The effect of ward‐based training on attendance rates and use of the Red Tray System employed to highlight patients requiring assistance with eating: a pilot
Authors: Heuberger C. 
Published: May 2009

Background:  Nursing and healthcare staff are vital for delivering nutritional treatment. In our district general hospital, they currently receive no regular nutrition training post‐induction, and attendance at off‐ward training sessions in the past has been poor. An important part of nutritional treatment is ensuring that assistance with eating is provided where required (Department of Health, 2007). The Red Tray System (RTS) has been endorsed by the Royal College of Nursing to highlight those who need assistance with eating by serving their meals on red trays (Age Concern, 2006). A local RTS audit recommended the RTS be revisited trust‐wide. This project aimed to improve attendance at nutrition training sessions within current resources by piloting ward‐based training. It also aimed to facilitate RTS use.

Methods:  RTS updates for nursing and healthcare staff were delivered on wards by the dietitians at ‘hand‐over’ time between the early and late shift. Obstacles to initiating the RTS were discussed and solutions agreed with the participants and, subsequently, the ward sisters. Participants completed a questionnaire on preferred further nutrition training topics, methods and frequency of training delivery to help guide future dietetic training. RTS use was re‐audited 3 months after the RTS updates. Comprising an exact copy of the audit conducted prior to the updates, it determined the total number of red trays ordered across the hospital for one meal from the menu cards received by the catering department. To ascertain whether these red trays had been ordered for the appropriate patients, the nutrition risk assessment tools for red tray recipients were scrutinised for an identified need for assistance with eating, as indicated by a score of one in the ‘ability to eat’ section. This score is arrived at through questioning of the patient and carer or through observation. In addition, a review of all nutrition risk assessment tools on two elderly care wards was completed to check whether those patients identified as requiring assistance with eating had had a red tray ordered. Results were analysed using the chi‐square test.

Results:  The updates attracted 91 participants. Obstacles and solutions to initiating the RTS were ward‐specific. Recurrent themes included a lack of communication between staff, a lack of RTS awareness, inaccurate documentation of the need for assistance, and a lack of responsibility for initiating the RTS. The questionnaire on future nutrition training highlighted that 95% of participants requested more regular updates on topics covering all aspects of nutrition treatment. Both participants and dietitians preferred ward‐based sessions at hand‐over time to off‐ward training. The RTS re‐audit showed a 60% increase in RTS use (P = 0.05), a 17% increase in appropriate ordering of red trays (P = 0.41), and an 85% increase in those requiring assistance with eating receiving a red tray (P = 0.02).

Discussion:  Ward updates can help facilitate RTS use. They can be practical and ward‐specific and can be supported by ward posters, nutrition folders and nutrition link nurses.

Conclusions:  Shorter, more regular training at hand‐over time is a realistic way of keeping more nursing and healthcare staff up‐to‐date within current resources. It can improve RTS use.

References  Age Concern (2006) Hungry to be Heard. London, Age Concern England.

Department of Health and Nutrition Summit Stakeholder Group (2007) Improving Nutritional Care – A Joint Action Plan from the Department of Health and Nutrition Summit Stakeholders. London: The Stationery Office.