Activity/ Description Responsibility Ref.

Documents / Record
Dietary advice The doctor/ dietician Doctor/Dietician Bed Head Ticket/ Diet Char
(where available) advises diet as per
the nutritional requirement of patient.
Calculation of No. of Diet: The Nursing Incharge Diet Register
concerned nurses at the IPD calculate
the dietary requirement of the patient
in the diet register and sent it to the
kitchen incharge.
Procurement of Raw Materials: Concerned Nurse Diet Menu Diet Register
Approved Diet Menu is available in the
hospital and with the kitchen in-charge.
On the basis of Diet menu & no. of diet
to be prepared, the concerned person at
the kitchen purchases the raw material
under the supervision of the nursing In-
charge. The inventory of perishable &
non perishable item in the kitchen is
properly maintained by the cook.
Vegetables are purchased on daily
basis.
Preparation of Utensils, Stove Utensils Kitchen Incharge / Cook
are kept ready neat, clean & dry. Stove
and gas cylinder are always kept in
clean and working environment. Stove
in running condition is kept ready for
use.
Washing, Cleaning & Cutting Cook
Vegetables are washed with clean
water and cut on clean and hygienic
surface.
Preparation of Food The food is Cook
prepared by the cook in the hospital
kitchen three times a day in a hygienic
environment wearing gloves, caps and
kitchen gown.
Quality Check of Cooked Food The Cook Monthly Report on Quality of
quality of the food is first checked by food
the cook itself. The nursing In-charge
herself checks the quality of food, and
after consulting the patients, concerned
duty doctors (during evening and night
hours) and the nurses, prepares
monthly quality report and submits it
to the Civil Surgeon
Distribution of Cooked Food The Helper Diet Register
concerned person distributes the food
to the admitted patients at the definite
time thrice a day with the intimation of
concerned nurse.
Feedback on Cooked Food Feedback is Concerned Nurse Diet register
taken from the IPD patient and
reported to the nurses.
Cessation of Dietary Services to
patient
When discharge or referral is advice to Concerned doctor Discharge Slip
the patient the concerned nurse update
the diet register and informs the
concerned person at the kitchen to stop
the dietary services of the patient.
 With advancement in the field of nutrition science the daily needs of human health and disease are now well established. The department of dietetics in hospital is a
vital organization that carries multiple responsibilities related to patient’s daily intake of nutrition. Patients are being provided with nutrition education and
hygienically prepared high quality food services.

Location:

Diet Distribution Centre: D-1, Ground Floor, Main Building, Civil Hospital, Ahmedabad.

Address of Office – D-7, Third Floor Main Building,

Civil Hospital, Ahmedabad

Phone No. – 079 – 22683721 (Ext.1135)

Fax No. – 079 – 22683421

Number of diets provided to patients:

Daily Average 1100

Monthly Average 33200

Clinical services:
 Daily ward rounds are taken by the dieticians in their respective wards and diet is prescribed and implemented in consultation with the doctors. Individual diet
counseling along with diet chart is provided to indoor as well as outdoor patients.
 The main objective of this department is to provide better nutritional care through properly planned and executed diets to indoor patients.
 It provides tea and milk twice a day, breakfast and two balanced meals – lunch and dinner, providing optimal nutrition which is free of cost.
 Lunch & Dinner is outsourced to “Touch Stone Foundation” which provides seven types of diet to patients as recommended by consultant and dietician.
 Breakfast, Tea (Morning & Evening) served by the Hospital.
Patient Services:
 According to patient’s need R T Feed is prepared and served to the patient which is prepared under supervision of dietitian.
Diet Distribution Timings:
 Breakfast – 8:30am to 9:00 am
 Lunch – 11:30am to 12:00 pm
 Dinner – 6:30pm to 7:00 pm
Services Offered

SR.NO FOODS AVAILABLE

1 FD (Full Diet)
2 SFD (Salt Free Diet)
3 FFD (Fat Free Diet)
4 HPD (High Protein Diet)
5 DD (Diabetic Diet)
6 LD (Light Diet)
7 MD (Milk Diet)
Feed back
 In General wards the feedback forms are given to the patients on a regular basis. On the basis of the various suggestions/opinions thus obtained, efforts are
made to improve the meal services accordingly.
Medical checkup
 Routine medical examinations are done for Cooks and supportive
staff once in a year and suitable treatment are given to them.
Personal hygiene
 Regular checking of hair, nail, dress are done by the dieticians for maintaining good personal hygiene of food handlers and are taught them about the cleanliness
and hygienic food preparation and services on regular basis.
 

Hospital food service does not operate in isolation but requires the co-operation and integration of
several disciplines to provide the ultimate patient experience. Accordingly, stakeholders such as
medical staff, food service staff, dietitians, hospital managers, pharmaceutical staff, patients and
visitors were consulted to identify factors contributing towards patient satisfaction and to elucidate
patient meal experience.

