Memorial Sloan Kettering Cancer CenterMemorial Sloan Kettering Cancer CenterDepartment of Food and Nutrition Department of Food and Nutrition

ServicesServices

Diet Change Study Diet Change Study

Mentor: Veronica McLymontMentor: Veronica McLymontMemorial Sloan Kettering Cancer CenterMemorial Sloan Kettering Cancer Center

Jaleesa DiazJaleesa DiazThurgood Marshall AcademyThurgood Marshall Academy

GoalGoal

Determine whether patients’ Determine whether patients’ satisfaction with the Room Service satisfaction with the Room Service Program is related to a change in Program is related to a change in the patient’s diet during their the patient’s diet during their hospital stay.hospital stay.

ContentsContents

GoalGoal IntroductionIntroduction Side EffectsSide Effects Introduction Pt. IIIntroduction Pt. II Top ReasonsTop Reasons Introduction Pt. IIIIntroduction Pt. III Room Service ProgramRoom Service Program Introduction Pt. IVIntroduction Pt. IV DataData MethodologyMethodology ResultsResults GraphGraph GraphGraph GraphGraph SummarySummary ReferencesReferences AcknowledgmentsAcknowledgments

IntroductionIntroduction

Cancer patients’ that undergo therapy Cancer patients’ that undergo therapy or surgery may have different side or surgery may have different side effects which can interfere with the effects which can interfere with the patient’s ability to eat healthy.patient’s ability to eat healthy.

Side Effects IncludeSide Effects Include

Nausea Nausea Decreased SmellDecreased Smell Decreased TasteDecreased Taste AnorexiaAnorexia VomitingVomiting Early SatietyEarly Satiety

Introduction Pt. IIIntroduction Pt. II

Previous studies have shown that Previous studies have shown that many patients have not been many patients have not been consuming enough food to consuming enough food to maintain their health.maintain their health.

Top Reasons Why Patients May Top Reasons Why Patients May Not Consume Enough FoodNot Consume Enough Food

Patients are out of the room or Patients are out of the room or sleeping during delivery of foodsleeping during delivery of food

Patients health condition prevents Patients health condition prevents them from having an appetitethem from having an appetite

Patients are not hungry during Patients are not hungry during time of delivery of the foodtime of delivery of the food

IntroductionIntroduction Pt. IIIPt. III

To increase the oral intake patient To increase the oral intake patient satisfaction, a Room Service Program satisfaction, a Room Service Program was created by Food and Nutritional was created by Food and Nutritional Services.Services.

Room Service ProgramRoom Service Program

A Restaurant Style MenuA Restaurant Style Menu Meals On DemandMeals On Demand A Room Service Associate Trained A Room Service Associate Trained

In HospitalityIn Hospitality

Introduction Pt. IVIntroduction Pt. IV

PATIENT SATISFACTIONPATIENT SATISFACTION

Press Ganey SurveyPress Ganey Survey Questionnaires are mailed after Questionnaires are mailed after

dischargedischarge Scores are monitored by Food Scores are monitored by Food

and Nutrition Department and Nutrition Department *special restricted diets explained*special restricted diets explained

MethodologyMethodology

The steps required to perform this The steps required to perform this study involved ……study involved ……

A patient database A patient database Observing amount and types of dietsObserving amount and types of diets Recording the amount of diet Recording the amount of diet

changes during a single admission in changes during a single admission in the month of July 2006.the month of July 2006.

Results Results

Physicians Change Diets FrequentlyPhysicians Change Diets Frequently Only three of the patients during the month of July Only three of the patients during the month of July

were placed on low residue dietswere placed on low residue diets During the month of July the average patient stayed at During the month of July the average patient stayed at

the hospital five daysthe hospital five days During those five days the average amount of times a During those five days the average amount of times a

patients diet changed was three timespatients diet changed was three times For patient’s that were admitted in July, but For patient’s that were admitted in July, but

discharged in both the month of July and August, the discharged in both the month of July and August, the most frequently ordered diets were Regular, NPO, and most frequently ordered diets were Regular, NPO, and Clr. Liquid.Clr. Liquid.

For these patient’s the most frequently ordered diet For these patient’s the most frequently ordered diet that they were discharged on were Regular, Soft, and that they were discharged on were Regular, Soft, and Diabetic 18.Diabetic 18.

