Assessing Adherence to Protected Mealtime Guidelines in Iranian Hospitals

Document Type: Research Paper


1 Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences Mashhad, Iran.

3 School of Medicine، Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Malnutrition is a prevalent problem in hospitalized patients, causing a wide range of negative clinical and economic challenges. Protected mealtimes (PM) aim to enhance the quality of mealtime experience, improve nutrient status in hospitalized patients, and limit all non-essential interruptions so that patients might eat in a clean, quiet, and safe environment.
Materials and Methods: This study is a clinical audit and was conducted in Mashhad teaching hospitals in order to evaluate mealtime interruptions that occurred among non-nutritional staff and influenced their food intake. Data were collected by direct observation. Lunchtime was chosen for audit because medical interruptions were more likely to happen during this meal. Two researchers (one dietitian, student and one dietetic assistant) observed lunch mealtime. The mealtime environment was monitored, and every negative interruption was registered. Exclusion criteria included patients who were nil-by-mouth or received enteral or parenteral nutrition.
Results:A total of 208 patients were involved in the audit. The recorded negative interruptions included medical round, educational round, nurses’ change-of-shift, and activities of environmental service workers. Among interruptions, both medical round and nurses’ change-of-shift were the most frequent. All mealtime interruptions summarized to medical round (2.5%) (including serum replace, drug injection, and IV replace), change-of-shift (2.5%), environmental-service-worker activities (2%), and educational round (2%). 
Conclusion: Our study demonstrated that non-urgent interruptions during mealtimes were not adhered to PM guidelines, indicating the importance of addressing mealtime related issues in hospitals.