Patient Care All clinical stakeholders were in accord, that there should be a nutritional policy
framework and that this should be under the auspices of the nursing directorate, ‘…a clinical champion
is needed for food’ – chief pharmacist ‘…an advocate (voice) is required at directorate level’ - dietitian
and nurse

Patient Satisfaction Medical and catering staff identified that patients are becoming more demanding
and more critical. Generally though, patients thought the quality of food was better than expected and
when asked to recount ‘the best meal experience in hospital’, answers reflected the importance to
patients of correct temperature and food quality. ‘…my best hospital meal experience was where the
food was just like at home, hot, and we ate it sitting around a table’ - patient There was no mention in
patient responses of empathy and/or service delivery attributes. The ward hostesses confirmed that the
main complaints from patients refer to the temperature and texture of the food. Patients commented on
their preference for traditional food, such as, ‘…chicken and mushroom pie, fish and chips and roast
dinner’ This was endorsed by the food service manager who said that a popular dish in this hospital is
pilchard salad. Another idea under discussion within this hospital is the use of branded foods for items
such as coffee and soup. ‘…patients would feel safe and secure, know what they were getting – rather
like a comfort blanket, hopefully this would improve satisfaction’ – food service manager Patients were
quite enthusiastic about this suggestion and felt that they would have trust in a known product. Those
patients who had experienced both the plate and trolley system of food delivery commented that they
much preferred the latter. ‘There is usually sufficient choice. I much prefer this method of distribution
to the menu system because you cannot foresee how hungry you will be’ – patient 9 There was also
endorsement from dietitians and nursing staff who agreed that the trolley system of delivery did allow
for greater patient/server interaction. A common theme from patients was their inability and difficulty
in providing feedback to the catering staff. The perception was that food was prepared some distance
away by anonymous people who rarely came on the ward. Dissatisfaction was also expressed with the
menu system where items were described without interpretation. ‘Description on the menu does not fit
reality’ - patient ‘I don’t understand what a B.L.T. sandwich is or macedione of vegetables’- patient.
Meal Times The potential of protected meal periods, food service uninterrupted by medical staff, was
greeted with enthusiasm by patients and hostesses, ‘…we are all falling over each other in the morning
– what with the blood lady, nurses and consultants’ – hostess but with caution by medical staff.
Ambience of the ward was discussed and it was agreed by patients and medical staff alike that music
would disturb, ‘…patients may become confused particularly the elderly’ - doctor However, the
opportunity to sit and eat a meal in company was welcomed especially by visitors, ‘…eating with
others is a good idea – a social thing, it’s bad enough being in hospital’ – visitor Food Service
Management The main theme with regard to food service management was the fragmentary nature and
difficulty of communication between the kitchen and wards. Food service managers have to rely on
kitchen porters for the delivery of food to the ward, ward staff have difficulty in communicating with
food service staff and dietitians/doctors are reliant on nurses to communicate any concern regarding
patients. There was agreement that the 10 post of hospital food service manager was essential to
oversee the whole meal process from kitchen to consumption. Financial constraints are a prominent
part of the concern of the food service and facilities managers, with budgets continually being reduced
and not ‘ring-fenced’ (protected). Patients are willing to make a payment towards the ‘hotel facilities’
that hospitals offer, if it would mean improved food provision. However, the food service manager is
reluctant to agree as he felt that this would make the patient even more critical. Food Service Staff The
food service manager was enthusiastic in the potential for dedicated food service staff who could be
trained to, ‘sell the product’ ‘reduce wastage’ and ‘tempt jaded palates’ Food wastage forms (ERIC –
Estates Return Information Collection, 2001) (NHS Estates, 2001) are used as a measure of consumer
satisfaction, and wards where there are hostesses, demonstrate less waste and greater patient
satisfaction. Hostesses see their role as carers and feel their allegiance is towards the ward, whereas
paradoxically, the food service manager felt this role was 60% food service and 40% carer.

