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eCommunicating Patient Feeding Assistance Needs

Prince of Wales Hospital
Project Added:
11 February 2015
Last updated:
11 February 2015

eCommunicating Patient Feeding Assistance Needs


In 2013 a modification to electronic medical record (eMR) diet ordering was initiated to communicate patient feeding assistance requirements electronically at the time of ordering a patient diet. This modification now triggers a bright marker on the patient’s meal tray to clearly indicate their eating assistance needs at every meal.

This enhancement to eMR has resulted in a significant increase in the number of patients identified as requiring assistance and the number receiving assistance. 

This project was a finalist in the Collaborative Team category of the 2014 NSW Health Awards. Download a poster from the 2014 NSW Health Awards.

Patient meal tray with sandwiches, drink and covered plate. Blue paper tag clearly displayed to indicate assistance required


To provide effective assistance and meet the needs of patients when eating and drinking as part of the key directive of the NSW Health Nutrition Care Policy.


  • Improving the identification and communication of patient assistance needs.
  • Improved patient outcomes and nutritional health.
  • Improving efficiency of resources and processes.

Project Status

Sustained: The project has been implemented, is sustained in standard business.


A hospital wide audit of mealtime assistance needs carried out in April 2010 identified 25% of patients required meal packages opened and 9% required supervision, however the number of patients flagged to receive this assistance was significantly lower with only 10% flagged to receive assistance to open packages and 5% flagged to require full supervision with eating and drinking.

Providing assistance to eat and drink is a key directive of the NSW Health Nutrition Care Policy. However, the assistance each patient requires can vary and there was not an effective system in place to record/communicate patient assistance needs.


A local multidisciplinary working party investigated various strategies to assist in identifying and providing assistance for patients to eat and drink. These included a hospital wide audit of patient feeding assistance needs and the assistance provided, analysis of audit results identifying areas for improvement, a survey of staff re their understanding of the issues, their methods of providing patient assistance to eat and their suggestions for improvements.

The strategy of using coloured tray ‘indicators’ or tray mats to indicate the level of feeding assistance a patient requires has been reported elsewhere to be an effective mechanism as it clearly displays at the bedside the level of assistance the patient requires to consume their meal and drinks.

In 2013 a modification to eMR diet ordering was initiated to communicate patient feeding assistance requirements electronically at the time of ordering a patient diet. The eMR team were ready to assist with a local enhancement to the eMR Powerchart state base build.

Clinicians were consulted on the design of a short mandatory question in eMR when ordering patients’ diets. It is answered by ticking one of three options – “nil assistance required”, “assistance to open food packages” or “full supervision required”. This information then downloads to the food and nutrition information technology (IT) system and triggers the appropriate brightly coloured tray slip which clearly indicates the level of assistance the patient requires at each and every mealtime.

Staff have been engaged via the provision of information in varying formats including posters, newsletters, information sessions and focus groups. This has kept them informed of current performance, identified their understanding of the issues and garnered their suggestions for improvements.

Patients have been consulted via repeat questionnaires and interviews.


As a mandatory step in electronic diet ordering, a high level of awareness of patient feeding assistance issues has been ‘automatically’ achieved.

This project was a Prince of Wales Hospital initiative, however, as we share our eMR system across South Eastern Sydney Local Health District (SESLHD), this new functionality has been successfully rolled out across the entire local health district.

While the enhancement has been built to interface with each hospital’s food and nutrition IT system (Cbord), it has been successfully applied to smaller sites in the district that do not use Cbord. For these hospitals, modifications to their eMR Diet Reports allows for this important information to be included in their ward reports.

The team members have demonstrated a strong commitment to working collaboratively to improve this aspect of patient nutrition care. They have displayed respect and recognition of each discipline’s roles and expertise by their commitment to a multidisciplinary approach. They have taken an open approach to the issues and supported each other in recognising and improving each discipline’s patient nutrition care practices. This has included acknowledgement and promotion of each team member’s contributions, a commitment to the project work by their active and continued participation and their willingness to collectively develop, critique and refine the solutions.

A re-audit of the patients identified to receive assistance after the implementation of the eMR enhancement re patient assistance needs displayed that 19% of patients were flagged to require assistance to open packs and 8% for full assistance to eat. That is achieving a significant improvement from the previous level of identification. The current identification rate now matches the previously predicted level of patient need. 

The project directly supports clinicians to meet the patient mealtime assistance directives of the NSW Nutrition Care Policy.

This new approach has proved to be more efficient. Previously nursing staff were required to phone through and place a ‘special order’ for patients that required assistance to eat. There was a poor awareness of this process and it was time consuming and disjointed from the process of diet ordering.

By moving to an e-ordering system, efficiencies have been realised by removing the need for phone calls to be made and importantly by prompting feeding assistance needs to be considered for every patient. 

Lessons Learnt

The project has been a strong example of building partnerships via its broad consultation and engagement across the staff groups in the inpatient environment.

Collaboration across nursing, allied health and food services staff has been achieved via the formation of a dedicated working party to address this issue. 


  1. NSW Health. 2011. NSW Health Policy Directive PD2011_078 Nutrition Care
  2. Bradley L, Rees C. Reducing nutritional risk in hospital: the red tray. Nursing Standard 2003 17(26):33-37.


Margaret Holyday
Head of Department, Nutrition and Dietetics
Prince of Wales Hospital
South Eastern Sydney Local Health District (SESLHD)
Phone: 02 9382 2871

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