Implementation of A Better Choice Healthy Food and Drink Supply Strategy for staff and visitors in government-owned health facilities in Queensland, Australia.

OBJECTIVE: The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising. DESIGN: An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information. SETTING: Public sector-owned and -operated health facilities in Queensland, Australia. SUBJECTS: One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48.2% and 96.0%, respectively. RESULTS: Of facility managers, 78.4% reported implementation of more than half of the A Better Choice requirements including 24.6% who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising. CONCLUSIONS: Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.

A detailed feeding algorithm improves delivery of nutrition support in an intensive care unit.

OBJECTIVE: To determine whether a detailed feeding algorithm improved nutrition support of critically ill patients compared with a standard feeding protocol. DESIGN, SETTING AND PARTICIPANTS: Pre- and post-intervention comparison of nutrition commencement and nutritional adequacy in intensive care unit patients receiving enteral or parenteral nutrition until length of stay (LOS) exceeded 30 days, oral intake resumed, the patient was discharged from the ICU or the patient died. The study was conducted at the Royal Brisbane & Women's Hospital, a tertiary hospital with 27 ICU beds, in 2005 (pre-intervention) and 2007 (post-intervention). INTERVENTION: A detailed feeding algorithm that included commencement of nutrition support, progression to goal nutrition rates and management of gastric residual volumes. MAIN OUTCOME MEASURES: Time to commencement of nutrition support; time to reach goal nutrition rate; nutritional adequacy over ICU stay. RESULTS: No demographic differences between pre- (n=42) and post-implementation (n=41) patient groups were observed. Implementation of the detailed feeding algorithm reduced the mean time to commence nutrition support from 28 hours to 16 hours (P=0.035). Time to reach goal nutrition rate fell from 22 hours to 13 hours, although the difference was not statistically significant. There was no significant difference between pre- and post-implementation groups in the number of patients reaching goal volume during ICU admission. Interruptions were a major obstacle to goal volumes of enteral feeds being reached. CONCLUSIONS: Introduction of a detailed feeding algorithm resulted in earlier commencement of nutrition support and increased numbers of patients reaching goal rates in less time. To improve nutritional adequacy, the algorithm needs to be modified to account for unavoidable interruptions during ICU stay.