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Development of a computerized spreadsheet for enteral nutrition products in a pediatric facility
TUESDAY, OCTOBER 26 POSTER SESSION: QUALITY ASSURANCE/QUALITY IMPROVEMENT THE EFFECT OF PEDIATRIC MENUS ON INTAKE AND PERCEPTION IN CHILDREN. B.M. Acree, RD LD CNSD, R.G. Janiec, BS DT, R.P. Puckett, MA RD LD, D.G. Boe, RD LD, Department of Food and Nutrition, Shands Hospital at the University of Florida, Gainesville, FL Ambulatory hospitalized children at Shands Hospital, Registered Dietitian (RD) and Dietetic Technician (DT) ate together as a group to determine the intake and perception of food using foods from the newly revised pediatric menu versus foods from the traditional hospital menu. The new pediatric menu contains foods such as, t Spaghettios , Ravioli, pizza and fun meals served in brightly designed boxes, as compared to menus which serve standard hospital fare. A method was developed to provide feedback which would be independent of reading skills, and would maximize interaction and observation while providing fun for the participants. The 23 children who participated were divided into 2 groups. There were 11 patients in the Regular menu group and 12 patients in the Pediatric menu group. The average age for each group was 8 years. The ages ranged from 3-18 years. As the children became more familiar with the environment they were asked to score the hospital meal by using a letter grade (ie, A, B, C, D, or F). The criteria for measuring intake was Poor <25% food consumed, Fair 25-50%, Good 50-100%. The intake of the Regular menu group was: Poor 27%, Fair 37%, Good 36%; as compared to the new Pediatric menu: Poor 8%, Fair 50%, Good 42%. Perception between the two types of menus were noted as Regular: D-=2 patients, C = 1, 8=3,A=3; Pediatric: D = 0 patients, C=2, B = 1, A= 6. The results of this ongoing study continue to show improved food intake and perception. Children enjoy and request fun meals and familiar foods. Providing this service improves the nutrition intake and the overall perception of the hospital.
THE USE OF MODULES IN PROVIDING PATIENT RIGHT TRAINING. J.S.Keaten Jr., BS, S.W.Crimmins, MS,RD, and J.F.Bailey, MS,RD,CDE, Newton-Wellesley Hospital, Newton, MA. The need to educate staff on Patient Rights is required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). JCAHO also requires staff training and education to include learning objectives, use effective teaching strategies, and to be evaluated for effectiveness. To meet these regulations we set out to design an education training program. Individual self study education and training modules with self assessment quizzes were used. The modules allow employees to work at their own speed. Learning objectives were developed. Patient Rights were broken down into the following lessons: Maternity, Confidentiality, Patient Bill of Rights, Dying Patients, and the Right to Privacy based on the needs of the patient population. A team consisting of a Registered Dietitian and Food Service Supervisor wrote the modules, using easy understandable texts, and highlighting important tips. The lessons contain an introduction, body of information, general hints, and a quiz. The module also includes a twenty question final test. The modules were piloted to evaluate for appropriateness, and changes were made. Supervisors administered the module and monitored progress. The effectiveness of the module was evaluated through the quality improvement process. The indicator was that 90% of employees will complete the module by scoring 100% on all quizzes and the final exam. The supervisors worked closely with the employees, reviewing incorrect answers. After the first month 76% of employees had completed the module with a score of 100%. By the next month over 90% had completed the module. Our department plans to develop additional training modules and incorporate them into our orientation and training programs and to repeat the modules on a yearly basis for employee recertification.
