Assignment 1: Field Study in Food Service Standards Preparation, Distribution, Service Teamwork: Menus, Diets and Practices in San Pablo City District Hospital Submitted to: Professor Beatriz Dykes

Elisha Gay C. Hidalgo, RND

1/22/2011

Assignment 1:

Field Study

Make arrangements to go to a foodservice in a health facility (hospital or clinic). Interview the

dietitian, director, or manager and ask to tour the foodservice area, including the storeroom.

Check on the menus used. Observe the food preparation, production, service, and distribution

as well as the storage/disposal of left-over food. Note staff and their activities during the major

part of the food service. If possible, check on the mission and vision statements. In your report,

include your thoughts/impressions and the perspectives gained from your experience. Need to

spend at least 5 hours for the project.

TABLE OF CONTENTS

I. INTRODUCTION - Overview of the Establishment

A. Background

B. Location

C. Clientele

D. Organizational Chart and Manpower Profile

E. Type of Food Service System

F. Vision and Mission Statement

II. OPERATIONAL PROCEDURES

A. Menu

a) Menu Planning Process

b) Sample Menu Cycle

B. Purchasing

a) Purchasing Methods and Procedure

b) Sample Purchasing Form and Procedures

C. Receiving, Storing and Issuing

a) Techniques and Procedures

b) Sample Form and Records used

c) Inventory Control, Forms and Record

D. Preparation and Production Management

a) Preparation and Production Supervision

b) Production Scheduling

c) Use of Standardized Recipe

d) Portion Control Procedures

E. Food Assembly, Deliver and Service

a) Methods and Procedures Used

F. Sanitation and Safety Practices

a) In the Different Functional Areas

b) Equipment Sanitation and Safety Procedures

c) Personnel Hygiene

d) Waste Management

III. Summary, Evaluations and Recommendations

IV. Appendices

I. INTRODUCTION - Overview of the Establishment

Background

The Panlalawigang Pagamutan ng Laguna, also known as San Pablo City District Hospital, is a tertiary

government hospital in the province of Laguna. It has a bed capacity of 100 patients. It was built for the

purpose of providing quality affordable health care to the public. At present, it is under the leadership

and supervision of Dr. Jose F. Guia and under the provision of the provincial governor, Hon. Ejercito R.

Estrada.

Location

The hospital is located along General Luna Street, at the center of San Pablo City. The City of San Pablo,

a first class city in the province of Laguna, Philippines, is one of the country's oldest cities. The City of

San Pablo lies in the southern portion of Laguna province. This city is otherwise known as the "City of

Seven Lakes" (Filipino: Lungsod ng Pitong Lawa) because it has seven lakes—Sampalok, Palakpakin,

Yambo, Bunot, Pandin, Muhikap, and Calibato. By Land Area, it is the largest in the province of laguna.

By population, it ranks fifth in the province of Laguna.

Gen Luna

4000 San Pablo City

Laguna, Philippines

Phone: 562-4130 / 562-4135 / 562- 5260

Clientele

It serves patients local to San Pablo City and also patients from neighboring towns and provinces. It

offers complement of services including pediatrics, general medicine, surgery, and intensive care .

Organizational Chart and Manpower Profile

At present, it is under the leadership and supervision of Dr. Jose F. Guia and under the provision of the

provincial governor, Hon. Ejercito R. Estrada.

Dietary Department: ND II or the Chief Dietitian: Isabel Ticzon, RND ND I: Nenette Ricafor, RND Food Supervisor/Cook 1: Susan Alcantara Food Production/ Service: Cook 1: (2) Admin Aide/ utility worker: (6) Type of Food Service System

The Dietary Department of the Panlalawigang Pagamutan ng Laguna uses the Conventional type of

Food Service System (COOK TO SERVE). In conventional foodservice systems, ingredients are assembled

and food is produced onsite, held either heated or chilled, and served to customers. The central kitchen

is located in the department and two other pantries are located at the 2nd and 3rd floor of the hospital.

Foods are portioned and served on trays.

Vision and Mission Statement

VISION: “A nutritionally healthy client.”

MISSION: “To upgrade the competence of dietary personnel in the delivery of

nutrition services.”

II. OPERATIONAL PROCEDURES

Menu

Menu Planning Process

The main goal of menu planning in the department is to serve food that is both pleasing and appropriate

for the patient. The Chief Dietitian considers five factors in menu planning. First is the budget, the

budget for each patient in a government hospital is P50-P60 (Philippine Peso)/day (3 meals). Second is

the number of patients or the daily census. Oftentimes, the hospital has admission of more than 100

patients. Third, she considers the availability and seasonality of food. Fourth is food acceptability. And

fifth, good color combination or the aesthetic value of food.

