Hospital Inpatient Nutrition Service Errors and Patient Safety Interventions: A Scoping Review

OBJECTIVES

Food service errors are prevalent in healthcare hospital inpatient settings. Like medication administration errors, these mistakes can result in disastrous consequences. This scoping review aimed to identify the evidence describing hospitals' nutrition department service errors and subsequent patient safety interventions.

METHODS

The review was conducted on four electronic databases, OVID MedlinePlus, PubMed, Scopus, and CINAHL, to search for articles reporting hospital food-related errors. All studies and reports on parenteral nutrition were excluded, and errors reported by departments other than nutrition services were excluded. A total of 245 studies published from 1984 to 2022 were identified. After removing duplicates, 98 abstracts were evaluated, with particular attention given to dietary errors, meal accuracy, and interventions.

RESULTS

Twenty-nine articles were selected, and 14 (n = 14) were considered relevant to the review after a full-text review. More than half of the studies (n = 8) were conducted outside the United States. Eight studies (n = 8) were descriptive, retrospective, and observational; 3 were mixed-method studies (n = 3), 2 (n = 2) were quality improvement projects, and 1 was an implementation study (n = 1). Four (n = 4) studies were published before the year 2000.

CONCLUSIONS

Various types of nutrition service inaccuracies were identified. The severity, causes, and stages of food service provision where errors occur were also documented. These errors were used as the basis for interventions to improve patient safety, justify implementing computerized dietary services systems, or add resources to augment dietary department service offerings. This review also generated valuable recommendations to promote patient safety by mitigating food service errors.

Diverting Food Waste From Landfill in Exemplar Hospital Foodservices: A Qualitative Study

BACKGROUND

The US Environmental Protection Agency Food Recovery Hierarchy suggests methods for diverting food waste from landfill. Knowledge of how hospital foodservices implement food waste management strategies could help modernize food waste practices.

OBJECTIVE

The aim of this study was to explore hospital staff members' experiences of implementing a food waste management strategy to divert food waste from landfill in their hospital foodservice, including the journey, challenges, and facilitators of this practice change.

DESIGN

A qualitative study was conducted in 2022-2023 using semi-structured interviews.

PARTICIPANTS/SETTING

Eighteen participants were staff members with knowledge of the food waste management strategy from 14 exemplar hospitals in United States, Spain, Scotland, and Australia using strategies to divert food waste from landfill within the last 10 years.

ANALYSES PERFORMED

Mapping and thematic analysis were undertaken to code and identify themes from the interviews that described staff members' experiences of the journey to implement the strategy.

RESULTS

Six hospitals donated food, 1 transferred food waste for animal feed, 4 used an industrial solution, and 3 sent food waste for composting. A common journey pathway for successful implementation was identified from participants' experiences. It features the following 6 phases: idea, preparation, roll out, maintenance, established practice, and evolution. Facilitators included legislation, enthusiastic staff members, executive support, and "luck." Challenges were smells, occasions when food waste was not collected, equipment breakage, and funding depletion.

CONCLUSIONS

This study identified a common journey pathway for implementing a food waste management strategy in hospital foodservices that can be used to anticipate and prepare for the steps in the implementation process.

Guidelines on Standard and Therapeutic Diets for Adults in Hospitals by the French Association of Nutritionist Dieticians (AFDN) and the French Speaking Society of Clinical Nutrition and Metabolism (SFNCM)

AIM

Hospital food provision is subject to multiple constraints (meal production, organization, health safety, environmental respect) which influence the meal tray offered to the patient. Multiple diets can add complexity and contribute to non-consumption of the meal. To avoid undernutrition, it appeared necessary to propose guidelines for foods and diets in hospitals.

METHODS

These guidelines were developed using the Delphi method, as recommended by the HAS (French Health Authority), based on a formal consensus of experts and led by a group of practitioners and dieticians from the AFDN (French Association of Nutritionist Dieticians) and SFNCM (French Society of Clinical Nutrition and Metabolism).

RESULTS

Twenty-three recommendations were deemed appropriate and validated by a panel of 50 national experts, following three rounds of consultations, modifications and final strong agreement. These recommendations aim to define in adults: 1-harmonized vocabulary related to food and diets in hospitals; 2-quantitative and qualitative food propositions; 3-nutritional prescriptions; 4-diet patterns and patient adaptations; 5-streamlining of restrictions to reduce unnecessary diets and without scientific evidence; 6-emphasizing the place of an enriched and adapted diet for at-risk and malnourished patients.