HOW
DEVELOPMENT OF A COMPUTERIZED SPREADSHEET FOR ENTERAL NUTRITION PRODUCTS IN A PEDIATRIC FACILITY. R.R. Bethel, RD, LD, S.A. Fulmer, BS, and M.A. McGinnis, LD, Arkansas Children's Hospital, Little Rock, AR In order to inventory the rapidly changing products for the Enteral Nutrition Laboratory at Arkansas Children's Hospital (ACH), a computerized spreadsheet was developed. The original purpose of the project was to have a current list of all products used by ACH which could be easily changed and alphabetized to aid a manual inventory process. The spreadsheet function of the hospital's main frame computer was chosen for data entry. With the ease of data entry, other purposes of the spreadsheet were added such as current product number, manufacturer, major supplier, alternate supplier, packaging information, cost per unit of issue, unit of issue, recommended stock level, and space for recording present inventory. Once completed, the tool proved invaluable within the Nutritional Services department. By changing the computer access from private to open, a distribution list makes it possible for all dietitians, coordinators, and dietetic assistants to have an updated copy of the spreadsheet at all times. The spreadsheet can be updated at any time and changes can immediately be read by the distribution list on any of the 850 computer terminals in the hospital and in more than 87 clinics. Some of the benefits include knowledge of direct availability, cost awareness, storage information, product usage data, compact source of procurement information, as well as a complete list of products and information which can be databased for other computer applications. The Enteral Nutrition Laboratory Inventory Spreadsheet is a very useful management and clinical tool for ACH. Organization, planning, and coordinating functions within and between the departments of Nutritional Services and Clinical Nutrition and Research have been enhanced. This type of tool could easily be used by any facility with a network based office information system with the capability of sharing files.
ACCURATE
ARE
THE
SCALES
USED
TO
WEIGH HOSPITAL PATIENTS? L.A. Beaston, R.D., Department of Veterans Affairs Medical Center, San Diego, CA Although errors in recording body weight, weighing methods, and reading scales may result in inaccurate body weight measurements, the accuracy of scales is often blamed for body weight discrepancies. The primary objective of this study was to examine the accuracy of hospital scales at the Department of Veterans Affairs Medical Center (VA Medical Center) to determine if the scales contribute to inaccurate body weight measurements. The accuracy of 25 beam (N=12) and digital (N=13) scales used to weigh patients at the VA Medical Center was measured using an increasing load test. All the scales were initially zeroed without a load and then tested at 25 pound increments up to 250 pounds. The raw data was compiled and the mean, standard deviation, and range were determined for the digital scales, the beam scales, and for all scales combined. The mean accuracy of the beam and digital scales was fairly accurate, within approximately 1.5 pounds of the test load. While the mean of the digital scales only varied from the test load by 1 pound, the beam scale mean varied up to 2.5 pounds from the test load. The beam scales also had a much broader weight range than the digital scales, particularly at a 250 pound test load, 29.5 pounds versus 2.8 pounds, respectively. Comparison of the digital and beam standard deviations indicated that the digital scales had limited weight variations (.5 to .7 standard deviation range) while the beam scale variation increased progressively with each test load increment (.4 standard deviation for a 25 pound test load and a 8.2 standard deviation for a 250 pound test load). Without accurate patient weights the physicians, nurses, and dietitians cannot accurately assess the patient's nutritional and hydration status, which could impair patient care. Scales used to weigh patients should be tested for accuracy with standardized weights and recalibrated annually by qualified professionals to improve scale accuracy, thus increasing the accuracy of a patient's weight.
A-38 / SEPTEMBER 1993 SUPPLEMENT VOLUME 93 NUMBER 9
THE USE OF MODULES IN PROVIDING PATIENT RIGHT TRAINING. J.S.Keaten Jr., BS, S.W.Crimmins, MS,RD, and J.F.Bailey, MS,RD,CDE, Newton-Wellesley Hospital, Newton, MA. The need to educate staff on Patient Rights is required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). JCAHO also requires staff training and education to include learning objectives, use effective teaching strategies, and to be evaluated for effectiveness. To meet these regulations we set out to design an education training program. Individual self study education and training modules with self assessment quizzes were used. The modules allow employees to work at their own speed. Learning objectives were developed. Patient Rights were broken down into the following lessons: Maternity, Confidentiality, Patient Bill of Rights, Dying Patients, and the Right to Privacy based on the needs of the patient population. A team consisting of a Registered Dietitian and Food Service Supervisor wrote the modules, using easy understandable texts, and highlighting important tips. The lessons contain an introduction, body of information, general hints, and a quiz. The module also includes a twenty question final test. The modules were piloted to evaluate for appropriateness, and changes were made. Supervisors administered the module and monitored progress. The effectiveness of the module was evaluated through the quality improvement process. The indicator was that 90% of employees will complete the module by scoring 100% on all quizzes and the final exam. The supervisors worked closely with the employees, reviewing incorrect answers. After the first month 76% of employees had completed the module with a score of 100%. By the next month over 90% had completed the module. Our department plans to develop additional training modules and incorporate them into our orientation and training programs and to repeat the modules on a yearly basis for employee recertification.
