Diet Wheel to Ensure Correct Patient Diets and Reduce Errors

Intervention Title:
Reducing Errors and Ensuring Delivery of Correct Diet—Methodist LeBonheur Germantown Healthcare, Germantown, Tenn.

Goal:
Reduce errors and ensure patients receive the correct diet ordered by physicians.

Innovation:
A diet wheel posted outside patient rooms ensures that they receive the correct diet and improves communication between dietary and nursing staff.

Result:
This helped staff reduce communications errors in delivering food to patients and made patients and their families more familiar with their physician-ordered diets and what they might eat when discharged.

Institution:
Methodist LeBonheur Germantown Healthcare
7691 Poplar Avenue
Germantown, TN 38138
P: (901) 516-6418

From the C-Suite:
“Patient-centered care is a priority at our hospital and it’s no surprise that food is important to patients. Although the diet wheel seems to be a simple innovation we have seen patient and family satisfaction increase since implementing it. Additionally, communication among staff has increased and errors have decreased through this simple innovation.”

Deborah Dafferner, R.N., B.S.H.A.
Chief Nursing Officer

Profile:
309-bed not-for-profit community hospital serving Germantown, TN and the surrounding areas.

Clinical areas affected:

  • Inpatient units

Staff involved:

  • Nurses
  • Dietary staff/services
  • Physicians

Timeline:
Development and full implementation of the diet wheel took approximately five months from the initial test to see if staff utilized it and how it could be improved. After this the diet wheel was sent to the hospitals marketing department for a professional designer to develop. Within the first week, the diet wheel was integrated across the entire unit and then within eight months it had spread to other units across the hospital.

Contact:
Ptosha Jackson, R.N., M.S.N.
Clinical Director, 4 West A
fordp@methodisthealth.org
P: (901) 516-6798

Innovation implementation:
Like at most hospitals, delivering patient food according to physician diet orders is a complicated dance that involves staff from several departments and teams to coordinate. At Methodist LeBonheur Germantown Healthcare, dietary staff runs a list at 5:00 a.m. of physician directed diets and prepare trays to serve on the patients’ floors. Sometimes physicians make rounds and change a patient’s diet order between the tray preparation and delivery. In addition to errors, these discrepancies resulted in confusion among patients and staff on the correct physician ordered diet for a patient.

Responding to errors made when patients receive the incorrect food tray, a diet wheel was developed to indicate what physician directed diet a patient should receive. The diet options listed on the wheel include: ADA, AHA, Ask Nurse, Bland, Clear Liquids—ADA, Clear Liquids, Renal, Full Liquids, Low Fat, Low Residue, Low Sodium, Regular, Soft, Wise, NPO and Bariatric. A nurse or floor secretary always updates the diet wheel according to the current diet order. When a tray is delivered, dietary staff check to make sure the tray matches the diet indicated on the diet wheel. If there is a discrepancy, dietary staff check with a nurse for the correct diet.

The diet wheel has helped to involve families on the importance of their patient’s diet and better educate them on what patients may eat when they go home from the hospital. Physicians and food services staff are aware of the diet wheel which minimized miscommunication on patient diets.

Advice and lessons learned:

  1. Customize. When developing a diet wheel, make sure the diets listed are correct for your unit.
  2. Identify champions. Select a team representative from each shift to instruct staff members on how to utilize the diet wheel and ensure it was implemented correctly.
  3. Engage families. The diet wheel focused families on the importance of diet. Take the time to educate them on their patient dietary needs and how to make a successful transition home.

Cost/benefit estimate:
Satisfaction improved among nursing associates and dietary associates. Communication between the various hospital departments also improved.

Tools to download:

  • Diet wheel