Graph

Amount of Diet Types Ordered by Patients on M - 16 in July 2006

169

2

139 137

31 2411 13

2 115

412

210

1 1 2 2 2 7 31

21

41

61

81

101

121

141

161

Regular

Neutropenic

NPO

Clr. LiquidFull Liquid

Soft

KosherDB18

Fat40/LowChol

LactoseDB20

Post Gas.

Puree

Tube FeedMech. Soft

DB24DB22Low Na

BratThickRenal

Low Res.

Diet Types

Amount of Times Diet Type Was

Ordered

N = 139 Patients

Graph

Amount of Diet Types Ordered by Patients on M- 16 in July/August of 2006

136

2

109102

2621

83

12

1 1

134 4 1

71 1 2 2 2 3

0

20

40

60

80

100

120

140

Regular

Neutropenic

NPO

Clr. LiquidFull Liquid

Soft

KosherLow Res.

DB18

Fat40/LowChol

LactoseDB20

Post Gas.

Puree

Tube FeedMech. Soft

DB24DB22Low Na

Brat ThickRenal

Diet Types

Amount of Times Diet Type Was

Ordered

N=179 Patients

Graph

Types of Diets Patients Were Discharged on July/August 2006

2

104

6 8 7 11 4 3 7 5 1 1 1 4 3 10

50100150

Neutropenic

RegularKosherDB18NPOSoft

Post Gas.

PureeDB20

Clr. Liquid

DB22Low Na

Full Liquid

Renal Low Res.

Fat40/LowCh

ol.

Types of Diets

Amount of Patients

Discharged on

Diet

SummarySummary

We believe that the information, that the We believe that the information, that the studies were collected but may not be as studies were collected but may not be as accurate as they should be. accurate as they should be.

We believe that either the information was We believe that either the information was completely wrong or the results of the study completely wrong or the results of the study were just very surprising and unexpected.were just very surprising and unexpected.

In further studies the goal will be to In further studies the goal will be to determine if doctors are placing patients on determine if doctors are placing patients on appropriate diets that fit patients’ health appropriate diets that fit patients’ health condition. condition.

To compare the number of low residue diets To compare the number of low residue diets on the 16on the 16thth floor with the amount of low floor with the amount of low residue diets on the other floors.residue diets on the other floors.

ReferencesReferences

Journal of Healthcare Management 45: 2 copy written Journal of Healthcare Management 45: 2 copy written March/April 2000. Creating A Healing Environment: March/April 2000. Creating A Healing Environment: The Importance of The Service Setting in The New The Importance of The Service Setting in The New Consumer Oriented Healthcare System.Consumer Oriented Healthcare System.

Journal of Nursing Care Quality Vol. 18. No. 1, pp. 27-Journal of Nursing Care Quality Vol. 18. No. 1, pp. 27-37 copy written 2003. Lippincott Williams & Wilkins 37 copy written 2003. Lippincott Williams & Wilkins Inc. Improving Patient Meal Satisfaction with Room Inc. Improving Patient Meal Satisfaction with Room Service Delivery.Service Delivery.

Journal of Pediatric Oncology Nursing, Vol. 15, No. 3 Journal of Pediatric Oncology Nursing, Vol. 15, No. 3 (July), 1998:pp 183-189. Clinical Issues. Room Service (July), 1998:pp 183-189. Clinical Issues. Room Service Improves Patient Food Intake and Satisfaction With Improves Patient Food Intake and Satisfaction With Hospital Food. Williams, Ruth. Virtue, Karen. Adkins, Hospital Food. Williams, Ruth. Virtue, Karen. Adkins, Alisa.Alisa.

Acknowledgments Acknowledgments

Veronica McLymont M.S., R.D., C.D.NVeronica McLymont M.S., R.D., C.D.N James WuJames Wu Anita ApicelloAnita Apicello MonicaMonica Memorial Sloan Kettering Cancer CenterMemorial Sloan Kettering Cancer Center Department of Food and Nutrition ServicesDepartment of Food and Nutrition Services Dr. Sat BhattacharyaDr. Sat Bhattacharya Harlem Children's SocietyHarlem Children's Society