An apple a day …

The catering business is tricky, and the catering business in care facilities is trickier still. DANIELLE DU TOIT investigates hospital care catering.

The various different types of catering operations each have their own challenges and risks, but catering for those in hospitals and care facilities is filled with a dizzying set of responsibilities and hazards.

Clinical governance is a term used to describe a systematic approach to maintaining and improving the quality of care within a health care environment. It is vital, even in a care catering environment, to adhere to the clinical governance guidelines at all times as this helps minimise risks to patients, practitioners and the whole organisation.

Poor quality is a threat in any industry, but risks can be mitigated by having a strict code of conduct in all areas. This governance requirement includes employing not only high quality staff but also maintaining a hygienic environment which translates to excellent medical standards and ethics.

All hospitals should have a policy for food service and nutritional care which is patient-centred and performance-managed, and which is in line with country government frameworks.

How it all works
Screening patients on arrival is the first step. Four of every 10 patients in the UK arrive at hospital malnourished, according to a 2008 study by the British Association for Parenteral and Enteral Nutrition. South African figures are likely to be higher. “Malnourished” doesn’t necessarily mean the person is underweight. They could be overweight but be consuming food with insufficient nutritional value.

All patients, especially those more at risk, such as the elderly, need to have their nutritional needs met in order to help advance recovery. It is important that all staff are aware of the fundamental importance of nutrition as this has an affect on recovery and general wellness. The screening process is one of the most important steps in the hospital admission process, and is often overlooked.

Common indicators of nutritional risk in a patient include being overweight, underweight, having anaemia, food insecurity, eating disorders, substance abuse and excessive intake of foods and beverages with high fat or sugar content. Other factors to be considered are medical and psychosocial history, growth and development and physical activity.

Following the screening process, hospital staff will have a better understanding of the individual nutritional requirements of each person and can begin to formulate a plan to tackle
these needs.

This step is not followed very closely in many South African hospitals – yet it is strictly adhered to in the United Kingdom whose primary health care system is nationally funded and serves 62 million people a year. Even in the South Africa’s private hospitals, this screening process is rare.

One of the most important parts of the job in care catering is presentation. No one wants to eat a meal that is unsightly or cold. More importantly, it should be a strict rule in all hospitals that meal times cannot be interrupted.

Florence Nightingale (1820-1910), the nursing sister who pioneered hospital hygiene and sanitation development, once said: “Nothing shall be done on the ward whilst patients are having their meals.”

This has become paramount in care catering today, where 40 percent of hospital food is wasted because of interruptions and an environment that is not conducive to relaxation. Called “protected meal time policy”, this rule has to be adhered to by all hospital staff. The hospital ward environment, sights, sounds and smells and preparedness to eat can all affect an individual’s desire and ability to eat and enjoy their food.

Hospital staff, regardless of designation, should all have the appropriate skills and competencies needed to ensure that patients’ needs are met, irrespective of whether they require specific nutritional care or not.

Public versus private
The differences between the public and private healthcare sectors in South Africa are vast – and although out government hospitals are known for having world class doctors and surgeons, and state of the art equipment, the same cannot be said about the quality of food served.

“Mostly pap and bits of meat when available” – that’s what DA spokesman Jack Bloom said patients were being given to eat at Chris Hani Baragwanath Hospital, a state-owned facility, apparently due to administrative backlogs.

Conversely, Netcare, the largest private healthcare organisation in South Africa, is home to the country’s top chefs. Netcare’s Chef of the Year is a bi-annual competition open to all chefs and caterers working in any Netcare facility. Netcare even has chefs on the South African team for the Culinary Olympics taking place this year. There is a startling disparity between these two stories.

Hospital facilities should be designed to be flexible and patient-orientated, with the aim of providing and delivering food services and nutritional care 24 hours a day. It is vital to ensure that kitchen facilities are built in such way that
they can be easily accessed throughout the hospital.

Warming trays are one of the easiest ways to keep food warm from kitchen to ward. Bacteria will grow exponentially in an environment just 2°C cooler than when it was prepared, which is why the layout of the facility is vital to food hygiene.

As you can see, catering for a wedding may be challenging but catering for a hospital with 1 500 patients with their own specific nutritional needs provides a new set of complications.