crh manipal sikkim no: cau| c

# CRH TITLE: PATIENT DIETARY SERVICE MANAGEMENT DOCUMENT NO: C,op | CAU| C<?P| P3 0 4>

SIKKIM MANIPAL UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMS REVISION NO: 00

REVISION DATE: tO

DocumentedProcedure

VERSION NO. Cl

ISSUE/EFFECTIVE DATE:

PAGE NO: 1 4o 9^-_________DOCUMENT CONTROL STATUS: MASTER COPY

i

Standard OperatingProcedure

Patient Dietary ServiceManagement

f)

e.-

Ms. Priya Ravi- Executive Operations

Ms. Binapani Rajkumari- Dietician

Dr. Gautam Dey-MS Dr. M«ngma L. Sherpa-HO DP

Prepared By Reviewed By Approved By0, i:“Ze SwZS," ^ M,S C'im,a, R0',!^,a, H0SP"al' Ga"»,0k R8»roli"a“ in -VAll

, either m oart

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTm CRH SIKKIMMANIPALUNIVERSITY DOCUMENT NO:

% v"' REVISION NO: 00CENTRAL REFERRAL HOSPITAL - SMIMS''«r u

REVISION DATE: OQ

DocumentedProcedure

01-VERSION NO.


l-tOPAGE NO:

DOCUMENT CONTROL STATUS: MASTER COPY

Amendment Details

Details of Amendment

Sec No. & Page No.

Signature of Reviewing Authority

S.No Signature of Approving Authority

Reasons

i

*dJLl

MsrlYfya Ravi- Executive Operations


Dr. Gautafn Dey-MS Dr. Mi a L. Sherpa-HO DP

Prepared By Reviewed By Approved ByAll information in this document is confidential and properly of M/s Central Referral Hospital Gangtok Reproduction in any form, either in partor full to be done only with written permission

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENT# CRHEsvCENTRAL REFERRAL HOSPITAL - SMFMS

DOCUMENT ^0^c^>lceHjC0e/ Pf)^l^REVISION NO: ^ '‘'"/H

r l> »»'*

REVISION DATE:

DocumentedProcedure

VERSION NO. o±ISSUE/EFFECTIVE DATE:

PAGE NO: ^ 7.1


Page No.ContentsSR.No.

6Definition

62 Scope

63 Objectives

64 Organogram

65 Roles and responsibilities of dietician

6 7Roles and responsibilities of Kitchen Supervisor

87 Layout

8 9Workflow

9 9Nutritional assessment & reassessment

10 Diet ordering process 10#

I I Diet slip generation process 10

12 Diet verification process 10

'■>>>

/Ms. Prtya Ravi-

Executive OperationsMs. Binapani Rajkumari- Dietician

Dr. Gautai^n Dey-MS Dr. Mingma L. Sherpa-HO DP

Prepared By Reviewed By Approved ByAll information in this document is confidential and property of M/s Central Referral Hospital. Gangtok Reproduction in any form, either in partor full to be done only with written permission. '

of 22

W CRH TITLE: PATIENT DIETARY SERVICE MANAGEMENTSIKKIM MANIPAL UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMS

^oPlc^jccfj PDS»iJ C>GDOCUMENT NO:v"S REVISION NO: no»<rii

REVISION DATE:

DocumentedProcedure

VERSION NO. (0.^


i -fo *2-2-.PAGE NO:


13 10Diet preparation process

14 Food tasting process 11

15 Diet dispensing process

16 Procedure during diet changes 1 I#

17 Diet Service Workflow 12

18 Types of patient diet 13

19 Monitoring food intake 14

20 Storage 14

21 General Hygiene and sanitation 15

22 Dishwashing 20

23 Staff Personal health and hygiene 20#

24 Pest Control 21

25 Records and Reference 21

V*'

Ms. Prlya Ravi- Executive Operations


Dr. G^utarr Dr. MingnW L. Sherpa-

D S

HO

Prepared By Reviewed By Approved ByAll information in this document is confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in part or full to be done only with written permission

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENT» CRH SIKKIM MANIPAL UNIVERSITY


‘bopjcZ.Hj daf! pDSjnfM~Q0r

DOCUMENT NO:

REVISION NO:

REVISION DATE: 0ODocumentedProcedure

VERSION NO. oiISSUE/EFFECTIVE DATE:

PAGE NO:


SOP on Hospital dietary services

1. Definition

Dietary service is one of the support services that aims at providing clean, hygienic and nutritious diet to patients according to their nutritional assessment and caloric requirement.