CONCLUSION

These guidelines will enable catering services and health-care teams to rationalize hospital food and therapeutic food prescriptions in order to focus on individual needs and tasty foods. All efforts should be made to create meals that follow these recommendations while promoting the taste quality of the dishes and their presentation such that the patient rediscovers the pleasure of eating in the hospital.

Older Adults' and Their Informal Caregivers' Experiences and Needs regarding Nutritional Care Provided in the Periods before, during and after Hospitalization: A Qualitative Study

To enhance prevention and treatment of malnutrition in older adults before, during and after hospitalization, deeper understanding of older adults' and informal caregivers' perspective on nutritional care is important. One-time in-depth interviews were conducted with 15 older adults who had been discharged from hospital, and seven informal caregivers. We explored their experiences and needs regarding nutritional care provided in the periods before, during and after hospitalization. Five themes emerged from the data: (1) dietary intake, (2) food service during hospitalization, (3) nutrition-related activities, (4) whose job it is to give nutritional care, and (5) competing care priorities. Further, several opinions about nutritional issues were identified. Older adults and informal caregivers did not always experience optimal nutritional care. When discussing nutritional care, they mainly focused on the in-hospital period. When providing nutritional care and developing guidelines, older adults' and informal caregivers' perspective on nutritional care should be incorporated. Here, the periods before, during and after hospitalization should be taken into account equally.

Improving mealtimes for patients and staff within an eating disorder unit: understanding of the problem and first intervention during the pandemic-an initial report

BACKGROUND

Mealtimes occur six times a day on eating disorder (ED) inpatient units and are a mainstay of treatment for EDs. However, these are often distressing and anxiety provoking times for patients and staff. A product of patients' distress is an increase in ED behaviours specific to mealtimes. The aim of this quality improvement project was to decrease the number of ED behaviours at mealtimes in the dining room through the implementation of initiatives identified through diagnostic work.

METHODS

The Model for Improvement was used as the systematic approach for this project. Baseline assessment included observations in the dining room, gathering of qualitative feedback from staff and patients and the development of an ED behaviours form used by patients and staff. The first change idea of a host role in the dining room was introduced, and the impact was assessed.

RESULTS

The introduction of the host role has reduced the average number of ED behaviours per patient in the dining room by 35%. Postintervention feedback demonstrated that the introduction of the host role tackled the disorganisation and chaotic feeling in the dining room which in turn has reduced distress and anxiety for patients and staff.

CONCLUSIONS

This paper shows the realities of a quality improvement (QI) project on an ED inpatient unit during the COVID-19 pandemic. The results are positive for changes made; however, a large challenge, as described has been staff engagement.

Improved meals service and reduced food waste and costs in medical institutions resulting from employment of a food service dietitian - a case study

BACKGROUND

A recurring problem in medical institutions is patients not always receiving food meeting their nutritional and medical needs. A proposed contributing factor is non- inclusion of dietitians in food service staff. Recently, positions for food service dietitians in hospitals were created. For the newly defined role of "Food Service Dietitian", comprehensive training courses were developed (70 dietitians participated).

OBJECTIVE

To examine the impact of the addition of the role of a "Food Service Dietitian" in medical institutions on suitability of foods served, food costs and food waste.

METHODS

A three years (2014-2017) national case study to examine the new role's impact was carried out, in 18 hospitals, nine of which employ a food service dietitian (intervention), and 9 without (control). The number of nutritional analyses of menus was checked, as was the extent of kitchen staff training, and how often night meals were served for all patients. Data were gathered regarding food costs and waste with respect to food distributed to staff and patients. Food costs savings and waste reduction were calculated, based on reduction in provision of unnecessary meals, at a cost of 18 NIS per day per meal.