Patient Satisfaction The consideration of patient’s expectations and perceptions should have particular
significance in shaping the objectives of any food service operation. Expectations were matched by the
trolley service of delivery and hence a corresponding level of satisfaction was achieved. Food Quality
Unfortunately hospital food service has an image problem, before even tasting it patients generally
expect poor quality (Beck et al., 2001); previously described as ‘institutionalised stereotyping’
(Cardello et al., 1996). Food quality attributes, particularly temperature and texture have been
demonstrated in this case study to have a critical effect on patient satisfaction. Although service
features were not a high priority from a patient perspective, it has been suggested that staff attitudes can
be as crucial as 3 strain-gauge - a device whose electrical resistance varies in proportion to the amount
of strain or weight 13 food temperatures (Jackson, 1997). Results from this study agree with other
research showing that the service predisposition of NHS staff is such that the food service experience is
mostly satisfactory (Lee-Ross, 1999; Hwang et al., 2003), and therefore it can be concluded that food
quality is the driving factor for satisfaction. Food Service System Patients expressed satisfaction with
the trolley style of delivery and certainly there is more opportunity for patient/staff interaction and
nurture. However, one instance was observed in a ‘close to discharge bay’, where the presence of
nursing staff is infrequent, a nurse performed a medical procedure during food service. The potential
for crosscontamination is evident, adding weight to the argument of employing dedicated food service
employees. The benefit of ward hostesses has also been demonstrated by factors such as reduced food
wastage and less need for sip feeds (Waite et al., 2000) together with increased patient satisfaction
(Gledhill, 2000; NHS Estates, 2003). In any food service programme, perceptions of freshness can
greatly affect how patients rate the overall meal (Doucette, 1999). If patients can choose their food just
before they eat it, this greatly enhances their perception of the item’s freshness and influences
satisfaction; perceived control and patient empowerment have also been shown to strongly influence
patient satisfaction with food services (Bélanger and Dubé, 1996; Faulkner, 2001). This research
supports the suggestion that where patients have increased involvement with the process of food
service such as in the trolley system of delivery, satisfaction is increased. Meals The main problem, as
observed in this study, is the lack of structure and priority given to food service both pre and post
operative; clinical considerations taking precedence. In some hospitals, such as acute, prioritising
clinical care might be appropriate. However, for rehabilitation and elective surgery, food should gain a
higher priority and become embedded in the concept of an integral part of treatment. Meal times need
to be protected so that meals can be enjoyed, free from interruption as one would expect in any
hospitality situation. Much was made by patients regarding food that was easily recognisable and
traditional. When in hospital, there is a need for familiar meals that remind patients of home;
complicated, sophisticated dishes are not well received. 14 Interactive Menu Menus are an important
tool for the food service manager as they are the first point of contact with the patient and can be used
both for communication and marketing purposes. However, if not easy to read or interpret, a negative
message can be portrayed. A touch screen facility with a direct link to the catering facilities is being
considered at the case study hospital, as all patients have access to bedside televisions. This will enable
patients to preview dishes available and then select as required. Feedback and Communication Hospital
food service requires a policy, framework, manager and representation at Trust Board level. There
needs to be a continuum from kitchen to consumption, with emphasis on hospitality and quality.
Feedback and communication in this hospital is fragmentary at best and not actioned at worst. There is
a dependence on informal dissemination of information without structure, reflecting the multi-
disciplinary nature of the service and stakeholders. Ultimately, it is the patients who are disadvantaged;
whose health ironically, is the focus of attention. Poor communication and relationship conflict have
been identified in the literature as a cause for concern (Riddiford et al., 2000) and it has been suggested
that organisational research should be conducted within hospital food service to assess and improve the
communication between different staff disciplines (Council of Europe, 2003).

The SOP in Nutrition Care is composed of four standards that apply the Nutrition Care Process and
Terminology in the care of patients/clients/populations (see Figure 1).3 The SOPP for RDNs consist of
standards representing six domains of professional performance (see Figure 1). The SOP and SOPP
reflect the education, training, responsibility, and accountability of the RDN. Both sets of standards and
indicators (Figures 2 and 3, available at www.jandonline.org) comprehensively depict the minimum
expectation for competent care of the patient/client/customer, delivery of services, and professional
practice outcomes for the RDN. This article represents the 2017 update of the Academy’s SOP in
Nutrition Care and SOPP for RDNs.

The SOP in Nutrition Care: reflect the Nutrition Care Process and workflow elements as a method to
manage nutrition care activities (ie, nutrition screening, nutrition assessment, nutrition diagnosis,
nutrition intervention/plan of care, nutrition monitoring and evaluation, and discharge planning and
transitions of care); and apply to RDNs who provide individualized nutrition assessment, intervention,
and discharge planning for patients/clients/populations in acute and post-acute health care, ambulatory
care, home-based, public health, and community settings. The SOPP: are formatted according to six
domains of professional performance (ie, Quality in Practice, Competence and Accountability,
Provision of Services, Application of Research, Communication and Application of Knowledge, and
Utilization and Management of Resources); and apply to all RDNs maintaining the RDN credential: B
in all practice settings; and B not practicing in nutrition and dietetics.

WHY ARE THE STANDARDS IMPORTANT FOR RDNs? The standards promote: safe, effective,
quality, and efficient food, nutrition, and related services, and dietetics practice;
evidence-based practice and best practices; improved nutrition and healthrelated outcomes and
costreduction methods; efficient management of time, finances, facilities, supplies, technology, and
natural and human resources; quality assurance, performance improvement, and outcomes reporting;
ethical and transparent business, billing, and financial management practices9,10; verification of
practitioner qualifications and competence because state and federal regulatory agencies, such as health
departments and the Centers for Medicare and Medicaid Services (CMS), look to professional
organizations to create and maintain standards of practice7,11,12; consistency in practice and
performance; nutrition and dietetics research, innovation, and practice development; and individual
professional advancement. The standards provide: minimum competent levels of practice and
performance; common measurable indicators for self-evaluation; a foundation for public and
professional accountability in nutrition and dietetics care and services; a description of the role of
nutrition and dietetics and the unique services that RDNs offer within the health care team and in
practice settings outside of health care; guidance for policies and procedures, job descriptions,
competence assessment tools; and academic and supervised practice objectives for education programs.