The Implementation of a Nutrition Intervention in Food Pantries: The Spirit of SWAP.

Background. Food insecurity, affecting approximately 10% of the U.S. population, with up to 40% or higher in some communities, is associated with higher rates of chronic conditions and inversely associated with diet quality. Nutrition interventions implemented at food pantries are an effective strategy to increase healthy food choices and improve health outcomes for people experiencing food and nutrition insecurity. Supporting Wellness at Pantries (SWAP), a stoplight nutrition ranking system, can facilitate healthy food procurement and distribution at pantries. Purpose. Guided by the RE-AIM Framework, this study assesses the implementation and outcomes of SWAP as nutritional guidance and institutional policy intervention, to increase procurement and distribution of healthy foods in pantries. Method. Mixed-methods evaluation included observations, process forms, and in-depth interviews. Food inventory assessments were conducted at baseline and 2-year follow-up. Results. Two large pantries in New Haven, Connecticut, collectively reaching more than 12,200 individuals yearly, implemented SWAP in 2019. Implementation was consistent prepandemic at both pantries. Due to COVID-mandated distribution changes, pantries adapted SWAP implementation during the pandemic while still maintaining the "spirit of SWAP." One pantry increased the percentage of Green foods offered. Challenges to healthy food distribution are considered. Discussion. This study has implications for policy, systems, and environmental changes. It shows the potential for SWAP adoption at pantries, which can serve as a guide for continued healthy food procurement and advocacy. Maintaining the "spirit of SWAP" shows promising results for food pantries looking to implement nutrition interventions when standard practice may not be possible.

Coalition Building and Food Insecurity: How an Equity and Justice Framework Guided a Viable Food Assistance Network.

Food insecurity is widespread in the United States. The COVID-19 pandemic intensified the need for food assistance and created opportunities for collaboration among historically-siloed organizations. Research has demonstrated the importance of coalition building and community organizing in Policy, Systems, and Environmental (PSE) change and its potential to address equitable access to food, ultimately improving population health outcomes. In New Haven, community partners formed a coalition to address systems-level issues in the local food assistance system through the Greater New Haven Coordinated Food Assistance Network (CFAN). Organizing the development of CFAN within the framework of Collaborating for Equity and Justice (CEJ) reveals a new way of collaborating with communities for social change with an explicit focus on equity and justice. A document review exploring the initiation and growth of the network found that 165 individuals, representing 63 organizations, participated in CFAN since its inception and collaborated on 50 actions that promote food access and overall health. Eighty-one percent of these actions advanced equitable resource distribution across the food system, with forty-five percent focused on coordinating food programs to meet the needs of underserved communities. With the goal of improving access to food while addressing overall equity within the system, the authors describe CFAN as a potential community organizing model in food assistance systems.

Massive transfusion protocol activation does not result in preferential use of older red blood cells.

Widespread, anecdotal belief exists that patients receiving massive transfusion, particularly those for whom a massive transfusion protocol (MTP) is activated, are more likely to receive older red blood cells (RBCs). Retrospective review of blood bank records from calendar year 2011 identified 131 patients emergently issued ≥10 RBC units (emergency release (ER)) prior to obtaining a type and screen. This cohort was subclassified based on whether there was MTP activation. For comparison, 176 identified patients transfused with ≥10 RBC units in a routine fashion over 24 hours represented the nonemergency release (nER) cohort. Though the median age of ER RBCs was 5 days older than nER RBCs (ER 20, nER 15 days, P < 0.001), both fell within the third week of storage. Regardless of MTP activation, transfused ER RBCs had the same median age (MTP 20, no-MTP 20 days, P = 0.069). In the ER cohort, transition to type-specific blood components increased the median age of transfused RBC units from 17 to 36 days (P < 0.001). These data refute the anecdotal belief that MTP activation results in transfusion of older RBCs. However, upon transition to type-specific blood components, the age of RBCs enters a range in which it is hypothesized that there may be a significant effect of storage age on clinical outcomes.

Incomplete pretransfusion testing leads to surgical delays.

BACKGROUND: The Joint Commission has highlighted the importance of having appropriate and complete pretransfusion testing before surgery begins. The maximum surgical blood ordering schedule (MSBOS) indicates which patients require preoperative transfusion testing. We determined the number of times surgical delays were caused due to the lack of completed pretransfusion testing. STUDY DESIGN AND METHODS: All transfusion events reported through the common medical event reporting system of eight networked hospitals over a 12-month period were evaluated to determine how often patients experienced surgical delays due to not having complete pretransfusion testing. RESULTS: During this 12-month period 12 patients were identified who were either in or en route to the operating room with incomplete pretransfusion testing leading to a delay in providing crossmatched red blood cells (RBCs). In 6 of 12 cases a new antibody was discovered, which required extra time for the provision of crossmatched RBCs, while in 4 of 12 patients the samples were not sent or were lost on the way to the blood bank. In the remaining two patients other parts of the pretransfusion testing process were not followed according to hospital policy. The median surgery start time delay was approximately 12 hours (range, 1-168 hr) in 11 of 12 cases. One patient's case was not aborted when it was discovered that crossmatched RBCs were not immediately available due to newly detected alloantibodies. CONCLUSIONS: We identified three mechanisms by which delays in completing pretransfusion testing in surgical patients occurred. Adherence to the MSBOS and sample collection policies should reduce delays.