title: Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Imperial College Healthcare NHS Trust, Nutrition and Dietetics Research Group, London, UK. mary.hickson@imperial.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Hickson
authors.forename: A
authors.initials: A
authors.lastname: Connolly
authors.forename: K
authors.initials: K
authors.lastname: Whelan
mesh_terms: D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D004777:Environment; D005521:Food Service, Hospital; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D044342:Malnutrition / Q000517:prevention & control*; D019370:Observation
chemical_list: D004044:Dietary Proteins