Quality Indicators of Catering Services in a Hospital


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Quality Indicators of Catering Services in a Hospital

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Quality Indicators of Catering Services in a Hospital

  1. 1. Group Members of EPGDHA Batch 2013-2014 1. Dr. Susan Fernandes 2. Dr. Allan Pereira 3. Dr. Sreya Joseph 4. Mrs. Elizabeth David 5. Ms. Diana Vincent 6. Mr. Tapan Doshi 7. Mr. Sameer Shinde
  2. 2. Quality Control Equipments Food Cooked Kitchen Sanitation Raw Materials
  3. 3.  Quality Control of Food: 1. Its is very important to maintain quality of food 2. Standardization of cooking methods. 3. Regular Health Check up of Kitchen Staff. 4. Regular Training in Food Handling 5. Surprise testing of cooked food by senior officials  Quality Control of Area: 1. Schedule of Kitchen Cleaning 2. Maintenance & calibration of equipments. 3. Monitoring of Cold room, Deep freezers & Refrigerator 4. Method of Disposal of waste 5. Proper ventilation & smoke exhaust
  4. 4.  Hospital malnutrition & increased prevalence of hospitalized patients with chronic diseases require hospital improvements in nutritional care quality.  This presentation describes the construction of indicators to assess the quality of hospital food & nutritional care.  Design Nutritional Groups: each group has 4 indicators. 1. Nutritional Care Quality (NCQ) : It includes a. Inpatient dietary coverage b. Evaluation & monitoring of nutritional status c. Integration of nutritional assistance activities within the team d. Diet therapy. 1. Food Service Quality (FSQ): It includes a. Mediation with users & other hospital sectors, b. Autonomy & management control c. Meal production d. Staff qualification
  5. 5. There are nine meals in a day  Bed tea  Breakfast  Mid morning  Lunch soup  Lunch  Evening tea  Dinner soup  Dinner  Health beverage
  7. 7. Sr. No Date : Time: Ward Comments 1 No. of beds 2 No. of Patients 3 No. of patients fasting 4 No. of patients requiring a meal 5 Time trolley left the kitchen 6 Time trolley arrived in ward 7 Time service commenced 8 Time service completed 9 No. of patients eating in this environment (Yes / No) a In bed b At bedside c At table in bay d Communal dinning room 10 Preparation All Most Some None a Was the patient provided help with using the toilet and washing hands? b Were the bed tables & eating areas cleaned
  8. 8. Sr. No Meal Checking All Most Some None 11 Was the meal trolley large enough to carry hot food? 12 Were the temperatures of the food recorded on any of the services at the ward level 13 Were the meals checked against what the meal had been ordered? 14 Did the patient/ clients receive his/ her menu card along with the meal Sr. No Meal Service & Beverage All Most Some None 15 Meal service carried out in pleasant manner 16 Appropriate crockery provided? 17 Patients/ clients proper identified? 18 Patients well seated for meal? 19 Lids / cling film removed? 20 Assistance given to cut food? 21 Nutritional intake noted? 22 Was water made available? 23 Was the meal accompanied by choice of beverage ordered Sr. No Interruptions All Most Some None 24 Did routine rounds disrupt patients meal? 25 Did the medicine trolley disrupt patients meal? 26 Did blood test or others clinical investigation disrupt patients meal Had patient finished eating before the meal
  9. 9. Sr. No Details Accountable Who carries out the task? 1 Meal ordering fro e.g.: diet order form or bulk order form, if applicable 2 Menu completion on behalf of individual patients 3 Preparation of ward environment for meals 4 Preparation of patients for meals 5 Ensuring the patients receives the correct meal 6 Distribution of meals 7 Assisting patients with feeding 8 Monitoring food consumption of individual patients 9 Collection of plates 10 Dealing with complaints/ feedback on catering services
  10. 10.  A strict check on the quality of the food prepared & served to patients.  Quality of food grains, raw vegetables, fruits, sweets beverages are to be checked routinely  Non veg items should be absolutely fresh if served.  Quality of cooking medium & spices OF  Supervisory visits /Quarterly quotations /Regular checks on the dietary department.  Good Physical layout ensuring easy workflow.  Correct use of standardized recipes.  Scientific technique& procedure for preparing each category of food so that their natural flavor & nutritional value is not compromised.  Progressive cooking & preparation of food in the shortest period of time .  Availability of Quality trained staff.  Good management & supervision.