RESULTS

Kitchen staff training was carried out in all intervention institutions, and not in the controls. In most controls, nutritional analyses were not performed, whereas in the intervention hospitals, full analyses were performed and tailoring of menus to specific department requirements improved significantly. In most intervention hospitals, late night snacks were provided, this not being so in the controls. Total food cost savings of $229,569 per annum was seen in the six intervention hospitals, attributable to 4 factors: 1.Meals not delivered to fasting patients, or those receiving parenteral/enteral nutrition- cost savings of 328,500 NIS ($93,857)2.Better tailoring and monitoring of food delivered to the wards and staff (bread, cheese, milk etc)- annual cost savings of 235,000 NIS ($67,142) in the hospitals with a food service dietitian.3.Checking expiry dates of medical foods, and improved communication between the wards, the kitchen and the food distribution centers, has lessened food waste with savings of 5% from the medical food budget per annum of 40,000 NIS ($11,428).4.As a result of dietitian-performed nutritional analyses, tailoring of food provided according to the patient's medical and nutrition needs was improved. In one hospital, after re-evaluation of serve sizes in high protein diets, sizes were reduced while retaining adequacy, with immediate cost savings of 200,000 NIS ($57,142) per annum.

CONCLUSIONS

Implementation of the new role of Food Service Dietitian led to cost savings and significant improvements in adherence to the nutritional care plan.

The quest to improve the quality of hospital food for patients

Emeritus Professor Alan Glasper, from the University of Southampton, discusses an initiative by the Government to review and improve the nutritional quality of hospital food.

The quest to improve the quality of hospital food for patients

Emeritus Professor Alan Glasper, from the University of Southampton, discusses an initiative by the Government to review and improve the nutritional quality of hospital food.

Hospital food: raise standards, cut costs

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on the problems of ensuring the quality of hospital food and examines the latest Government initiative to reduce costs.

Antibiotic resistance pattern and spa types of Staphylococcus aureus strains isolated from food business and hospital kitchen employees in Çanakkale, Turkey

Background/aim

The aim of this study was to determine antibiotic resistance profiles and spa types of Staphylococcus aureus strains isolated from food business employees in Çanakkale, Turkey.

Materials and methods

S.aureus isolates were collected from hand and nasal swabs of 300 individuals working in 17 food businesses and 9 hospital kitchens. All S. aureus isolates obtained from each carrier were typed by staphylococcal protein A (spa) typing method.Staphylococcal cassette chromosome mec (SCCmec) and multilocus sequence typing (MLST) of MRSA were performed by sequencing method.

Results

Of the 300 individuals, 125 (41.6%) were found to be carriers of S. aureus, 215 isolates of which were obtained in total. Three (1.4%) of 215 isolates were identified as MRSA. Sixty spa types were identified among the 121 MSSA isolates, the most common being t084 (9%). A novel spa type was discerned and added to the Ridom SpaServer database as t14963. The MLST type of the MRSA strains identified as spa type t786 was ST88 and as spa type t223 was ST22. All MRSA were determined to be SCCmec type IVa.

Conclusion

spa typing can be performed to screen for transmission of S. aureus. t786, ST88, and SCCmec IVa MRSA strains were identified for the first time in Turkey.

Improving hospital food menu quality: an experimental approach

PURPOSE

The purpose of this paper is to examine whether the negative impressions consumers hold toward institutional food can be remedied by subtle changes in menu descriptions. While an expectancy-disconfirmation explanation would suggest this, a negativity bias explanation would suggest otherwise.

DESIGN/METHODOLOGY/APPROACH

The authors test the research question using an experimental 2 × 2 full factorial design, with data collected from 100 university students.

FINDINGS

The results show that when hospital menus are made somewhat fancier in their description, consumers evaluate the food as more attractive and menu variation to be greater. This implies that the judgments are more likely to be based on an expectancy-disconfirmation process that on being subject to negativity bias.

RESEARCH LIMITATIONS/IMPLICATIONS

The authors study perceived attractiveness and menu variation, but future research should include taste perceptions and consumption volume.

PRACTICAL IMPLICATIONS

Institution managers could improve consumer perceptions of how attractive the food being served is, and the perceived variation in their menus, by subtly changing the course descriptions to become fancier. However, as such, a strategy based on an expectancy-disconfirmation process, institution managers should beware not to sweeten the pill too much, i.e., making promises they cannot keep may backfire if one makes the menus too fancy compared to what is delivered.

ORIGINALITY/VALUE

The authors extend current knowledge on menu label effects by addressing them for food suppliers, which are inherently associated with low food quality. The authors also show that when managers apply such strategies, the effect is due to a disconfirmation process rather than a negativity bias.

[A novel in-hospital meal service improves protein and energy intake]

OBJECTIVE

To investigate whether a novel meal service, FoodforCare, improves dietary intake and patient satisfaction, compared to the traditional 3-meals a day service (TMS).

