Reducing risk of development or exacerbation of nutritional deficits by optimizing patient access to mealtime assistance.

OBJECTIVE: Optimize patient access to mealtime assistance, decrease missed meal incidence, risk of malnutrition, reduce food waste and staff rework. DESIGN: Lean Six Sigma methodology informed a pre/post intervention design. SETTING: 31 bed ward including Specialist Geriatric services and Acute Stroke Unit within an Irish University teaching hospital. PARTICIPANTS: Clinical and non-clinical staff including catering, nursing, speech and language therapy, dietetics and nutrition; patients, relatives. INTERVENTIONS: An interdisciplinary team used the structured Define/Measure/Analyse/Improve/Control (DMAIC) framework to introduce visual aids and materials to improve the access of patients to assistance at mealtimes. MAIN OUTCOME MEASURES: Pre and post outcomes measures were taken for the number and cost of uneaten meals, rework for staff, staff and patient satisfaction, patient outcomes. RESULTS: Following a 1-month pilot of a co-designed process for ensuring access to assistance at mealtimes, average wasted meals due to staff not being available to assist patients requiring mealtime assistance went from 3 per day to 0 corresponding to an average reduction of 0.43 kg per participating patient in food waste per day. Patients receiving assistance did not require additional oral therapeutic nutritional supplements, evidenced no new incidences of aspiration pneumonia or swallowing difficulties and were discharged without requirement for ongoing Dietetics and Nutrition support. Following a 6 month Control period comprising repeated PDCA cycles, the initiative was incrementally introduced to a further 10 wards/units, with positive feedback from patients and staff alike. CONCLUSION: The co-designed new process highlights the importance of staff and patient collaboration, inclusion and participation in designing quality improvement projects.

Supply and demand: application of Lean Six Sigma methods to improve drug round efficiency and release nursing time.

OBJECTIVE: To improve efficiency, reduce interruptions and reduce the time taken to complete oral drug rounds. DESIGN: Lean Six Sigma methods were applied to improve drug round efficiency using a pre- and post-intervention design. SETTING: A 20-bed orthopaedic ward in a large teaching hospital in Ireland. PARTICIPANTS: Pharmacy, nursing and quality improvement staff. INTERVENTION(S): A multifaceted intervention was designed which included changes in processes related to drug trolley organization and drug supply planning. A communications campaign aimed at reducing interruptions during nurse-led during rounds was also developed and implemented. MAIN OUTCOME MEASURE(S): Average number of interruptions, average drug round time and variation in time taken to complete drug round. RESULTS: At baseline, the oral drug round took an average of 125 min. Following application of Lean Six Sigma methods, the average drug round time decreased by 51 min. The average number of interruptions per drug round reduced from an average of 12 at baseline to 11 following intervention, with a 75% reduction in drug supply interruptions. CONCLUSIONS: Lean Six Sigma methodology was successfully employed to reduce interruptions and to reduce time taken to complete the oral drug round.