Imperial College Healthcare NHS Trust, Nutrition and Dietetics Research Group, London, UK.
J Hum Nutr Diet. 2011 Aug;24(4):370-4. doi: 10.1111/j.1365-277X.2011.01167.x. Epub 2011 May 17.
Malnutrition is a common problem in hospitalised inpatients, resulting in a range of negative clinical, patient-centred and economic sequelae. Protected mealtimes (PM) aim to enhance the quality of the mealtime experience and maximise nutrient intake in hospitalised patients. The present study aimed to measure mealtime environment, patient experience and nutrient intake before and after the implementation of PM.
PM were implemented in a large teaching hospital through a range of different approaches. Direct observations were used to assess ward-level mealtime environment (e.g. dining room use, removal of distractions) (40 versus 34 wards) and individual patient experience (e.g. assistance with eating, visitors present) (253 versus 237 patients), and nutrient intake was assessed with a weighed food intake at lunch (39 versus 60 patients) at baseline and after the implementation of PM, respectively.
Mealtime experience showed improvements in three objectives: more patients were monitored using food/fluid charts (32% versus 43%, P = 0.02), more were offered the opportunity to wash hands (30% versus 40%, P = 0.03) and more were served meals at uncluttered tables (54% versus 64%, P = 0.04). There was no difference in the number of patients experiencing mealtime interruptions (32% versus 25%, P = 0.14). There was no difference in energy intake (1088 versus 837 kJ, P = 0.25) and a decrease in protein intake (14.0 versus 7.5 g, P = 0.04) after PM.
Only minor improvements in mealtime experience were made after the implementation of PM and so it is not unexpected that macronutrient intake did not improve. The implementation of PM needs to be evaluated to ensure improvements in mealtime experience are made such that measurable improvements in nutritional and clinical outcomes ensue.
营养不良是住院患者中常见的问题，会导致一系列负面的临床、以患者为中心和经济后果。保护性进餐时间（PM）旨在改善进餐体验并最大限度地增加住院患者的营养摄入。本研究旨在测量 PM 实施前后的进餐环境、患者体验和营养摄入。
通过一系列不同的方法，在一家大型教学医院实施 PM。直接观察用于评估病房级别的进餐环境（例如餐厅使用、消除干扰）（40 个病房与 34 个病房）和个体患者体验（例如协助进食、访客在场）（253 名患者与 237 名患者），并分别在午餐时使用称重食物摄入评估营养摄入（39 名患者与 60 名患者），在 PM 实施前后进行评估。
进餐体验在三个目标上有所改善：更多患者使用饮食/液体图表进行监测（32%与 43%，P = 0.02），更多患者有机会洗手（30%与 40%，P = 0.03），更多患者在整洁的桌子上用餐（54%与 64%，P = 0.04）。进餐时中断的患者数量没有差异（32%与 25%，P = 0.14）。PM 后，能量摄入没有差异（1088 与 837 kJ，P = 0.25），蛋白质摄入减少（14.0 与 7.5 g，P = 0.04）。
PM 实施后，进餐体验仅略有改善，因此营养摄入没有改善并不出人意料。需要评估 PM 的实施情况，以确保改善进餐体验，从而使营养和临床结果得到可衡量的改善。