2. Scope

It is applicable to indoor and outdoor patients of CRH.#

3. Objectives• To plan and serve nutritionally well balanced food for all inpatients.

• To educate all inpatients during hospitalization and at the time of discharge for

Therapeutic diet requirements

• Outpatients diet counselling

4. Organogram

Head operations

Operations executive^ ► Dietician

# ▼Kitchen Manager

▼Utility staff, Service Staff, Production staff

Dr. Gautam Dey-MS Dr. Mingma L. Sherpa-

,Vr*


Ms. Bmapani Rajkumari- Dietician

- DPHO

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TITLE: PATIENT DIETARY SERVICE MANAGEMENTCRH SIKKIMMANIPALUNIVERSITY g>Qp/Ic^>fj pD&rYv]DOCUMENT NO:

REVISION NO:CENTRAL REFERRAL HOSPITAL - SMIMSKfli

REVISION DATE: OODocumentedProcedure

VERSION NO.


PAGENO: ^


5. Roles and responsibilities of Dietician

• Plan menus for inpatients in co-ordination with treating consultant

• Verifies and sending diet slips to the kitchen prepared by nursing staff and maintains

a record

Meets patients individually and informs them regarding their nutritional requirement

and plan of diet

Checks for changes in diet as mentioned by the treating doctor and accordingly makes

changes in the diet chart

Visits inpatients on a daily basis and ensures dietary needs are met and documents

their nutritional assessment.

Tastes food prepared on a daily basis to ensure quality

Takes steps to ensure that hygiene standards are maintained in the kitchen

#

Educates patients/ relatives regarding diet for patients getting discharge

Participate in interdisciplinary team rounds as appropriate Screen patients admitted to

assigned units to determine nutrition risk

Assist in the education of students and interns and helps orient new employees

Educate the patients discharged regarding their nutrition#

6. Roles and responsibilities of Kitchen Supervisor

• Discusses the requirement of the department wit e management/Q

7^Dr. Gautam dey-M^ Dr, Mingma Sherpa-

Ms. Pnya Ravi- Executive Operations


HO

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of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTm CRHEtbrv'■%<„ ^ ''' CENTRAL REFERRAL HOSPITAL • SMIMS

DOCUMENT NO: g>oP^ cnn] cop! Pnim/otREVISION NO:

REVISION DATE: noDocumentedProcedure

VERSION NO. o£ISSUE/EFFECTIVE DATE: Ztfo?ICh

1 'fo IsuPAGE NO:


• Plans the budget and monitors the functioning of the department as per the quality

standards of the hospital

• Monitors the financing part of the department

• Conducts periodic audits to monitor the quality standard of the department

• Ensures supply of safe food throughout the hospital

• Ensures finest quality of food

• Monitors the day to day activities of the department

• Selects the vendors for obtaining various food items

• Raises the bills and sends to the accounts department

• Checks the quality of the food items received

• Checks proper storage of the food items as well as chemicals and reagents

• Monitors quality of food making as well as service standards

• Checks unnecessary wastage, theft, pilferage

• Maintaining sanitation standards in the department

• Monitors the hygiene standards of the staff

• Ensure timely service of food to all patient

• Ensures uniform quality standard of food for all patients

• Proper maintenance of cutleries and crockery.