HOW
DEVELOPMENT OF A COMPUTERIZED SPREADSHEET FOR ENTERAL NUTRITION PRODUCTS IN A PEDIATRIC FACILITY. R.R. Bethel, RD, LD, S.A. Fulmer, BS, and M.A. McGinnis, LD, Arkansas Children's Hospital, Little Rock, AR In order to inventory the rapidly changing products for the Enteral Nutrition Laboratory at Arkansas Children's Hospital (ACH), a computerized spreadsheet was developed. The original purpose of the project was to have a current list of all products used by ACH which could be easily changed and alphabetized to aid a manual inventory process. The spreadsheet function of the hospital's main frame computer was chosen for data entry. With the ease of data entry, other purposes of the spreadsheet were added such as current product number, manufacturer, major supplier, alternate supplier, packaging information, cost per unit of issue, unit of issue, recommended stock level, and space for recording present inventory. Once completed, the tool proved invaluable within the Nutritional Services department. By changing the computer access from private to open, a distribution list makes it possible for all dietitians, coordinators, and dietetic assistants to have an updated copy of the spreadsheet at all times. The spreadsheet can be updated at any time and changes can immediately be read by the distribution list on any of the 850 computer terminals in the hospital and in more than 87 clinics. Some of the benefits include knowledge of direct availability, cost awareness, storage information, product usage data, compact source of procurement information, as well as a complete list of products and information which can be databased for other computer applications. The Enteral Nutrition Laboratory Inventory Spreadsheet is a very useful management and clinical tool for ACH. Organization, planning, and coordinating functions within and between the departments of Nutritional Services and Clinical Nutrition and Research have been enhanced. This type of tool could easily be used by any facility with a network based office information system with the capability of sharing files.
ACCURATE
ARE
THE
SCALES
USED
TO
WEIGH HOSPITAL PATIENTS? L.A. Beaston, R.D., Department of Veterans Affairs Medical Center, San Diego, CA Although errors in recording body weight, weighing methods, and reading scales may result in inaccurate body weight measurements, the accuracy of scales is often blamed for body weight discrepancies. The primary objective of this study was to examine the accuracy of hospital scales at the Department of Veterans Affairs Medical Center (VA Medical Center) to determine if the scales contribute to inaccurate body weight measurements. The accuracy of 25 beam (N=12) and digital (N=13) scales used to weigh patients at the VA Medical Center was measured using an increasing load test. All the scales were initially zeroed without a load and then tested at 25 pound increments up to 250 pounds. The raw data was compiled and the mean, standard deviation, and range were determined for the digital scales, the beam scales, and for all scales combined. The mean accuracy of the beam and digital scales was fairly accurate, within approximately 1.5 pounds of the test load. While the mean of the digital scales only varied from the test load by 1 pound, the beam scale mean varied up to 2.5 pounds from the test load. The beam scales also had a much broader weight range than the digital scales, particularly at a 250 pound test load, 29.5 pounds versus 2.8 pounds, respectively. Comparison of the digital and beam standard deviations indicated that the digital scales had limited weight variations (.5 to .7 standard deviation range) while the beam scale variation increased progressively with each test load increment (.4 standard deviation for a 25 pound test load and a 8.2 standard deviation for a 250 pound test load). Without accurate patient weights the physicians, nurses, and dietitians cannot accurately assess the patient's nutritional and hydration status, which could impair patient care. Scales used to weigh patients should be tested for accuracy with standardized weights and recalibrated annually by qualified professionals to improve scale accuracy, thus increasing the accuracy of a patient's weight.
A-38 / SEPTEMBER 1993 SUPPLEMENT VOLUME 93 NUMBER 9