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Case study: Mealtimes study

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Mealtimes study

Impact of trained volunteers on the care of older patients - the Southampton Mealtime Assistance and Mobility Programme

Key features

• Programme of research started in 2010

• 12 month feasibility study recruited 29 volunteers who assisted 3911 patients including 386 who were fed

• Implementation study across 4 departments demonstrated a cost-effective improvement in quality of care for older inpatients with trained volunteers

• Trained volunteers released nurses’ time for clinical care

• Training packages for volunteers to safely help older inpatients at mealtimes and to keep mobile were developed and evaluated

• £50,000 awarded by HelpForce to develop the programme

• Chief Investigator: Professor Helen Roberts

Background

Undernutrition in hospital is very common, affecting approximately 39% patients aged over 65 years. Being malnourished can have an adverse effect on a patient’s health and add to NHS costs.

Deconditioning, i.e. loss of physical function during hospital admission, is increasingly recognised to be associated with poor healthcare outcomes and is potentially avoidable. Poor nutrition and deconditioning commonly occur together amongst older people in hospital.

An initial feasibility study led by Professor Helen Roberts recruited mealtime volunteers to work on weekday lunchtimes on a female Medicine for Older People (MOP) ward. Over the 12 month period 29 volunteers assisted 3911 patients including 386 who were fed.

Evaluation of the study revealed that volunteers could be trained to feed patients safely and were perceived by patients and nurses to improve the quality of mealtime care. However, the daily energy and protein intakes were very low among 407 older female patients studied and the volunteers were unable to significantly improve this.

A subsequent study called the Southampton Mealtime Assistance Roll-out Trial, led by Professor Helen Roberts with Dr Fiona Howson, evaluated the wider implementation of mealtime volunteers over nine wards in four clinical departments in University Hospital Southampton (UHS); male MOP wards, Acute Medical Unit, orthopaedics and adult general medicine. Working with the hospital voluntary services team 65 volunteers aged 17-77 years were recruited, trained and helped patients aged over 70 years at 846 weekday lunchtime and evening meals over 15 months. The main outcomes were:

• There was a high level of need for assistance: 56% volunteer activity in the MOP ward and 34-35% in the other three departments was feeding patients

• Patients, relatives and nurses reported that trained volunteers improved the quality of mealtime care in all four departments

• Volunteers released considerable nursing time for clinical duties - 65 volunteers released the equivalent of £17,200 - £34,400 of nursing time over 846 sessions (dependent on nurse grade) above the training costs. This is equivalent to a potential cost-saving of £27-45 per patient per day. Building on this, the SoMoVe study led by Prof Roberts with Dr Stephen Lim evaluated the feasibility of training ‘mobility volunteers’ to increase patients’ physical activity in hospital through additional walking practice and/or chair-based exercises. This is an area that has been little researched, partly because it is difficult to measure physical activity in hospital.

A formal half day training programme was delivered with therapy staff to 17 volunteers who were able to safely help keep older inpatients mobile. Since Autumn 2017 volunteer mealtime and mobility assistants have been embedded in clinical services and teams and trained and supported by UHS staff. Based on the scientific evaluation of the volunteers, UHS was awarded £50,000 by HelpForce (www.helpforce.community ) to further develop the programme, as one of five pilot exemplar trusts in the UK.

Impact

• The mealtime and mobility volunteer programme has been adopted by UHS with considerable interest from other trusts

• The outcomes have been disseminated nationally and internationally through scientific presentations and publications including an NIHR themed review on caring for older people living with frailty in acute service hospitals

• Identification as an exemplar programme by HelpForce with award of £50,000 to further develop volunteers at UHS to inform national development of volunteers

• Development of evidence and experience-based training programmes for volunteers which can be exported

• Development of research capacity among UHS clinical staff and volunteers

• This is the first study to formally evaluate the involvement of volunteers in mealtime assistance (or other forms of patient personal assistance). Previous studies had been small with limited evaluation. 

NIHR involvement

The initial feasibility study was supported by the NIHR Southampton Biomedical Research Centre. The Southampton Mealtime Assistance Roll-out Trial (CPMS ref 17531) was supported by the NIHR Wessex CLAHRC and the Southampton University NIHR Wellcome Trust Clinical Research Facility. SoMoVe was supported by the NIHR Wessex CLAHRC. Both Dr Howson and Dr Lim were supported by the NIHR clinical academic fellowship scheme.

The study team is now working with Wessex Academic Health Science Network to scale up the mealtime assistance programme.

“The Southampton Mealtime Assistance and Mobility Volunteer Programme findings are good news for patients, their nurses and carers and families as the assistance from the volunteers improves the quality of care, frees up valuable nurse clinical time and offers better healthcare outcomes for their patients”

Professor Helen Roberts, Chief Investigator

Value to the NHS

• Demonstrably improved the clinical care of older inpatients

• Improved clinical care from the patient’s perspective, which is reassuring for their nurses, the patient’s carers and patient’s family

• Potential cost-savings can be made by releasing the nurse’s time for clinical tasks

• Nursing capacity is maximised

• Patients’ have a greater opportunity to be fed than before the volunteers were in place

• Clinical care time is maximised as the nurses can focus on feeding patients with swallowing difficulties

• The study team has developed training programmes which could be rolled out to other NHS trusts.

Website: www.nihr.ac.uk/ageing

Key publications:

1. Howson FFA et al. Can trained volunteers improve the mealtime care of older hospital patients? An implementation study in one English hospital. BMJ Open 2018;8:e022285 2. Lim et al. Physical activity among hospitalised older people: insights from upper and lower limb accelerometry. Ageing Clin Exp Res. 2018 Mar 14. doi: 10.1007ls40520-018-018-0930-0. (Epub ahead of print) 3. Roberts HC. Changing the food environment – the effect of trained volunteers on mealtime care for older people in hospital. Proc Nutr Soc. 2017 Oct 30:1-5 4. Judy Robison et al. Can trained volunteers make a difference at mealtimes for older people in hospital? A qualitative study of the views and experience of nurses, patients, relatives and volunteers in the Southampton Mealtime Assistance Study. International Journal of Older People Nursing 2015; 10(2): 136-45 5. Roberts HC et al. The feasibility and acceptability of training volunteer mealtime assistants to help older acute hospital in-patients: the Southampton Mealtime Assistance Study. J Clin Nurs. 2014; 23: 3240-9.