• Addresses complaints if any regarding food or service quality

• Monitoring rosters for the kitchen staff

• Monitoring the structural standards of the department and rectify if any

• Ensures safety of the department and prevent any jnis-happening• Ensures proper handling of waste and chemicals //


7^ xautam Dey-MSMs. Priya Ravi- Executive Operations

Dr. GDr. Mingma L. Sherpa-HO DP

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of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTfuML T TsikkimI® CKHtMSrY'"N CENTRAL REFERRAL HOSPITAL - SMIMS

tboPlCKI-f] C 6Pj fD£tn/06DOCUMENT NO:

REVISION NO:''"ni> ft- onREVISION DATE: 00

DocumentedProcedure

VERSION NO. C)~iISSUE/EFFECTIVE DATE: zq/vllr}

1 0--UPAGE NO:DOCUMENT CONTROL STATUS: MASTER COPY

• Addresses staff grievances if any

7. Layout

7.1 Receiving area-The kitchen shall have an entrance and an exit.

7.2 Storage area- Then there shall be storage area. This area is again divided into 2 areas-

• Dry storage for items like pulses, rice, fruits, vegetables, salt, sugar-and other dry

items

• Wet storage for items like milk, curd, ghee, juices, etc

Items like milk, butter, fruits, vegetables, juices, ice creams etc can also be kept in a separate

area called the cold storage where temp of 0 degree shall be maintained

After the storage area there shall be a Dishwashing area. This area shall be away from the

cooking area so as to maintain hygiene of the food being prepared.

7.3 Chopping Area- Next to the washing area there shall be the chopping area. Here the

vegetables and fruits shall be chopped and made ready to cook

7.4 Cooking Area- The cooking area shall lie next to the chopping area. This area shall be

restricted to the cook and the stewards or bearers and minimum traffic flow shall be observed

here. This area shall be equipped with chimneys and exhausts to evacuate the smoke and

heat generated.

#


Ms. Bmapani Rajkumari- Dietician

Dr. Gauta Dr. Mingn

n Dey-fyiS .a L. Sherpa-

Wim | dpHO

Prepared By Reviewed By Approved ByAll information in this document is confidential and properly of M/s Central Referral Hospital, Gangtok Reproduction in any form either in part or full to be done only with written permission.

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENT« CRH SIKKIMMANIPALUNIVERSITY hop/c«u{£6Ff POSm/MDOCUMENT NO:

v*s REVISION NO:'‘‘•U |. B' CENTRAL REFERRAL HOSPITAL - SMIMS nr,REVISION DATE: nrDocumented

ProcedureVERSION NO. OiISSUE/EFFECTIVE DATE:

PAGE NO: ^


7.5 Food pickup counter- The food prepared is packed into individual patient trays, and

picked up from this counter as per the diet sheet. It is loaded into the trolleys after it is

checked by the dietician.

7.6 Trolley area- Trolleys have two chambers. One chamber is heated by element and the

other is ambient. Hot food is kept in the hot chamber and cold foods like desserts, salad etc

are kept in ambient chamber.

7.7 Exit- Finally the trolley laden with food is taken out through the exit doors and then

carried to the wards and served to the patients

8. Workflow

8.1 Nutritional assessment and reassessment

• Nutritional assessment is done for all patients within 24 hours of admission. The

nutrition form of the admission record which helps the dietician to screen all patients

for nutritional status and requirements

• If the patient is identified as malnourished a detailed nutritional assessment is carried

out to certain if the patient is at nutritional risk (part of nutritional assessment form)

• The nutritionally risk group is identified and special nutritional plan is prepared and

recorded in the inpatient record.

• Nutritional assessment will be done for all patients irrespective of what type of diet (eg,

normal, diabetic, renal, liquid etc.) they may be prescribed.

• Nutritional assessment will be documented as a template in the EMRD records.

• Nutritional assessment will not be done for patiehts who are NPO.

.PriyaRavi- Ms. BinapaniJdautarJ Dey^IS^'

Ms. Dr.Executive Operations Rajkumari- Dietician Dr. Mi gmi^ L. Sherpa

HO DP(

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of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENT<3$ CRHN\V

SIKKIM MAN1PAL UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMS'zDoP/CiZtf/Cop/ Pcsm/wDOCUMENT NO:

REVISION NO:f U «*' nnREVISION DATE: no

DocumentedProcedure

0^VERSION NO.