  11. 11.  A food borne hazard is a physical, chemical, or biological object in food or drink that can cause injury or illness.  Physical: Hard or soft objects in food that can cause injury. Eg: broken glass, jewellery, adhesive bandages, staples, & fingernails.  Chemical: Poisonous substances that occur naturally or are added during food handling. Eg: include cleaning agents, pesticides, & certain metals. Due to a broken valve in a soda machine.  Biological: Germs that cannot be seen without a microscope. Eg: parasites, bacteria & viruses. Several customers became infected with hepatitis A after eating sandwiches prepared by an ill food worker.
  12. 12.  Potentially Hazardous Foods include:  Animal Products 1. Meat, fish, poultry, seafood, eggs 2. Dairy products  Cooked Starches a. Cooked rice, beans, pasta, potatoes  Fruits & Vegetables a. Cooked vegetables b. Tofu c. Sprouts (such as alfalfa or bean sprouts) d. Cut melons e. Garlic or herbs bottled in oil
  13. 13.  Food workers with good personal hygiene  Food cooked to or held at correct temperatures  Prevention of cross contamination Top three Food Safety Defences
  14. 14. Food workers, even if they look & feel healthy, may accidentally spread harmful germs to food if they do not have good hygiene. Food workers should work with food if they have:  Diarrhoea, vomiting, or jaundice  Diagnosed infections that can be spread through food such as Salmonella, Shigella, E. coli, or hepatitis A  Infected, uncovered wounds  Continual sneezing, coughing, or runny nose
  15. 15. Proper food worker hygiene includes:  Not working with food when you are sick Washing your hands the right way & at the right time  Using clean gloves & utensils when handling food  Keeping fingernails trimmed so hands can be easily cleaned 8 Steps of HAND WASHING
  16. 16. Proper temperatures are required for the safety of potentially hazardous foods. A thermometer must be used to make sure the cooked, cooled, & stored at food is delivered at correct temperature. Most bacteria do not grow in hot or cold temperatures. To keep food safe, cold foods must be kept 41°F or colder. Hot foods mu 140°F or hotter. The range of temp between 41°F - 140°F is called the Danger Zone When potentially hazardous foods are left in the Danger Zone, bacteria can grow fast or poisons that can make people sick.
  17. 17. The metal stem “dial” thermometer is the most common thermometer used in food service. Dial thermometers work well for taking temperatures of thick foods. The stem must be pushed several inches into the food & left in for at least 20 seconds Digital thermometers are also used to measure food temperatures. They have a metal stem too, but have digital numbers instead of a dial. Digital thermometers are easy to read & are better for measuring temperatures in thin foods
  18. 18.  Thermometers should be checked often to make sure they read the correct temperature.  To check for accuracy the thermometer’s sensor is put in a cup of crushed ice & water. The mixture should be 32°F. If the thermometer doesn’t read 32°F, the thermometer needs to be calibrated from a recognised lab.  Using a thermometer: 1. Make sure it is clean, sanitized & accurate 2. Insert into the thickest part of the food – usually the center of the food 3. Take the temperature for several seconds until the numbers stop changing.
  19. 19.  Cooking food to the right temperature is the best way to kill germs that might be in the food.  All raw animal products cooked in a microwave oven must be heated to at least 165°F.  Cooked potentially hazardous food must be kept until it is served.  Hot food must be kept at 140°F or hotter.  Cold food that will be hot held must be reheated to at least 165°F quickly (within two hours).  Tips for keeping food hot: 1. cover pans 2. stir food often to distribute heat 3. never mix cold foods with cooked foods  COLD food must be kept 41°F or colder .  Potentially hazardous salads made from food at room temperature (such as canned tuna) must be cooled to 41°F within 4 hours of preparation  There are three safe methods for thawing food: 1. In the refrigerator Put frozen food in the refrigerator until it is thawed. 2. Submerged under cold running water. Keep the food covered in cold (70°F or colder), running water until it is thawed 3. As part of the cooking process or in the microwave: Small items, such as frozen burritos, may be thawed while they cook  Three approved cooling methods 1. shallow pan method (food no more than 2 inches deep) 2. size reduction (cutting solid food into smaller pieces) 3. time & temperature monitored (forcing food to cool in a short amount of time) Keep “Hot Foods Hot” & “Cold Foods Cold”
  20. 20.  Cross contamination happens when bacteria from raw foods get onto other foods. Raw meat is the main source of cross contamination.  Tips to avoid cross contamination: 1. Wash hands after handling raw meat 2. Wash & sanitize all food-contact surfaces that touch raw meat 3. Prepare raw meat in an area away from other foods 4. Use a separate cutting board for raw meat 5. Store raw meat below other foods in the refrigerator & freezer 6. Store meat with a higher cooking temperature (like chicken) below meat with a lower cooking temperature (like fish) 7. Food-contact surfaces should be washed, rinsed, & sanitized after each use to remove germs that can cause illness. 8. The sanitizer should be changed often because grease, dirt & food piece make the sanitizer less effective Prevention of Cross Contamination
  21. 21. Personal hygiene  Clean hands & clothing.  Minimise jewellery on hands & wrists.  Tie-back or cover hair.  Clean & short fingernails.  Avoid unnecessary contact with food.  Cover all cuts & sores with a brightly coloured waterproof dressing.  Do not eat over food or food surfaces.  Do not prepare food when you are ill.  Avoid touching your face & hair.  Do not cough or sneeze over food.  Do not taste food with your fingers or “double dip” with a spoon.  If wearing gloves, change frequently. Cleaning  Essential for the safe operation of any food business.  Must be continuous and ongoing.  Thoroughly clean and sanitise all food surfaces, equipment and utensils with hot water and detergent and chemicals (sanitisers). Remember that most detergents do not kill bacteria, but hot water and sanitisers do!  Implement a cleaning schedule to ensure that cleaning is conducted on a regular basis (including hard to reach places).
