The second stage of the Improving Care for Older People (ICOP) program operated in Victoria from 2010 to 2013. Across Victoria, 35 public health services participated in the initiative, including all metropolitan health services. As part of the program, they were required to undertake initiatives to minimise the risk of functional decline in older patients and improve the provision of care in four areas:

  • Evidence-based environmental improvements
  • Organisation-wide policy development that provides a framework for improving care for older people across the organisation
  • Embedding the evidence base contained within The Toolkit to inform models of care to minimise functional decline for older people, with a focus on acute settings
  • Professional development activities to support workforce capacity building to better respond to the needs of older people in hospital settings

Outlined is a snapshot of the types of initiatives taken by health services relating to nutrition and swallowing.

Health Service

Requirement Addressed and Project Summary

Albury Wodonga Health

Models of Care - “Meal Time Mates” program (volunteers assisting with meals) and protected meal times embedded practices in acute wards – staff education prior to introduction; policies and guidelines in place

Alfred Health

Policy Development - Under-nutrition Assessment, Prevention and Management Guideline in place

Professional Development - Interdisciplinary education program has run 180 sessions across 3 sites with over 1200 attendees, including focus on under-nutrition

Models of Care – Opportunities for practice development identified via education sessions – including focus on under-nutrition. Executive led Under-Nutrition Steering Committee to have started from August 2013

Bairnsdale RHS

Policy Development - Malnutrition screening on admission implemented – Malnutrition screen being trialled in acute and sub-acute units at June 2013

Ballarat Health Services

As at November 2012

Environmental improvements – Refurbished acute wards’ sunrooms and included communal dining areas

Models of Care - Malnutrition Screening Tool and improved referral process introduced as part of Nursing Management Plan and education provided; volunteer meal assistance program operating and training provided

Bass Coast Regional Health

Policy Development - Developed Nutrition and Hydration Policies and assessment tools including Malnutrition Screening Tool

Models of Care – Food services review, implementation of weekly weighs in sub-acute units. Improvements to malnutrition screening planned

Bendigo Health

Policy Development – Management of malnutrition key focus in strategic plan 2015-18 Redeveloped policies on Nutrition Screening and Assessment; Nutrition and Food; Mealtime Environment and Assistance Guideline

Redeveloped Malnutrition Screening Tool – increased compliance

Models of Care - Improving Care for Older Persons (ICOP) Nutrition Project Officer; introduction of ‘Plum Domes’ to indicate patient need for assistance with meals – gradual roll out across wards; introduction of high energy/high protein meal plan for those identified as undernourished via screening; consultation with patients and menu changes to remove/replace unpopular items; education around ‘Plum Domes’ via brochures, displays in hospital foyer and local newspaper coverage

Castlemaine Health

Policy Development - Procedures reviewed in line with ICOP principles including Malnutrition Assessment, Prevention and Management Procedure; Malnutrition Risk Reduction – Red Tray Procedure

Models of Care - Red Trays (indicating need for assistance with meals) established on acute and rehabilitation wards; menu choices review conducted

Professional Development - Nutrition education identified as a need – Nutrition Education Plan developed by dietetics department for nursing staff; nutrition education provided to Food Service staff; Nutrition Allied health Assistant trained (unclear if completed or position ongoing)

East Grampians Health Service

Models of Care - Blue Tray system (to denote patients needing meal assistance) developed and implemented in Inpatient Unit – ongoing; protected mealtimes (lunch) implemented in Inpatient Unit and information distributed to consumers; Malnutrition Screening Tool (MST) used within global screening tool; nutrition screening/referral audit completed

Professional development - Nutrition education developed based on nutrition audit results and pre-education survey; education on Blue Tray system (including for support/catering staff) and Protected Mealtimes conducted

Echuca Regional Health

Policy Development - High Protein Diet Implementation Policy; Malnutrition Screening Policy

Models of Care - Red Tray (denoting need for assistance with meals) implemented on acute ward; electronic food ordering system implemented in hospital to facilitate correct and appropriate meal ordering; Residential Aged Care food process includes serving on site to allow residents the sensory enjoyment of meals

Professional Development - Swallowing education provided to nursing staff on identifying and managing swallowing problems prior to Speech Pathology review – in context of stroke project

Goulburn Valley Health

Environmental Improvements – Purchase of Joey scales and red trays

Policy Development - Clinical Practice Guidelines on nutrition with ICOP focus developed and introduced

Models of Care - Organisation wide implementation of meal alert and red tray initiative and roll out to local Small Rural Health Services. Initiative involves use of red trays for patients requiring assistance with meals and information about program and nutrition for patient and families on trays

Latrobe Regional Hospital

Models of Care - Protected mealtimes and red trays to flag need for assistance implemented in GEM and Rehabilitation wards; ongoing education provided; regular auditing; Protected Mealtime Champions utilised; Meal Tray Advisory Group convened and recommendations for dark purple trays to provide contrast to food and hot beverage cups with larger handles implemented

Maryborough District Health Service

Models of Care - Review of hotel services with improvement in meal quality and reduction of waste; updated signage for patients with nutrition needs; food chart for patients at risk of malnutrition implemented

Melbourne Health

Policy Development – ICOP principles embedded in policies including Nutrition Assessment and Management

Models of Care - Recruitment of a part-time Nutrition Project Officer for 12 months who developed and validated a mental health nutrition risk screening tool

Monash Health

Environmental improvements, Policy Development, Models of Care, Professional Development – Red trays to identify need for meals assistance in use across organisation Associated Policy and Procedure implemented and communicated to staff via formal education processes

Northeast Health Wangaratta

Models of Care - Swallowing screen implemented with accompanying staff education – in use on medical ward and in emergency department; to be implemented in Coronary Care Unit

Policy Development – Improving Care for Older Persons (ICOP) principles embedded in policies including Nursing Screen of Dysphagia

Northern Health

Models of Care - Introduction of protected mealtimes on selected sub-acute wards; audited baseline and subsequent; further expansion of program (mealtimes and settings) continuing; communal dining introductions planned

Peninsula Health

Models of Care – Protected mealtimes implemented and sustained in sub-acute, trial in acute services scheduled for June 2013

Policy Development, Professional Development – Protected mealtimes supported by clinical practice guidelines and staff roadshow

South West Healthcare

Policy Development – Development and implementation of Communal Dining policy; review of nutrition policy

Models of Care - Introduction of nutrition screen into admission documentation across organisation, (auditing occurring); introduction and embedding of protected meal times

St Vincent’s Hospital Melbourne

Models of Care - Blue Dome system reviewed; PAS software system upgrade for an electronic identifier for patients requiring the blue dome (assistance). Evaluation demonstrated a 38% increase in blue dome usage

Stawell Regional Health

Policy Development - Nutrition policy developed and implemented; use of malnutrition screening tool

Models of Care - Nutrition Screening Policy and Tool implemented and periodically audited; volunteer meal assistance introduced and in use in residential aged care; communal dining area expanded in acute ward and use encouraged

Western Health

Policy Development – ICOP strategies embedded into organisation wide nutrition management policy (developed with BCOP involvement)

Wimmera Health Care Group

Policy Development - Under-nutrition policy and guidelines (draft); under-nutrition assessment, prevention and management flow chart (draft)

Models of Care - Embedded use of Malnutrition Screening Tool; plan to further embed domain via NSQHSS Nutrition policy; use of nutrition survey to educate staff particularly in acute ward

Professional Development - Education of nursing staff by Dietician; plan to develop e-learning tool