ISSUE/EFFECTIVE DATE: £ ^

^ BORAGE NO:


• Reassessment will be done for people on special diets only.

• Reassessment will not be done for patients who remain on normal diets throughout

their hospital stay.

• Reassessment will be documented in the patients’ progress notes.

8.2 Process of Diet Ordering

• The doctor after visiting the patient prescribes the type of diet according to patient's condition and drug considerations.

• The patient is counselled by the nursing staff for opting hospital diet which includes informing the patient about the menu and dietary benefits.

• If the patient opts for hospital diet, further process is followed, or else the patient is allowed to eat home food.

8.3 Process of Diet Slip generation

Once the patient opts for hospital diet, diet slip is generated by the nursing staff everyday till the patient gets discharged.

Along with diet slip generation a compiled record of patient’s diet is also maintained

The diet book containing the diet slips along with the daily record is then sent to ADNS for verification.

8.4 Process of Diet verification

The ADNS verifies the diet slips as per the record, counter signs and sends it to the dietician for compilation of total number of patient diets

Diet slips are then sent to the kitchen for food preparation /)

r'y. v*

Ms. Binapam Rajkumari- Dietician

Ms. priya Ravi- Executive Operations

Dr. Gawtam [ Dr. MiHO DP

Prepared By Reviewed By Approved ByAll information in this document is confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in partor full to be done only with written permission.

of 22

« CRH TITLE: PATIENT DIETARY SERVICE MANAGEMENTSIKKIM MANIPAL UNIVERSITY


DOCUMENT NO: irtP/c/ZHj eopf pa smlo-CREVISION NO:i'

REVISION DATE: 00DocumentedProcedure

VERSION NO.


PAGENO: ^ ^ ^


8.5 Process of Diet preparation

Food is prepared according to number of diet slips received.

Provision is made for preparation of extra food in order to cater to new admissions, on receiving respective diet slips

Food after being prepared is tasted by the dietician/operations executive to check the appearance, taste and consistency.

If required corrections are suggested and done immediately. Process is as under:

8.6 Food tasting process

vi

Dr.yautani Dey-lvT5 Dr. Mingm L. Sherpa-


Ms^Priya Ravi- Executive Operations

HO fmdM DPApproved ByReviewed ByPrepared By

All information in this document is confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in part or full to be done only with written permission.

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENT» CRH SIKKIM MAN IP A L UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMSibopjc erf/CAP/ pDSmlOtDOCUMENT NO:

REVISION NO:‘'■'Vf l! onREVISION DATE: OClDocumented

ProcedureVERSION NO.


PAGENO. ^ ^


Food prepared

1Tasting done by dietician andoperations executive to checkthe followingTextureTasteAppearance

Cook is informed of changes requiredFood found

suitable?

Yes Record made in the signing register

Cleared for tray setting <■

8.7 Process of diet dispensing

According to the diet slips received, food is served to the patients

8.8 Procedure for Diet Changes

4*JrMs. Pfiya Ravi- Executive Operations


Dr. GautamlDey- Dr. Mirwgma L. Sherpa-

DPHO

Prepared By Reviewed By Approved ByAll information in this document is confidential and property of M/s Central Referral Hospital, Gangtok. Reproduction in any form, either in partor full to be done only with written permission.

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTCRH SIKKIM MAN1PAL UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMSPb&mjotDOCUMENT NO:

REVISION NO: noREVISION DATE: 00

DocumentedProcedure

VERSION NO. clISSUE/EFFECTIVE DATE:

PAGE NO: ^ ^


Diet order changes are initiated by a physician or registered nurse practitioner and are

recorded in the patient record.

• Food Services are notified of diet orders by telephone, followed by diet slip. Each new

diet ordered by a physician automatically cancels all previous diet orders. The new

order includes any part of the previous order that is still to be continued.

When a patient has been transferred to another unit, the receiving unit will notify the kitchen of the transfer and follow-up.

