JCPSLP
Volume 16, Number 3 2014
155
audit results. Additionally, no incorrectly delivered meals
were identified in the second audit compared with the first.
Discussion
It is unclear which intervention directly related to improved
accuracy of the diet/fluid code matching across the two
electronic meal ordering systems, documentation in the
medical file and bed-signage. This is thought to be due to
the large number of steps in the process, the number of
disciplines involved and the interventions only targeting
parts of the meal provision process. No significant changes
were made to the process map during the course of the
audits or the focus groups as all stakeholders agreed that
the process map reflected the meal provision system.
Through the focus groups, increased engagement and
buy-in from the speech pathologists and nurse unit
managers was reported. Additionally, increased awareness
of the complexity of the meal provision system at Austin
Implementation of both interventions (i.e., the safe
swallow bed-signs and improved kitchen processes)
occurred three months following the first audit. Two weeks
after the interventions were implemented, the second audit
was conducted on six acute adult wards in the Austin
Hospital over two breakfast and lunch meals on two
consecutive days. Over the auditing period, 36 patients
were recommended to have texture modified diet/fluids.
However, one of these meals was not delivered due to
reduced patient alertness as directed by the nurse. The six
acute adult wards involved in the second audit were
selected on the basis of higher proportions of patients
requiring TMD/F.
Second audit
The second audit results (see Table 1) identified improved
accuracy of diet/fluid code matching across the EMOS,
patient’s medical file and bed-signs, with the bed-sign use
being the most significant change compared with the first
Plate meal for
next service
meal as per
meal tray slip
received
No
Yes
Prepare mid
meal fluids
& supps
according
to TrakCare
Has
original meal
been plated?
Has
re-therm trolley
with meal left
the kitchen?
Yes
No
Place MT/AF/supper fluids
and supplements on trolley
for delivery to ward
Can
the kitchen
produce the meal by
required time?
Yes
No Plate new meal
Take plated
meal to
re-therm
trolley
Place meal
on late trolley
from kitchen
to ward
Take re-therm
trolley from
kitchen to
ward
Deliver
meal +/or
fluids +/or
supplements
to patient’s
bedside
Does
the meal
+/or fluid +/or
supplements on
tray match the
meal tray slip
and signage
above pt’s
bed?
Yes
No
Do not deliver to pt.
Check with ANUM
&/or RN. Request
ANUM to follow up
Deliver meal
+/or fluids +/or
supplements
to patient
Is there
a discrepancy
between the SP/DT/medical
entry in pt’s file +/or bed sign
+/or diet code in
TrakCare?
Yes
No
RN to contact SP/DT
to clarify
recommendations
Call MM to rectify
Preparing
Dispensing
Deliver tea and coffee to patients
on the ward at patient request
