The proof is in the pudding clarity of

The proof is in the pudding: clarity of menu options for diabetic patients Utku ALHUN, FY 1 & Sophie HANINA, FY 1

Index case • 85 M on Ward 20 – PMHx: T 1 DM, NSTEMI, PVD (L-toe amputation), L-femoral bypass, dementia – Wildly fluctuating BMs • Persistent hypo- and hyperglycaemia despite numerous attempts to optimise medication (insulin) – Choice of food with high sugar content

Premise • Are diabetic pts making poor food choices for their sugar control? • Are the menus clear to enable them to make the right choices? • Do staff know which options are suitable for such patients (in helping them make their choices? )

Menu

Perceived problem • Lack of intuitive terms • Writing too small

Audit design 1. Questionnaire – To assess whether people knew there were options suitable for diabetics – To determine if they know which symbol it is 2. Diet vs. BM – Collection of used menus to collate food choices to compare against pre- and postlunch BMs

Patient cohort • 50 patients – 25 female, 25 male – Average 69. 6 ± 15. 2 years – 9 x T 1 DM, 41 x T 2 DM • Over 10 weeks • On wards 3, 15, 16, 20, 21, and 22

Questionnaire 1. Are you a health-care worker or patient? – 104 people recruited in total • • 20 HCAs 20 nurses 14 doctors 50 patients

Questionnaire 2. Are you aware that there is a “suitable for diabetics” option on the food menu? Yes Doctors HCAs & nurses Patients Aggregate 77. 8% 72. 5% 50% 63%

Questionnaire 3. Do you know which letter/symbol on the menu stands for “suitable for diabetics”?

Questionnaire 4. Do you know what the following letters stand for: ‘V’, ‘ED’, ‘BC’?

Questionnaire 5. Do you think the menus can/should be improved? [How? ]

Diet vs BM • Diet choice vs sugar control

No correlation

Summary • Only 6% of patients knew which symbol represented the suitable for diabetics option • Most nurses/HCAs think that ‘D’ is the symbol • Most people know intuitive terms like ‘V’ • 91% think menu should be changed

Future • Major discussions with Cook Chill – Denise Clifford, Catering Manager – Can’t use D- discriminatory! – New symbol (e. g. use of ♥ to designate food suitable for diabetics) – Bigger font – Close audit cycle

Questionnaire 1. Are you a health-care worker or patient? 2. Are you aware that there is a “suitable for diabetics” option on the food menu? 3. Do you know which letter/symbol on the menu stands for “suitable for diabetics”? 4. Do you know what the following stand for: ‘V’, ‘ED’ and ‘BC’ 5. Do you think the menus can/should be improved?

HCAs & nurses Patients Aggregate Yes 97. 5% 84% 91. 3% [Introduce ‘D’ as the new symbol] 36% 47. 5% 43. 3% [Introduce a separate menu for diabetics] 28% 42. 5% 36. 5%