8.9 Diet Service Workflow

v

mL A^Ravi- Dr. GDr. Mingn\a L. Sherpa-

Ms. Binapani Executive Operations Rajkumari- Dietician

\kM^ DPHO

Approved By _________________Ceniral ReferraTHospilal, GangfoK Reproduct.on m any form, erthe- m panPrepared By Reviewed By

(All information in this document is confidential and propeny of M/s | nr full to Oe done only with written permission.--------------- ----------

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTm CRH SIKKIM MANIPAL UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMSropj pot/nlMDOCUMENT NO:

v"' REVISION NO:I- I''' noREVISION DATE: 00Documented

ProcedureVERSION NO. o±ISSUE/EFFECTIVE DATE:

PAGENO:


Patient gets admitted

\ r

Nurses inform kitchen about the type of diet

prescribed

Is patient admitted during a working hours?

YesCheck doctors progress notes for any specific diet instructions

INoDietician meets the patient and explains their dietDietician speaks to the manager and

nurse over the phone and explains diet ootions available

IInstructs manager about patient food

Patient diet order taken and recorded (diet order sheet)

Food is delivered to the room <-

Dr. Gawtam bey-MS Dr. Mingma . Sherpa-

Ms.VfiyaiCavi- Executive Operations


\HO DPApproved ByPrepared By Reviewed By _______

All information in this document ,s confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form either in part or full to be done only with written permission._____________________________________________________________________

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTIp CRH SIKKIM MANIPAL UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMS^oPjc^HlCapfDOCUMENT NO:

REVISION NO: ^i-[i »"•

REVISION DATE: OCDocumentedProcedure

VERSION NO.


PAGE NO:


9. Types of Patient Diet

9.2 Therapeutic liquid Diet

It is one that includes foods that are liquids or liquefy at room temperature. The main purpose of this

diet is to provide oral nourishment that is well tolerated by patients who are acutely ill and who are

unable to swallow or chew solid foods or otherwise recovering from a surgery.

9.3 Therapeutic Semi Solid diet

It is basically a soft diet in a pourable consistency. It includes porridges, thin khichdi, and blended rice

with dal, strained soups. It is a transition between a liquid and a solid diet.

9.4 Therapeutic Normal diet (High calorie high protein diet, Renal diet, Dialysis Diet)

Isa balanced diet including optimum amount of food from each food groups so as to meet the nutritional

requirements of the patients.

9.5 Therapeutic Diabetic Diet

Is one in which the dietary intake is carefully controlled day to day; it implies assurance that total

amounts do not increase calorie consumption above the optimum level, as well as appropriate

consistency in timing, division, amounts and characteristics of carbohydrates consumed.

9.6 Therapeutic Enteral feed (Standard tube feed, High calorie high protein feed, Diabetic feed,

Renal feed, Hepatic Feed)

Ms. wiy^Kavi- Executive Operations

Dr. JSautam Dey-MS Dr. MingmS L. Sherpa-


HO DPApproved ByReviewed ByPrepared By

All information in Ihis document is confidential and property of M/s Central Referral Hospital. Gangtok. Reproduction in any form, either in partor full to be done onlv with written oermission.

of 22

0 CRH TITLE: PATIENT DIETARY SERVICE MANAGEMENTSIKKIM MAN IP A L UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMSjc z/-// r r^pj ddsm !<kDOCUMENT NO:

REVISION NO:< is C&.REVISION DATE: (30

DocumentedProcedure

VERSION NO. oiISSUE/EFFECTIVE DATE:

PAGENO: ^


Liquids or blenderized diets designed to provide essential nutrients in a form that will easily pass through

a tube. Tube feeding may be conveyed either through naso gastric tube or through a gastrostomy or

jejunostomy. They may vary from a homogenized or blenderized mixture of foods. Selected carefully

formulated to meet specific therapeutic needs.

