Service Notes

The Flow of Food: Service

Stages of Assembly, Delivery, and Service

  • Discuss stages of assembly, delivery, and service.
  • Describe the steps of service, including holding with or without temperature control and food service type considerations.

Importance of Service

  • Service is a critical stage in food handling.

Service: Assembly and Delivery

  • Made of related systems:
    • Assembly
    • Delivery
    • Service

Assembly

  • Tray lines are central in many hospitals.

Assembly and Delivery: Policy Example

  • Policy Name: Tray Preparation and Delivery
  • Policy Number: 3364-104-305
  • Department: Food & Nutrition
  • Approving Officer: Chief Experience Officer (CXO)
  • Responsible Agent: Director, Food & Nutrition
  • Scope: Food & Nutrition
  • Effective Date: 5/1/2019
  • Initial Effective Date: 8/2002
Policy Statement
  • Assemble and pass meal trays that are nutritious, appetizing, palatable, and at appropriate temperature.
Purpose of Policy
  • Deliver food in a safe, accurate, effective, and timely manner to patients consistent with physician prescribed diets.
  • Specify the system utilized to correctly identify patient meal trays.
Procedure
  1. Patients may phone meal requests to the call center between 7 A.M. and 7 P.M.
  2. A diet order must be received prior to meal request being accepted. If a patient does not have a diet order entered into the computer, they are treated as being "NPO". Diet clerks can contact the nurse to prompt them to obtain orders and to communicate back to the patient his care plan and diet order.
  3. All food/beverage requests are entered into CBORD Room Service Program. Foods/beverages not permitted within the diet order are flagged in red. Explanations and alternatives are offered to the patient; however, the patient may refuse these alternatives. Refer to policy 3364-104-316 Compliance to Physician Diet Orders.
  4. Meal delivery time may be specified. If not specified, delivery time is within an hour.
  5. Meal tickets print directly to the cook's station where food is prepared on an as needed basis.
  6. Once hot food and sandwiches are prepared the plate and meal ticket moves to the Expeditor and cold cart staff. Menu items are placed on the tray. Prior to loading, all items are checked against the meal ticket for accuracy.
  7. For patients unable to make their own selections and for clear liquid, full liquid and pureed diets, meal tickets are printed for house selections. These trays are "batched" and sent in between room service tickets.
  8. Diet clerks print new diet order reports throughout the meal period. This assures patients receive meal trays timely.
  9. Missed meal reports are printed at each meal period. See policy 3364-104-319 Monitoring of Missed Meal.
  10. 6CD, Senior Behavioral Health and Adolescent and Child Psychiatric unit patient meal trays are delivered on a cart at specified meal times. Nursing staff are responsible for passing meal trays to the patient. FNS Host/Hostess pass trays to all other patients using the following process:
    • Sanitize hands.
    • Check the door and frame for NPO and Isolation signs.
    • If the patient has an NPO sign, verify order with nursing and return tray to kitchen.
    • Patients in all isolation rooms, except airborne, may be delivered directly to patient. If unsure of isolation status, verify with nursing.
    • Knock lightly on the door before entering and announce "Room Service".
    • Use two patient identifiers, (name and birthdate). If the patient is unable to identify themselves, use the wrist band.
    • Place the tray on the over bed table and adjust as needed.
    • Offer to open containers, assist as needed.
    • Sanitize hands.
  11. Nursing Staff will:
    • Pick up trays from patient rooms in a timely manner and place in the tray collection carts.
    • Record intakes in the medical record per hospital policy.
    • If a patient is placed on a Calorie Count, note intake and calculate calorie intake using information recorded on patient menu. Record calorie intake per hospital policy.
    • Load used trays on the tray collection carts for delivery to the kitchen.
  12. FSW will collect soiled trays from the nursing unit:
    • FNS will pick up carts approximately 1 hour after delivery.

Hospital Food Service Strategies

  • 12 Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review

Delivery Systems

  • Centralized Delivery-Service System:
    • Portioned and assembled in or near the kitchen and delivered directly to patient
  • Decentralized Delivery-Service System:
    • Bulk foods are prepared and sent to serving galleys or wards for final assembly and service

Service Styles

  • Self-Service
    • Cafeteria-style, Machine Vended, Buffet, Pick Up
  • Tray Service
    • Centralized or Decentralized
  • Wait Service
    • Counter, Table Service or Banquet
  • Portable Service
    • Off- or On-Premise Delivery
  • Room Service

Service: Food Safety

Considerations around service

  • Holding until service
  • Holding foods without temperature control
  • Proper physical serving of food
  • Regulating Self-Service Areas
  • Off-site Service Considerations
  • Vending Machines

ServSafe: Service

Holding

  • Minimize cross-contamination (e.g., sneeze guards)
  • Maintain foods outside the temperature danger zone
  • Check temperatures at least every 4 hours if on hot line (better would be every 2 hours)
  • If holding without temperature controls, use time as control
    • 6 hours for cold foods - label with throw out time and never allow to a temp above 70 degrees
    • 4 hours for hot foods - label with throw out time

Serving

  • Avoid bare hand contact by wearing gloves with RTE food
  • Use individual, clean, and sanitized utensils
  • Use long-handled and specialized serving utensils, cleaned regularly
  • Avoid handling food contact areas (plates, cups, utensils)
  • Ice scoops
  • Reserving food items and combining food batches

Self-Service

  • Always remember that guests are not trained in food safety
  • Protect foods with sneeze guards
  • Label foods
  • Check temperatures regularly and use enough of the right utensils for dispensing
  • Do not let guests refill the same plate or use the same soiled utensils on the serving line
  • Do not reuse ice

Other Service Locations

Off-site Service

  • Delivery poses additional risks of temperature abuse, contamination, cross-contamination, and labeling
  • Be aware of available utilities at the destination

Vending Machines

  • Check expiration dates daily, maintain temperatures
  • Keep TCS foods in original containers and wrap fruit so that edible parts do not come in contact with machine surfaces

Next Steps: Costing

  • Determining how much to order and cost per serving