JCPSLP Vol 16 no 3 2014_FINAL_WEB

Preparing

Dispensing

RN to contact SP/DT to clarify recommendations

Is there a discrepancy

Yes

between the SP/DT/medical entry in pt’s file +/or bed sign +/or diet code in TrakCare?

Call MM to rectify

No

Place meal on late trolley from kitchen to ward Take re-therm trolley from kitchen to ward

Has original meal been plated?

Yes

No Plate new meal

Can the kitchen produce the meal by required time?

Has re-therm trolley with meal left the kitchen?

Plate meal for next service meal as per meal tray slip received

Do not deliver to pt. Check with ANUM &/or RN. Request ANUM to follow up

Does the meal +/or fluid +/or supplements on tray match the meal tray slip and signage above pt’s bed?

No

Deliver meal +/or fluids +/or supplements to patient’s bedside

Take plated meal to re-therm trolley

Yes

No

Yes

No

Prepare mid meal fluids & supps according to TrakCare

Deliver meal +/or fluids +/or supplements to patient

Place MT/AF/supper fluids and supplements on trolley for delivery to ward

Yes

Deliver tea and coffee to patients on the ward at patient request

Implementation of both interventions (i.e., the safe swallow bed-signs and improved kitchen processes) occurred three months following the first audit. Two weeks after the interventions were implemented, the second audit was conducted on six acute adult wards in the Austin Hospital over two breakfast and lunch meals on two consecutive days. Over the auditing period, 36 patients were recommended to have texture modified diet/fluids. However, one of these meals was not delivered due to reduced patient alertness as directed by the nurse. The six acute adult wards involved in the second audit were selected on the basis of higher proportions of patients requiring TMD/F. Second audit The second audit results (see Table 1) identified improved accuracy of diet/fluid code matching across the EMOS, patient’s medical file and bed-signs, with the bed-sign use being the most significant change compared with the first

audit results. Additionally, no incorrectly delivered meals were identified in the second audit compared with the first. Discussion It is unclear which intervention directly related to improved accuracy of the diet/fluid code matching across the two electronic meal ordering systems, documentation in the medical file and bed-signage. This is thought to be due to the large number of steps in the process, the number of disciplines involved and the interventions only targeting parts of the meal provision process. No significant changes were made to the process map during the course of the audits or the focus groups as all stakeholders agreed that the process map reflected the meal provision system. Through the focus groups, increased engagement and buy-in from the speech pathologists and nurse unit managers was reported. Additionally, increased awareness of the complexity of the meal provision system at Austin

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JCPSLP Volume 16, Number 3 2014

www.speechpathologyaustralia.org.au