Note: Refer to the SOP on Implementation of Therapeutic diet with document number CRH/DM/01

10. Monitoring food intake

10.1 The nursing staff is responsible for overseeing the monitoring of the food intake of patients on their wards.

10.2 Tray collection should be supervised closely to enable monitoring of patients' food intake.

10.3 The food intake of all patients should be registered by means of a semi-quantitative system.

10.4 The food intake of all patients at nutritional risk and receiving nutritional support should be registered by means of dietary records.

10.5 Information from the catering department about the portion size and energy content of hospital food should be available, to aid ward personnel in noting the food intake of patients.

10.6 The appropriate personnel on the wards should be trained in how to monitor food intake.

11. Storage

11.1 Frozen and refrigerated storage

IDr. Gautarh Dey-MS Dr. Mingma L. Sherpa-


Ms. PExecutive Operations

HO DPApproved ByReviewed ByPrepared By ___________ _____

All information in this document is confidential and properly of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in pari or full to be done only with written permission.------------------------------ ---------------------------- --------------------------------------------------------------

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTqpCRH SIKKIM MANIPAL UNIVERSITY

CENTRAL REFERRAL HOSPITAL - SMIMS^opjc £ Hj (^tej pOZnifaDOCUMENT NO:

o'' REVISION NO:'’'h r o OPREVISION DATE:

DocumentedProcedure

VERSION NO. OXISSUE/EFFECTIVE DATE:

PAGE NO: ^ ^ ^DOCUMENT CONTROL STATUS: MASTER COPY

• Frozen foods are stored promptly at -18 C (0 F) or lower. Refrigerated foods are stored at 7 C

(45 F) or lower.

• The oldest products are used first, observing FIFO (first in, first out) procedures.

• All products are stored at least twelve inches off the floor.

• Leftovers are covered tightly and refrigerated or frozen. These are. labeled and dated Hot leftover items are refrigerated in shallow pans, stirred frequently to aid cooling, covered, and

labeled.

11.2 Dry storage

• All items are stored using FIFO system.

• The oldest products are used first, observing FIFO procedures.

• All products are stored at least six inches off the floor, and a minimum of eighteen inches from

the ceiling

• Store room is maintained at 45° to 65° Fahrenheit range.

11.3 Chemical storage

• All chemicals are separate from foods and supplies.

• The chemical storage areas are clearly identifiable.

• All products are stored at least six inches from the floor on shelves and a minimum of eighteen

inches from the ceiling.

12. Hygiene & Sanitation

• Supplies are clearly labeled. Supplies are stored in such a way as to be easily identifiable. No

items are accepted that are not clearly labeled

1

srRriya Ravi- Ms. Binapani

:

Dr. Gautar^i Dey-MS Dr. Ming^na L. Sherpa-

dpMs

Rajkumari- DieticianExecutive OperationsHO

Approved ByReviewed ByPrepared ByAll information in this document is confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in panor full to be done only with written permission

of 22

^ CRH TITLE: PATIENT DIETARY SERVICE MANAGEMENTSIKKIMMANIPALUNIVERSITY

.y'

^Op/rrtHj COPj Phij06DOCUMENT NO:

REVISION NO:CENTRAL REFERRAL HOSPITAL - SMIMS11 n'

REVISION DATE: 00DocumentedProcedure

VERSION NO. oi-ISSUE/EFFECTIVE DATE: /?-

PAGE NO:


• Items not identifiable are destroyed. Leftover items are covered and marked as to item, date prepared, and date by which they should be used Foods of a certain type are to be kept together and separated from other items.

• All non-food supplies are stored in an area separate from that in which food supplies are stored.

• Food is procured from sources that provide assurance that the food is processed under regulated quality and sanitation controls.

• Food is protected from contamination and spoilage.

• Thermometers are in each refrigerator and freezer.

• Food in open containers or cooked foods are covered, dated, and refrigerated.

• Fresh meats are not stored above other food items.

• Freezers are scraped periodically to remove ice and dirt,

• Food in storeroom (dry goods) is kept at 50 to 70 degrees. All food items are stored twelve inches off the floor and not within eighteen inches of the ceiling.

