Hospital food and beverage services

Food Beverages

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?

How will specification be met?

Standard recipes Standards of procurement

What is the most suitable portion size? What is the nutritional specification? What are the ingredients specifications? What are the cost specifications?

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 Home Start of this section

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 Home Start of this section

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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