DESIGN

We performed a prospective cohort study at medical (Gastroenterology) and surgical (Gynecology, Urology, Orthopedics) wards. Patients were offered TMS (July 2015 - May 2016; n = 326) or FfC meal service (after stepwise introduction per ward from January 2016 - December 2016; n = 311).

METHOD

Primary outcome was the mean percentage of protein and energy intake relative to requirements, between patients receiving TMS and those receiving FfC, on the first and fourth day of full oral intake. Patient satisfaction comprised rating of the experienced quality of the meals and the meal service by means of a validated questionnaire.

RESULTS

Patient characteristics were similar between groups, with the exception that the FfC group contained more oncology patients (p = 0.028). FfC improved mean daily protein intake (in g/day) relative to requirements (1.2 g/kg/day) at day 1 (mean % ± SD: 79 ± 33 vs. 59 ± 28; p < 0.05) and day 4 (73 ± 38 vs. 59 ± 29; p < 0.05). Mean daily energy intake (in kcal/day) relative to requirements improved at day 1 (88 ± 34 vs. 70 ± 30; p < 0.05) and day 4 (84 ± 40 vs. 73 ± 31; p = 0.05). On a scale of 1-10, patient satisfaction remained unchanged, in terms of food quality (7.7 ± 1.5 vs. 7.4 ± 1.4; p = 0.09) and meal service (7.8 ± 1.3 vs. 7.7 ± 1.1; p = 0.29). The FfC group was more satisfied with the appearance and smell of the meals (both p < 0.05).

CONCLUSION

Implementation of this novel meal service substantially improved protein and energy intake while maintaining, and to some extent, improving patient satisfaction.

Improving the Food Environment in Hospitals and Senior Meal Programs

Most Americans consume more than the recommended daily level of sodium, and tools are needed to assess and improve food practices related to sodium. We describe how the Sodium Practices Assessment Tool (SPAT) was developed and used in 19 hospitals and senior meal facilities in upstate New York. Initial results identified opportunities for improvement in food preparation, presentation, and purchasing practices to reduce sodium consumption. Pre-post comparison results showed significant increases in the use of herbs, spices, unsalted butter, fruits and vegetables, and in the availability of lower-sodium foods. Food service sites can use SPAT to assess sodium practices, inform development of action plans, and measure change over time.

[Hygienic suitability of food and food-contact surfaces in a hospital canteen: the experience of a University Hospital in Italy]

The Authors present the results of a study performed during a time-period of two years, to evaluate the hygienic quality of ready-to-eat foods, prepared and served in a hospital catering service, and the microbiological status of food-contact surfaces. Food hygiene was evaluated using non-pathogenic indicator microorganisms. The study was part of the verification activities that the hospital Health Department considers as a priority in order to guarantee patient safety. Only one of 52 food samples tested was considered unsatisfactory; the examined surfaces were not fully satisfactory in one of four cases. The study results, although encouraging as a whole, especially with respect to the hygienic safety of food prepared and served in the hospital, confirm the need to continuously verify that the appropriate environmental sanitation procedures are applied, even in the case of outsourcing. Considering the increased susceptibility of hospitalized patients, this remains a priority in the hospital where the study was performed.

From twitter

Nurses on Twitter.

Retail food reform: How to effectively bridge what we say and what we do in our hospital settings

Hospital leaders in Eastern Ontario, Canada, have acknowledged the critical role of food to health and the need for progressive change that goes beyond personal responsibility paradigms. The Healthy Foods in Champlain Hospitals program aims to create supportive, healthy nutrition environments in hospital retail food settings. Twenty independent hospital corporations have collectively initiated a plan to transition cafeteria, vending, franchise, and volunteer operations towards healthier offerings. Hospitals are actively implementing a set of progressively phased, evidence-based nutrition criteria, which cover food and beverage categories, preparation methods, product placement, and provision of nutrition information. Implementation strategies and successes, as well as challenges and limitations, are discussed.

Half of hospitals in England fail to meet mandatory food standards, report reveals

A new report reveals almost half of hospitals in England are failing to meet mandatory food standards two years after the government introduced them.