  22. 22. Measures to Control Pest Pest Control  Keep them out – seal the food premises.  Starve them out – keep food premises clean.  Throw them out – conduct regular pest inspections or services.  Don’t give them a home - remove all unnecessary equipment & items.  Report all pest sightings or evidence of pest activity to your supervisor.
  23. 23. Waste Management & Log sheets  Place waste in plastic lined bins.  Remove all waste from the premises as required.  Empty & clean waste bins regularly.  Ensure all external bins are covered.  Protect external waste bin area from pests & birds.  Label food and keep separate.  Recycle the waste generated.
  24. 24. Ward: Sheet Number: Period from: To: Date Meal Time ( B, L D) No. of meal ordered No. of additional meals supplied Total No. of Meals supplied Total no. of unserved meals % unserved meals Avg % of plate waste Total Total % of ward wastage
  25. 25. Date: Ward: Menu cycle: Meal time: Main course Items No. of portions ordered Additional portions supplied Total no. of portions supplied Total no. of un served portions supplied % of unserved portions Avg% of unserved Meals Avg % of plate waste Total % of ward waste
  26. 26. Hospital Name Unit: Date: Sheet No: Period from: To: Ward % of unserved meals Avg % plate waste Total % of ward waste Total % of food waste:
  27. 27. Date : Ward : Completed by: Menu cycle: Meal time: Sheet Number: Bed Patients/ clients name or tray / bed number Meal portion Size ( S, M, L) % of plate waste Reason of waste (see the codes) Corrective action Avg % of plate waste Reasons for not eating Codes Clinical Reasons: effect of drugs, dental problems, swallowing, nausea, vomiting, diarrhoea, poor appetite C Patients/ clients requiring food assistance with food & packets, unable to reach food, unable to consume food without assistance A The environment: interruptions, uncomfortable or unpleasant environment E The Meal Service: unacceptable food choices, insufficient time given to eat, patient not available at the ward meal time, too much food on the plate M Food Issues: unfamiliar dishes, lack of sauces, condiments, food cold or of poor quality ,incorrect or unfamiliar textures F
  28. 28. Research Articles:  Food safety is everybody's business, Washington State & Food Beverage Workers Manual.  Managing Food waste in NHS: 2005 New south Wales Websites: www.google.com www.slideshare.net
  29. 29.  Only work when you are healthy.  Wash your hands often & well.  Don’t touch ready-to-eat food with bare hands.  Keep food hot or cold.  Cook food to proper temperatures.  Cool hot food as quickly as possible.  Keep raw meat away from other food.  Wash, rinse, sanitize, air dry – always follow the 4 steps in order.  Keep food preparation areas & utensils clean & sanitized.  Report or prevent all suspected breaches of food safety.  Report all evidence of pest activity.  Conduct regular temperature checks of food with your probe thermometer.  Implement a cleaning schedule.  Obtain & read a copy of the Food Safety Standards.  Encourage other food handlers to attend food safety training programs like this one.  Be aware food hazards are everywhere! Don’t give them any opportunity to contaminate food.  Always remember - prevention is better than cure.  Ask questions if you have them.
  30. 30. It is essential that catering services in hospital requires skills & knowledge of food safety & food handling controls to minimise the risk of food poisoning in hospital hence it is our responsibility to ensure that food for your patients is safe & suitable to eat.
  31. 31. Thank You