Organization Of Dietary Services In a Hospital Introduction: Good food is important in the treatment of patient and is a part of his total

care The food service department in todays modern hospital ranks as one of the major department It is headed by a specialist who is either a professional (Food service) manager or a chief dietitian Hospital have long recognized the public relations value of the food service department Unfortunately, criticism of food is one of the most frequently heard complaints in any hospital. The major share of this criticism of food is one of the most frequently heard complaints in any hospital. The major share of this criticism can be avoided by a properly planned and administered food service

department.

Location: A ground floor location is preferable, and also convenient to deliver supplies The department should be close to the material management department The storage area should be close to the unloading dock Easy access to vertical transportation system serving patient care units is important to facilitate delivery of patients meals and return of used trays and utensils The cafeteria and dining rooms should be close to the food preparation and production area, and within convenient access to the hospital staff

Space requirement: Hospital kitchen is divided into number of division which has a particular activity. The board areas are supplies receiving area, storage area, cooking area, pots and pan wash, garbage disposal, LPG Stove and refrigeration

facilities, housekeeping, dietician and steward offices and circulation area. Following space requirements are recommended for different sizes of hospitals. 2oo bed or less 200 to 400 bed 500 beds and above : : : 20 sq ft per bed 16 sq ft per bed 15 sq ft per bed

Facilities: The following facilities are require. Food services managers office Secretarial, clerical office with space for file cabinets and other requirement, seating for visitors , vendors etc. Office space for chief dietician and staff dieticians. Receiving area Storage and refrigerator on area with walk- inrefrigerators, coolers and dry storage Pre- production preparation area

 Cooking or food production areas, separate for vegetarian and non- vegetarian foods Special diet kitchen Tray assembly or make up area Dishwashing area Pot washing area Trolley, cart washing area and clean cart storage area Deep sinks and hand washing facilities in various places Garbage disposal facilities Storage with ranks and cabinets for clean pots, pans , vessels etc. Employee facilities like lockers, staff toilet etc. Dining hall with self service counter, clean tray storage areas, seating for adequate number of people, used try depositing area, hand washing facilities, drinking water fountain etc. Special dinning rooms for officers, medical staff, special guests, meeting etc.

 Coffee shop/ snake bar, preferably off site.

Staff requirement: Number of beds Category of staff Chief dietician Senior dietician Dietician Asst. Dietician Steward Store ration) Store general) Clerk/ typist Head cook Therapeutic cook 1 1 1 2 1 2 2 1 2 3 keeper *( 1 1 keeper ( 100 1 200 2 300 3 1 500 1 5 1 1 750 1 1 1 7 1 1

Cooks Asst. cook or bearer Masalchi Store attendant Sweeper

4 6 4 1

6 14 4 1 1

8 20 6 1 2

10 28 8 2 2

16 32 10 2 3

Functions of the food service Department: Administrative: Formulation of departmental policies in consultation with the medical superintendent, e.g. Policies with regard to indent, selection and purpose, storage and issue of fraction, preparation and distribution of food etc. Establishment and supervision of adequate records and supervision of record keeping e.g. Purchase records, records of stock and various stores, equipment and financial records. Menu planning Budget planning

 Cost accounting Condemnation of equipment House keeping and sanitation General supervision of the personnel

General food services: Matters with regard to uniform, work schedules, time schedule for service of meals and safety etc., infection control, adequate measures for control of vermin, inservice training programme for class IV employees

Clinical functions: Dietician plays a very vital role in the planning of various types of therapeutic diets and provides dietary advice to patients admitted in the various indoor areas of the hospital. he/she tends to the outdoor patients and specially those attending the following clinics: Juvenile diabetic clinic

 Nephritic syndrome clinic Diabetic clinic Cardiac clinic Pediatric clinic

Educational function: The dieticians of the large hospitals also have to perform an important educational function in the form of a various training programme for the graduates in dietetics They also train nurses and other paramedical workers on the various aspects of hospital dietetics.

Organization: 1) Relating to the administration of department and food production 2) Therapeutic food service and instructions to patients, and their counseling Administrative duties ranging from purchases to planning of menus occupy most of the managers time.

The therapeutic duties include diet therapy, planning patient menus and special diets, supplying a special diet list to patients and counseling. Educational activities include teaching students and training dietician trainees Many hospitals make it mandatory that those working in the food service department undergo physical examinations regularly to ensure that they are free of communicable disease. Dietary aids, if properly trained, can perform a variety of functions such as checking routine tray line, and making out chare slips etc. Early in planning and design stage, hospital should decide as a matter of policy whether hospital food is to be compulsory for all patients and the concomitant facilities are dependent on this decision. Both these systems have their merits and demerits. In some hospitals, food is included in the charges for the room. Meal planning is one of the primary functions of the department It is the determination of meals that are

to be served to the patients .Cycle

menus that are

commonly used consist of a series of skeleton menus to be served over the length of the cycle- weekly, biweekly or monthly Variations are sometimes made to take

advantage of seasonal food. Therapeutic nutrition requires a qualified dietitian to assist in patient therapy. In most

cases, nutritional therapy, as ordered by a physician, requires modification of the normal diet in its content, consistency and preparation. It is necessary that a specially prepared diet be written for every individual patient although customarily a master cycle menu may have been developed .Therapeutic and special diets and meal should be clearly marked, preferably by colour coded labels.

Distribution of food Decentralized system Centralized system

1) Decentralized system: At present in many hospital the diet distribution system is decentralized, which means that the kitchen staff takes the diets to the respective wards as per requisition and leaves the food with the ward staff, to be distributed under nurses supervision This is found to be unsatisfactory for the following reasons: It resulted in delay in distributing the diets to patients It was also observed that 20- 40 % food was wasted as many patients eat the food brought from their homes Lot of nurses and ward staffs time was wasted

2) Centralized system: This would mean that diets distribution will be carried out entirely by the kitchen staff The bearers will take and distribute the food directly to the patients without much involvement of the ward staff

 The wastage of food would be reduced to bare minimum The ward staff would be able to devote more time to patient care With little more kitchen staff, it will help in speedier distribution of diets.

Dietary Stores Management: There is a need of a sort of watch- dog for the stores management in the kitchen. For this an internal

purchase committee may be constituted by the hospital administration. There should not be more than 3-4 members and the senior dietician should be the member secretary

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