manual used at a More-2-Eat hospital (Alberta Health Services)
Volunteer Training Presentation: A PowerPoint presentation template that can be used when training volunteers.
Volunteer Training Checklist: Checklist template to use for training volunteers.
Volunteer Log: A log to increase communication between volunteers and unit staff or dietitians.

Other Tools

The effect of the NPO diet order
This brief article, written by Dr. Jeejeebhoy, describes what happens to the body when fasting or kept “NPO” (or without food and fluids) for too long. A hospital practice that is not recommended.

Bedside Alert
A poster to be laminated and placed above each patient’s bed as a reminder to check for glasses, dentures, etc. particularly at mealtimes.

Malnutrition in hospitalized patients: a serious problem calling for interdisciplinary engagement
Webinar presentation for the Canadian Nurses Association, November 2018

Collaborating to Make Meals Matter Using Mealtime Strategies
Poster created by Alberta Health Services, Nutrition and Food Services

Videos

Protected Mealtimes Video (2018) – A must watch to protect the patient
This YouTube video (there are two parts but they run together) provides an overview of ‘protected mealtimes’ in NHS hospitals – a period of time over lunch and supper when activities on the wards stop to allow patients to eat in a comfortable environment.

Food Service Video (2015) – This YouTube video is brief but powerful!
This YouTube video is brief but powerful! It shows why “CATERING” (or food service) plays as a major role to play in caring for patients and fighting malnutrition in the National Health Service.