CAN COOK – DOES COOK

1. CAN COOK – DOES COOK The use of a ward based kitchen to improve patients’ appetites

2. The Clinical Nutrition Unit Queen’s Medical Centre, Nottingham The Clinical Nutrition Unit is a nine bedded unit for highly dependent adult patients from all disciplines who require complex nutritional support and high dependency nursing care.

3. Many of the patients transferred to the clinical nutrition unit have spent weeks in the intensive care unit. Many have been nil by mouth for prolonged periods. The majority receive their nutrition either via an enteral tube or via the intravenous route administered with a central venous catheter - all methods by-passing the patients’ mouth.

4. When re-introduced to normal eating, many patients have decreased appetites and increased nutritional needs, and patients need to be persuaded to eat again.

5. Background • Traditional hospital catering is more than adequate for the bulk of hospital patients. • For our group, many of whom have had multiple operations and long spells in the Intensive Care Unit, it is not enough.

6. To cater for these patients a dedicated kitchen was commissioned and opened. The kitchen is actually on the unit.

7. Fresh, hot food that is cooked to order. Appropriate portion size, so as not to over feed someone eating for the first time. Meals can be offered at short notice and on individual request. Attractive presentation Benefits:

8. Benefits: • Innovative step towards lowering costs – the salary of the cook being much less than keeping patients in hospital.

9. When patients have been nil by mouth for long periods, it is vital to be imaginative when re introducing food. With patients ranging from 16 – 100 years, tastes are so diverse, having the ward based cook means they can be catered for with ease! Benefits:

10. The bulk of food stuffs the cook uses are supplied from the in-house catering supplies. For extra treats the special trustees were approached for a sum of money each month.

11. At present we are only using £480 per year – this leaves a substantial amount of money in the pot!

12. Before the kitchen was opened both past and present patients were asked to preview a sample menu, and identify any additional items they would like to see! Building on patient comments, a core menu was developed. The menu will be reviewed and updated regularly.

13. In our own minds we were totally convinced that opening the kitchen would make a huge difference. We needed evidence!

14. Prior to opening, a patient satisfaction survey was carried out – including questions on, temperature freshness of food and portion sizes. It was repeated 2 months after opening.

15. Satisfaction Survey Before New Kitchen

16. Satisfaction Survey Post New Kitchen

17. Satisfaction Survey – Main Findings • Our survey found the following things were very important to patients: • Presentation. • Bigger variety of menu. • Freshly prepared ingredients • Temperature.

18. Satisfaction Survey- Actions • Improve the offer of food choices. • Portion Sizes. • More theme days. • Speciality foods. • Weekend and Holiday Cover.

19. We were keen to promote the kitchen, and it’s unique service and decided another way to encourage patients to eat, and to get them involved would be theme days.

20. The first theme day was an Italian day – to welcome an Italian dietetic student. • The day was a great success – with patients asking for second helpings!

21. The use of proprietary liquid supplement drinks has fallen – patients preferring real food and snacks! • By offering highly nutritious food, that is well presented, we are ensuring that patients are integrated back into a normal way of taking nutrition, and become ready to continue on the patient pathway.

22. By offering highly nutritious food, that is well presented, we are ensuring that patients are integrated back into a normal way of taking nutrition, and become ready to continue on the patient pathway.

23. To date: • One cook 35 hours per week. • For weekend and annual leave cover we have to revert back to in house catering, causing the voluntary oral intake to drop.

24. The future: • To continue to provide highly nutritional food for all our patients. • To have a service 7 days a week – 365 days a year.

25. Conclusion Malnourished patients are in hospital longer. Having a ward based kitchen and cook is an innovative way to lowering costs!