Quality Improvement Activity at St Bartholomew’s Court Nursing Home

M Dutton was undertaking a clinical shift and noted that residents were being served in a disjointed manner. One lady was trying to give her meal to another because that person had no food. On investigation, he noted that residents were being served in menu order. This was not holistic and not conducive to a positive dining experience. M Dutton arranged a meeting with the kitchen team and senior care workers and everyone discussed the importance of positive dining experiences and the associated benefits:

• Quality of Life
• Enjoyment of foods and associated weight gains
• Social engagement and contribution to mental and physical wellbeing
• Patient safety

The team spoke with residents and observed meal times to identify what was going well and what could be improved. They also looked at the following resources:

• Drinks Provided Before Meal
• Tables Laid
• IPC Guidelines Followed
• Residents Transferred as Necessary
• Presentation of Meal
• Residents Table All Served Together
• Environment Appropriate
• Residents Supported as Required
• Consistency of Nutrition (Person Specific)
• Menu & Appropriate Alternatives

Initial audit showed that there was room for improvement in the quality of the residents’ dining experience. Initial audits during mealtimes in both North and South Units were undertaken using these standards, and qualitative comments were also recorded to ‘capture’ examples of good practice and areas for improvement.
Baseline audit showed the following baseline % compliance with dining experience standards.

Quality of Dining Experience 17/05/2022
North Unit 64%
South Unit 77%
 
The team identified that the following was working very well:

• Residents were given the appropriate texture in diet and fluids
• Residents were served swiftly (although order was chaotic)
• Care team had excellent awareness of patient need
• Care team adapted their approach/gave assistance according to patient need on the day
• Independence was promoted
• Choices were given and flexibility by kitchen was positive

Areas for improvement noted were:

• Residents sat together should be served together
• Drinks were served after meals were
• Some residents had dropped food on their clothing
• There was no background music
• Presentation of meal could be improved
• Residents’ hands were cleaned on one unit and not the other
• Two residents feet were left on footplates (rectified by Deputy Matron)

 
An aim was set as follows:

SMART AIM: To improve the quality of the dining standards at St Bartholomew’s Court Nursing Home from current compliance status (64% North and 77% South) to 90% within the next 4 months.

“We decided as a business to make some environmental changes and launch a ‘New Dining Experience’.

We selected some wallpapers and gave samples to the residents so they could choose which they wanted in both dining rooms. The same wallpaper was chosen by both sides; but in different colours. We also planned on getting new table menus, which were dementia friendly and have photographs on to allow people to know what they are eating.

We changed the menu order to ensure residents are served together at their table. Our care team asked for additional tabards/napkins to ensure we had enough for all meals throughout the day.

We also purchased some new plates, with colour and design specifically for people with sight and/or cognitive difficulties.

Once the dining rooms had been decorated and we launched the new dining experience, we had care team meetings to ensure they knew what was expected. Feedback was provided on how they had performed and we all reflected on how we continue and maintain the new improved standards.

Changing the order that people were served their meals was slightly easier due to COVID-19, as people have been staying in the same seats and groups of friends usually sit together. This was more difficult for the North Team as they have a much larger turnover of people due to Intermediate Care Service. Dinners being served were also changed from the kitchen leading the service to the care team leading. This is because the care team know where people are and who they are sat with, ensuring that residents that are sat together are served together. This also has the added bonus of a different table being served first each day.

I also spoke with my manger and arranged for two Alexas to be purchased, to allow residents to have some music playing, if they so choose.”

Mealtime audits continued throughout June and July to track progress with dining standards. Audits showed steady improvement in both North and South settings.

The Aim to improve the quality of dining standards to 90% was achieved!

Key Performance Indicators (KPIs) were displayed on the staff notice boards and shared with the Board of Trustees.

Sustaining the Improvement

The audit processes have continued. We have senior care workers and they have been involved in Improvement to Dining Experience Audits and will be continuing to monitor this and the progress. The Senior Care workers will undertake audits monthly to maintain standards initially with the hope to move to bimonthly/3 monthly if standards maintained. Should standards fall below 90%, audits will continue monthly, and if they fall below 75% audits will increase to fortnightly.