• Storeroom and walk-ins are swept and mopped daily.

• An exterminator is contracted by the hospital and attends to Food Service areas twice a month

• Adequate hand washing and hand-drying facilities are located in convenient places throughout the food service areas.

• A disinfectant soap dispenser is above all hand sinks.

• Thorough cleansing and sanitizing of all working surfaces, utensils, and equipment occurs after each period of use. Equipment is constructed of non-toxic material and easily cleaned, kept in

good repair, and not used when chipped, cracked, rusted, or badly worn or in such condition as to make difficult to clean and sanitize.

• All working surfaces, utensils, and equipment are washed and rinsed with a food-safe disinfectant. Items that can be sent through the dish machine are sent through. All equipment or utensils are stored so as to remain clean, dry, and It free.

hnMs-Wr^a Ravi-

Executive OperationsMs. Binapani Rajkumari- Dietician

Dr. Geutam Dey-MS Dr. Mingma L, Sherpa-HO DP

Approved ByPrepared By Reviewed ByAll information in this document is confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in part or full to be done only with written permission

of 22

'om CRH TITLE: PATIENT DIETARY SERVICE MANAGEMENTSIKKIM MANIPAL UNIVERSITY


DOCUMENT NO: ccfj p/Km/cv?vv REVISION NO:«fl, KN 00

REVISION DATE: noDocumentedProcedure

VERSION NO.


PAGE NO: ^ ^ ^


• Cutting boards are made of non-absorbent material and are washed and sanitized between uses.

• The holding, transferring and disposing of garbage is done as follows: Garbage is held in food preparation area in garbage cans which are lined with a plastic liner and fitted with a lid. At

frequent intervals the plastic containers are removed to the back dock area.

• Garbage containers are leak-proof and non-absorbent and have close-fitting covers. Garbage is kept in durable containers which do not leak. Plastic liners are used in all garbage containers, and containers have tight-fitting covers in place at all times. Garbage containers are emptied or removed outside the preparation area at frequent intervals.

• Plastic ware or similar items that have lost their glaze or are chipped or cracked are disposed of immediately

• Lighting and Ventilation. Lighting, ventilation and humidity are controlled to prevent the condensation of moisture where moulds and bacteria might grow.

• Cafeteria and storeroom are equipped with swamp cooler, heater and sufficient fluorescent lighting. Equipment is in good working condition.

• Vented hoods over grills, deep-fryers and island area are used to remove condensation and grease from the kitchen.

• Contamination is avoided in making, storing, and dispensing ice through appropriate use and cleaning procedures.

• No food or supply items are stored on or in the machine.

• Unauthorized personnel are kept out of the food service area. Persons not employed by Food Services are not allowed behind the serving line or in the areas where food is being prepared.

• Delivery persons are allowed to bring food and supplies from dock to walk-in refrigerator and storeroom.

• Disposable Trays. /'

• Patients in isolation are given their meal on disposableJir^ys to prevent the spread of disease

MsVKiya Ravi- Executive Operations


Dr. Gayram tyey-MS Dr. Mingrna L. Sherpa-

[) pHO

Prepared By Reviewed By Approved ByAll information in this document is confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in partor full to be done only with written permission

of 22

rn> CRH TITLE: PATIENT DIETARY SERVICE MANAGEMENTSIKKIMMANIPALUNIVERSITY DOCUMENT NO: ^oPjCMfCQpl PP^mJ 06

v ssV REVISION NO:l/v* CENTRAL REFERRAL HOSPITAL - SMIMSII H'1

REVISION DATE: CODocumentedProcedure

VERSION NO.


PAGE NO: j ^ ^


• Disposable items are used in serving isolation patients.

13. Dish washing

• Dish washing and utensil-washing equipment and techniques sanitize

prevent contamination. Automatic dish washing equipment is operated according to

manufacturer's instructions and in accordance with temperatures, cleaning agents, and

sanitizers.

service ware and

• All dishes, utensils, and durable plastic ware are washed at a temperature of 120 to 140 with

a chlorinated detergent. Rinsing is done at a water temperature of 180 or higher.

