31 March 2015 Last updated:
15 May 2015
Patients transition through their episode of care and often require changes to their diets based on allergies, intolerances, procedural and/or diagnostic requirements. Clinicians often become confused by the diet choices available and do not assess the patient’s diet history due to a lack of understanding on the impact that an incorrect diet can have on the patient. This project aimed to investigate the causes of the errors and develop solutions that were systematic, achievable and sustainable.
To ensure that 100% of patients in Surgical Unit 3 at Gosford Hospital are ordering the correct diet by December 2014.
- Improved patient outcomes such as:
- decreased risk of adverse events such as aspiration and allergic reaction
- improved wound healing
- decreased risk of pressure ulcers
- decreased overall length of stay
- increased National Elective Access Target (NEAT) performance by decreasing cancellations due to eating whilst fasting.
- Increased compliance with National Standards.
- Increased effectiveness of malnutrition management.
Project status: Implementation - the initiative is partially completed with initial strategy implementation completed. Further strategies are being developed.
Project dates: February 2014 to December 2014.
Patients are ordered specific diet types according to their medical condition and as an adjunct to their medical treatment. This initial diet order is usually determined by medical or nursing staff at admission. At various points during the patient’s treatment, their diet needs change. There have been a number of incidents where the required change in a patient’s diet has not been communicated, resulting in an inappropriate diet type ordered for the patient. This has led to a range of consequences for the patient, from potential poor outcomes to actual poor outcomes.
Best practice and literature searches resulted in very little evidence of sustainable strategies to address this problem. The diagnostic phase highlighted solutions that required the engagement of stakeholders external to the Local Health District (LHD) setting.
- Solutions with the greatest impact are still in development, however some ‘quick win’ strategies have been implemented such as a ‘cheat sheet’ and focused education. A proposed strategy developed with assistance from the electronic medical record (eMR) team is almost ready for implementation with the next eMR upgrade.
- An eMR alert was developed to highlight diet changes to the clinician. For example: ‘Previous diet to nil by mouth was …. Please consider whether this diet or modifier needs to be reordered’.
- A discussion with eMR is underway to determine whether diet choices can be limited according to clinician type. For example, a dietician will have access to the full list, while a nurse will only have access to less complex list of diets. If a higher level of access is required, the eMR will trigger a referral to the dietician.
- A cheat sheet was developed, laminated and placed on each mobile computer in the unit, as well as uploaded to the intranet for ease of access.
- The electronic patient journey board was adjusted to show the patient’s diet type, with an icon highlighted when a special diet has been ordered. Clinicians can hover over the icon to identify the patient’s diet type.
Initially the test site will be Surgical Unit 3 at Gosford Hospital, with a timely rollout across Central Coast LHD.
Clinical Leadership Program - Clinical Excellence Commission
To date there has been a 17% reduction in incorrect diets ordered. Further evaluation for this initiative will include measurement of:
- number of incident notifications related to incorrect diet order
- number of theatre cancellations due to incorrect diet ordered
- number of pressure ulcers
- overall length of stay.
- Previous strategies were not successful due to implementation of ‘quick fixes’ that did not identify the cause of the problem.
- Team members were not confident that sustainable change could be implemented in a state-wide system such as eMR. However, initial discussions showed that the eMR team were interested in collaborating and reaching a solution.
Director of Nursing & Midwifery, Gosford Hospital
Central Coast Local Health District
Phone: 02 4320 3485
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