What was the problem you were trying to address?
The aim of this service was to ensure correct nutrition support appropriate to particular needs. Protein energy malnutrition is the most common secondary diagnosis in patients with cancer. For head and neck cancer patients (H&N) rapid and quick weight loss is detrimental to disease outcome. Nutritional status is often poor prior to surgery due to life style choices and disease symptoms such as pain and poor swallow compound the issue.
Post surgery, H&N cancer patients have multiple problems in initiating oral diet and swallowing dysfunction has a strong negative impact on health related quality of life e.g. poor lip seal, dysphagia, pain and altered structures within the oral cavity. Body image also has a huge impact on their ability to eat and drink.
The aim of the service was to provide the patients with a high calorie/high protein snack that would be available on the ward at all times. It was important to provide a product that would be easy and safe for a first attempt at eating and so instil confidence and minimise embarrassment.
How did you create your project plan?
A plan was written and presented at a head and neck business meeting asking for a donation of money towards the purchase price of the ice cream machine. The full cost of the machine was agreed. A demo meeting was set up with the company and all those who would be involved in the ongoing support of the service or would have an interest in the service such as infection control, catering, patient representatives’ and SALT were invited. Meetings were arranged with the heads of various departments to bring everyone on board whose help was necessary in the running of this service. Health and safety was discussed with the infection control department and frequency of cleaning of the machine was agreed. Catering agreed to clean the machine three times per week. Costings were made for consumables, replacement parts and the ice cream product and presented to the medical devices committee along with a statement as to why it would benefit the patients on the head and neck unit. Matron and the sisters/charge nurse from the surgical directorate Ward 20 and 21 agreed to cover the ongoing costs from the ward budget. The initial six months of cleaning costs were paid for by the ice cream company. The funding for this was obtained with the help of Health Enterprise- East NHS Innovation East.
- The service was originally introduced for the H&N cancer patients but is not exclusive to them. Any patient who needs nutrition support is give ice cream as a snack.
- The service was awarded a customer care award by the hospital and given £1000 towards the ongoing costs.
- Audit has shown the improvement in QOL for the H&N patients and the ice cream has been exceptionally well received by all patients.
- Local press/TV and radio have taken a great interest in the service and the hospital has received a great deal of publicity which has generated enquiries from other hospitals about installing a machine for their patients.
- Enquiries from the upper GI support group in London have been made.
- The elderly care directorate at the L&D hospital is now in the process of purchasing three more machines for the elderly care wards.
How are you going to maintain the improvement?
It is hoped that the role of cleaning the machines will be written in to the job description of the housekeepers when they are established.
Tips for others planning similar projects
Be passionate about what you are doing as a great deal of determination and perseverance is required. Make sure that everyone in fully on board with the project and that every thing is documented.
“I think the ice cream service was a very good idea and most needed, it helped me a lot when I couldn’t eat a lot, it is a good stepping stone to eating normally. Thank you very much”
“It reminds me of the ice cream I had a as child, delicious!!”
“I felt it was good you could take your time to enjoy it without it going too slushy too quickly”
“I think being offered the ice cream is really helpful, it makes you feel a bit special because it certainly doesn’t feel anything other than luxurious. It’s a treat and it definitely helped my recovery”
“It is the best ice cream I have ever tasted. It certainly is a big help to anyone suffering with throat operations”
“Being able to eat ice cream on a regular basis has helped remove not only the sharp shooting pains in the back of my throat but it helped relax my throat and remove the saliva”