Temperatures are recorded.

• Durable plastic ware is pre-soaked, run through the dish machine on a flat rack, then sorted

and loosely placed in holders with food-contact portion upward and run through the dish

machine a second time, then allowed to air-dry. Plastic wares which have lost their glaze are

discarded.

• Machines are checked monthly to insure proper operation.

• Any item that is too light to be properly washed in the dish machine is considered to be

disposable. Styrofoam trays and cups, plastic utensils, pie tins, and paper cups are discarded

after one use.

14. Staff Personal Health and Hygiene

to..Dr. Gaytampey-MS Dr. Miogmal. Sherpa-


Ms.Executive Operations orHO DP

Approved ByPrepared By Reviewed ByAH information m mis documenl is conMent.al and property' of M/s Central Referral Hosp.ial Gangtok ReproduCon m any form, erther >n pad or lull to be done only with wriHen permission

of 22

crh TITLE: PATIENT DIETARY SERVICE MANAGEMENTSIKKIM MANIPAL UNIVERSITY


DOCUMENT NO: (CM] ffipjEMm/M.REVISION NO:|. 00REVISION DATE: OADocumented

ProcedureVERSION NO. OtISSUE/EFFECTIVE DATE:

PAGE NO:


The hygiene standard of the kitchen staff is of utmost important for maintaining the hygiene

standard of the food. Hence care shall be taken that the staff maintains the cleanliness

standards of the hospital

Regularly after six months medical checkup is being done including hemoglobin, TLC, DLC,

Widal test and physical examination. Stool test is done quarterly.

For this it shall be ensured that the staff is not suffering from any sort of infectious disease

or any disease for that matter. The cook shall undergo a stool test on a quarterly basis.

Employees are free of infections and open skin lesions. Any employee found with an open skin

lesion or known to be infectious is not allowed to work until cleared by a doctor.

Food Service employees are instructed on health regulations, sanitary and safety procedures

on the first day of employment.

Caps, aprons, gloves etc must be worn while inside the kitchen or serving food

Body odors due to sweat shall be taken care of

Patient's privacy shall be taken care of while serving food. Doors shall be knocked before

entering the patient's room

TB test is given at the first physical examination and yearly thereafter. Notification of test due-

date is made to the employee by the laboratory.

Staff shall follow 7 steps of hand hygiene

15. Pest Control

Dr. GautamlDey-MSMs. Binapani Rajkumari- Dietician Dr. Mingma L. Sherpa-

Ms. mya Ravi- Executive Operations

HO DPApproved ByPrepared By Reviewed By ________ _

All information in th.s document is confidential and property of M/s Central Referral Hospital, Ganglok Reproduction ,n any fornr or full to be done only with written permission________________________________ __________________________—

. either in pan

of 22

TITLE: PATIENT DIETARY SERVICE MANAGEMENTnri T-f MANIPALJLVJL X UNIVERSITY


DOCUMENT &Hf CxsfJPO£m/<*>£REVISION NO:'"'HIU !■' 00REVISION DATE:

DocumentedProcedure

Oj,VERSION NO.


PAGE NO: ^


Routine gel treatments against insects, flies and treatment against rodents are being carried out and

should be documented.i

16. Records

Consumption of daily diet records

Menu planning records

Cleaning and sanitation records

Pest control records

Diet tasting records

Feedback records

Staff health records

References:

• Hospital Dietary Services, BM Sakarkar text book• FSSAI guidelines• A case study on improvement in patient dietary services and satisfaction scores, in a tertiary

care hospital-NRHM

c=

fL^Friy^Kavi- Ms. Binapani

* tDr. Gautam(pey-MS Dr. Mingma L. Sherpa-

Ms.Executive Operations Rajkumari- Dietician

HO f DPPrepared By Reviewed By Approved By

All information in this document is confidential and property of M/s Central Referral Hospital, Gangtok Reproduction in any form, either in part or full to be done only with written permission

of 22

crh manipal sikkim no: cau| c

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