Organisation of Dietary Services in Hospitals

8/14/2019 Organisation of Dietary Services in Hospitals

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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


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facilities, housekeeping, dietician and steward offices and

circulation area.

Following space requirements are recommended for

different sizes of hospitals.

2oo bed or less : 20 sq ft per bed

200 to 400 bed : 16 sq ft per bed

500 beds and above : 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- in-

refrigerators, coolers and dry storage

Pre- production preparation area


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Cooking or food production areas, separate forvegetarian 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.


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Coffee shop/ snake bar, preferably off site.

Staff requirement:

Number of beds

Category of staff 100 200 300 500 750

Chief dietician - - - - 1

Senior dietician - - - - 1

Dietician - - - 1 1

Asst. Dietician 1 2 3 5 7Steward - - 1 1 1

Store keeper (

ration)

- - - 1 1

Store keeper *(

general)

- - - 1 1

Clerk/ typist - - - 1 1

Head cook 1 1 1 2 2

Therapeutic cook - - 2 2 3


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Cooks 4 6 8 10 16

Asst. cook or bearer 6 14 20 28 32

Masalchi 4 4 6 8 10

Store attendant - 1 1 2 2

Sweeper 1 1 2 2 3

Functions of the food service Department:

Administrative:

Formulation of departmental policies in consultationwith the medical superintendent, e.g. Policies with

regard to indent, selection and purpose, storage andissue of fraction, preparation and distribution of food

etc.

Establishment and supervision of adequate recordsand supervision of record keeping e.g. Purchase

records, records of stock and various stores,

equipment and financial records.

Menu planning Budget planning


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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, in-

service 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


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Nephritic syndrome clinicDiabetic clinicCardiac clinicPediatric 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.


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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


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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


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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


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The wastage of food would be reduced to bareminimum

The ward staff would be able to devote more time topatient care

With little more kitchen staff, it will help in speedierdistribution 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 hospitaladministration. There should not be more than 3-4

members and the senior dietician should be the member -

secretary

Thanking You.


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Documents

Organisation of Dietary Services in Hospitals