Hospital food and beverage services

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Hospital food and beverage services

• Food
• Beverages

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Food service

• Menu planning
• The Food Chain

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Menu planning

• An inclusive process
• Requires in depth knowledge of the needs of the
  patient
• Menu requires structure
• Menu requires content
• Menu is complemented with non-meal food and
  beverage services

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An inclusive process

• Nutritional value of food not eaten is nil
• Need to involve the consumer at the planning
  stage
• Need to involve the producer and make sure that
  plans can be delivered
• Need to include service staff to engender a pride
  in the product
• Need to check nutritional content and menu
  capacity
• Need to check cost and affordability

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In depth knowledge of the needs of the patient

• Age and gender
• Ethnicity
• Food preferences
• State of health
• State of dentition
• Mental health

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Menu requires structure

• How many meals per day?
• How much choice on offer?
• Range of accompaniments etc etc

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Menu requires content

• What is the most suitable range of dishes?
• What specification of dishes?
• What is the most suitable portion size?
• What is the nutritional specification?
• What are the ingredients specifications?
• What are the cost specifications?

• How will specification be met?
• Standard recipes
• Standards of procurement
• Menu testing
• Feedback from patients
• Feedback from staff
• Nutritional capacity testing
• Nutritional analysis of menu

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Menu is complemented with non-meal food and
beverage services

• Ward issues of
• Milk, breakfast cereals, bread, butter, sugar,
  preserves, tea, coffee etc
• Suitable items for between meal snacks
• Supplements

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The Food Chain

• Patient orders food
• Food order communicated to kitchen
• Provisions procured
• Provisions delivered and receipted
• Provisions stored
• Food produced
• Food distributed
• Food served
• Food intake monitored and appropriate action taken

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Patient orders food

• Ordered at time of service
• Ordered using menu card
• Ordered using hand held device
• Ordered using bedside terminal

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Food order communicated to the kitchen

• Ward order predicted by forecasting
• Card collated at ward level
• Card collated centrally
• Hand held linked on ward or centrally
• Bedside terminal linked by ward or centrally
• Systems can be linked to nutritional databases

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Provisions procured

• Ingredients and product specification need to be
  determined
• PASA system provides data
• PASA manages specification of NHS contracts
• GM free
• Compliance with salt model
• Allergen information
• Nutrition information available

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Provisions delivered and receipted

• Availability is critical to success
• Critical control point with regard to hygiene and
  cost control
• Food bill in typical 1000 bed hospital c1.5M per
  annum
• C4,100 per day of perishable goods delivered

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Provisions stored

• Responsibility for food safety begins with
  delivery
• Food poisoning killed 19 people in Wakefield 1985
• Poor storage adversely affects nutritional
  content
• EHO enforces food hygiene regulations
• EHO can shut kitchen down with immediate effect
• Breach of regulations can lead to prosecution

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Food produced

• Standard recipes are vital
• Nutritional quality control
• Cost control
• Quality assurance

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Food distributed

• Any hospital with more than 300 beds will need to
  consider distribution technology
• Cook chill
• Cook freeze
• Sous vide
• All distribution technology requires regeneration
  at ward level

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Food served

• Protected mealtimes
• Essence of care food and nutrition benchmark
• HCA food service at ward level
• Ward prepared for the meal
• Patients prepared for the meal
• Right meal to the right patient
• Appropriate equipment available
• Appropriate assistance available and planned for
• Arrangements in place for last minute changes

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Food intake monitored and appropriate action taken

• Responsible Registered nurse must be aware of
  patients intake
• Systems in place to record food intake for
  vulnerable patients
• Systems in place to record missed meals
• Systems in place to trigger action when food
  intake deemed inadequate
• Regular communications with dietitian and
  clinical team about food intake

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