Can trained volunteers improve the mealtime care of older hospital patients? An implementation study in one English hospital

OBJECTIVE: Multinational studies report undernutrition among 39% older inpatients; importantly, malnutrition risk may further increase while in hospital. Contributory factors include insufficient mealtime assistance from time-pressured hospital staff. A pilot study showed trained volunteers could safely improve mealtime care. This study evaluates the wider implementation of a mealtime assistance programme. DESIGN: Mixed methods prospective quasi-experimental study. SETTING: Nine wards across Medicine for Older People (MOP), Acute Medical Unit, Orthopaedics and Adult Medicine departments in one English hospital. PARTICIPANTS: Patients, volunteers, ward staff. INTERVENTION: Volunteers trained to help patients aged ≥70 years at weekday lunchtime and evening meals. MAIN OUTCOME MEASURES: The number of volunteers recruited, trained and their activity was recorded. Barriers and enablers to the intervention were explored through interviews and focus groups with patients, ward staff and volunteers. The total cost of the programme was evaluated. RESULTS: 65 volunteers (52 female) helped at 846 meals (median eight/volunteer, range 2–109). The mix of ages (17–77 years) and employment status enabled lunch and evening mealtimes to be covered. Feeding patients was the most common activity volunteers performed, comprising 56% of volunteer interactions on MOP and 34%–35% in other departments. Patients and nurses universally valued the volunteers, who were skilled at encouraging reluctant eaters. Training was seen as essential by volunteers, patients and staff. The volunteers released potential costs of clinical time equivalent to a saving of £27.04/patient/day of healthcare assistant time or £45.04 of newly qualified nurse time above their training costs during the study. CONCLUSIONS: Patients in all departments had a high level of need for mealtime assistance. Trained volunteers were highly valued by patients and staff. The programme was cost-saving releasing valuable nursing time. TRIAL REGISTRATION NUMBER: NCT02229019; Pre-results.