In the shadow of the asylum: the Stanley Royd Salmonella outbreak of 1984

In August 1984, an outbreak of Salmonella at Stanley Royd Psychiatric Hospital in Yorkshire led to the deaths of 19 elderly residents. It was an incident that attracted a good deal of comment in both the local and national press, and one that had enduring relevance for ideas about psychiatric care, food handling and catering provisions, hospital management and the official inspection of medical institutions. This article examines the impact that the 1984 outbreak had on official and popular perceptions of these issues. As well as bringing to public attention the fact that large numbers of vulnerable elderly patients were long-term residents in psychiatric hospitals, the Salmonella outbreak highlighted the inadequacies of Victorian hospital buildings in modern healthcare. Throughout the press reports and official investigations examined here, the provenance of Stanley Royd was repeatedly emphasised; its Victorian fabric persistently interfered with cleaning regimes, cold storage facilities and the conveyance of food to patients. Within institutions like Stanley Royd, 'new' and 'old' risks came together--the microscopic bacterium and the crumbling nineteenth-century building--to create a strong critique of existing psychiatric care. The episode also highlighted broader problems within the NHS, such as systems of management and the status of psychogeriatrics as a specialism.

ASSESSMENT OF GOOD PRACTICES IN HOSPITAL FOOD SERVICE BY COMPARING EVALUATION TOOLS

INTRODUCTION

since food service in hospitals complements medical treatment, it should be produced in proper hygienic and sanitary conditions. It is a well-known fact that food-transmitted illnesses affect with greater severity hospitalized and immunosuppressed patients.

AIMS

good practices in hospital food service are evaluated by comparing assessment instruments.

METHODS

good practices were evaluated by a verification list following Resolution of Collegiate Directory n. 216 of the Brazilian Agency for Sanitary Vigilance. Interpretation of listed items followed parameters of RCD 216 and the Brazilian Association of Collective Meals Enterprises (BACME). Fisher's exact test was applied to detect whether there were statistically significant differences. Analysis of data grouping was undertaken with Unweighted Pair-group using Arithmetic Averages, coupled to a correlation study between dissimilarity matrixes to verify disagreement between the two methods.

RESULTS AND DISCUSSION

Good Practice was classified with mean total rates above 75% by the two methods. There were statistically significant differences between services and food evaluated by BACME instrument. Hospital Food Services have proved to show conditions of acceptable good practices.

CONCLUSION

the comparison of interpretation tools based on RCD n. 216 and BACME provided similar results for the two classifications.

[Standardization of hospital feeding]

INTRODUCTION

Normalization can be understood as the establishing measures against repetitive situations through the development, dissemination, and application of technical design documents called standards. In Andalusia there are 45 public hospitals with 14,606 beds, and in which 11,700 full pensions / day are served. The Working Group on Hospital Food Standardization of the Andalusian Society for Clinical Nutrition and Dietetics, started in 2010, working on the certification of suppliers, product specifications, and meals technical card.

AIMS

- Develop a specific tool to help improving food safety through the certification of their suppliers. - Develop a standardized technical specifications of foodstuffs necessary for the development of menus established codes diets Andalusian hospitals document. - Develop a catalog of data sheets plates of hospital meals, to homogenize menus, respecting local and unifying criteria for qualitative and quantitative ingredients.

METHODS

- Providing documentation and studying of several public hospitals in Andalusia: • Product specifications and certification of suppliers. • International standards certification and distribution companies. • Legislation. • Data sheets for the menu items. • Specifications of different product procurement procedures. - Development of the draft standard HOSPIFOOD®, and approval of the version “0.0”. - Training course for auditors to this standard. - Development of a raw materials catalog as technical cards. - Meals Technical cards review and election of the ones which will be part of the document.

RESULTS

After nearly three years of work, we have achieved the following products: - Standardized database of technical specifications for the production of food dietary codes for: fish, seafood, meat and meat products, meats and pates, ready meals, bread and pastries, preserves, milk and dairy products, oils, cereals, legumes , vegetables, fruits, fresh and frozen vegetables, condiments and spices. - Standardized database of technical cards for meals containing the following data: SAS Code, Province, Hospital, name plate, ingredients (g), edible ingredients (g) kcal, Proteins, HC, Fat and Fiber. - HOSPIFOOD® standard certification for food providers in hospitals, school cafeterias and other institutions of social restoration.

CONCLUSION

Patients expect food that is offered during the stay in the hospital, meet basic standards of quality and safety, and therefore it is necessary to design and develop control systems from the award and / or acquisition of food (raw materials and finished) products which subsequently become part of the menu that is offered as part of their treatment. To avoid the effect of fraudulent practice in public health, it’s needed to ensure the quality and safety of the food from the origin and establish the standards for acquisition and subsequent use of it.