Observations of mealtimes in hospital aged care rehabilitation wards.

Malnutrition is common in long-stay elderly hospitalized patients and their dietary intakes are often poor, despite the provision of adequate quantities of food to meet patient needs. The aim of this study was to identify environmental factors that were associated with achieving adequate food consumption in a hospital context. This study observed the daily routines of 30 elderly patients over 2days in rehabilitation wards in three Australian hospitals. All activities associated with mealtimes were recorded, from the commencement of breakfast to the conclusion of supper at the end of the day. Four key themes emerged: the eating location; assistance given at meals; negative and positive interruptions. The time taken to eat meals averaged 22min, ranging from 3 to 55min. Food intakes appeared to be better when meals were consumed communally in a dining room. There were many occasions when patients needed more assistance to eat than was available. The most common factors negatively affecting meal consumption were medication rounds, inappropriate placement of trays, packaging being hard to open, and patient showering. The presence of visitors, dietitians and nutrition assistants appeared to improve dietary intakes. Trials of protected mealtimes in Australian hospitals are certainly important and timely.

Pancreatic enzyme supplementation for patients receiving enteral feeds.

BACKGROUND: Pancreatic enzyme supplementation is an important part of management for a number of gastrointestinal conditions. For patients who are unable to swallow pancreatin capsules or granules, enteral feeding tubes can be used to administer the pancreatic enzyme. This presents challenges given the unique format of the pancreatic enzyme supplements, with common problems including tube blockage and loss of the enzyme's effect. METHODS AND RESULTS: A novel technique is described for administration of pancreatic enzyme via feeding tubes. For gastrically placed tubes, this involves opening the pancreatin capsules and suspending the enzyme microspheres in thickened acidic fluid (such as the mildly thickened or "nectar-thick" fruit juice used for dysphagia) for delivery into the feeding tube. This technique minimizes tube blockage by preventing the enzyme from clumping in the tube. For jejunally placed tubes, enzyme microspheres can be crushed and activated with sodium bicarbonate before flushing into the tube, or the activated enzyme mixture can be added to enteral feeds. CONCLUSIONS: Pancreatic enzyme supplementation can continue while patients receive enteral feeding. Using the described technique can help to avoid tube blockage and maintain optimal enzyme activity.