Due to her years of experience in the same hospital, the chief dietitian has already determined foods

that are least accepted and most accepted by clients. She is able to eliminate items from the menu and

pick dishes that can be served more regularly.

Breakfast usually serves Fruit, Protein Dish, Bread, and Hot Beverage. Lunch and Dinner includes a

Soup/Vegetable dish, Main Dish, Rice, and Dessert. Pay rooms have an additional side dish or another

entrée.

Menu for the day represents Full Diet for Pay Ward, Full Diet for Non Private Ward, and Therapeutic diet

for both wards.

Sample Menu Cycle (see Appendix).

Purchasing

Purchasing Methods and Procedure

Purchasing is done on a daily basis. There is an assigned marketer and designated vendor separate for

dry goods, for fruits and vegetables, and for meat products. The service uses an informal Open Market

Buying method.

Sample Purchasing Form (see Appendix for Daily Market Purchase and Purchase Receipt)

Purchasing Diagram (next page)

Purchasing Diagram

Receiving, Storing and Issuing

Techniques and Procedures

After checking food items for correct

quantity and quality, perishable goods

are directly brought to the kitchen for

preparation and non-perishable goods

are being hold in a small storeroom or

the department’s refrigerator/freezer.

Pre-ordering of products to suppliers

Delivery of perishable Goods (on the day of the

preparation

receiving and checking

food preparation

Delivery of non-perishable goods (one day ahead)

receiving and checking

food preparation

Forms and Records used

Checking of received items is being done by the chief dietitian. If chief dietitian is not available, the cook

or any food server present will check items delivered based on the menu for the day posted. Received

items are being recorded in the Reimbursement Expense form for meat, fish, and vegetables. Invoices

for dried goods like bread and rice are kept and recorded.

Preparation and Production Management

Preparation and Production Supervision

At present there are 12 Dietary personnel, aside from the Chief Dietitian, available in the dietary

department. One of them is the Administrative Dietitian and another is the Food Supervisor. Two cooks

work in rotation. Shown below

is a sample one week schedule

for the staffs:

Early duties will be involved in

the receiving of goods, food

preparation, and cooking. The

cook does the cooking for lunch

and dinner in the morning.

Late duties are responsible for

food distribution in the ward,

pre-heating of foods for dinner,

and cleaning. Osteorized tube

feeding is prepared by the

dietitian in the morning.

Production Schedule (at the next page)

Use of Standardized Recipe

The menu cycle is standardized to serve 100 patients. Modifications may be done based on the census

and food availability.

Portion Control Procedures

Portion sizes are estimated using cups, ladles and number of pieces. Private rooms for example would

be served 2 cups of rice and 2 portions of meat compared to the ward trays which only receives 1 cup of

rice and 1 portion of meat. Utensils for eating (spoon and fork) are not provided by the hospital.

Desserts for private room are only given to regular ward if there is an excess.

Sample of Food Tray delivered in the ward is shown below:

Food Tray for Pay Ward (Full Diet)

Food Assembly, Delivery and Service

Methods and Procedures Used

The hospital’s dietary department uses a centralized method of food assembly and delivery. The main

kitchen is located at the Ground Floor inside the dietary department; separate pantries are located at

the 2nd and 3rd floor. It is in the main kitchen that food preparation and cooking is being done. Food

trays for Pay Ward, which is also located in the ground floor, are also being prepared in the central

kitchen. The pantries in the upper floors are used to assemble the trays for the respective floor.

ntry at the 2nd Floor (left) and Food Conveyor loaded with Food Trays at the 3rd Floor Pantry (right)

Sanitation and Safety Practices

Equipment Sanitation and Safety Procedures

Proper Housekeeping is being observed in all areas of the dietary department and the two pantries.

Cleaning equipments such as detergents, mops, brooms and towels are available in all areas. Cleaning is

done in the afternoon, after lunch dishing out and also at night time before closing the di etary. Doors

are being kept close all the time to prevent rodents and other insects from entering.

Water supply is also available and maintained adequate. Insect and pest control is being done once a

year.

No mechanical dishwashers are available but separate sinks are being used for cooking utensils and for

serving trays.

Training for safety during emergencies and sanitation is being given to all hospitals every year.

Personnel Hygiene

Staffs are provided and reminded to wear disposable masks and hair caps/hair nets during food

preparation, cooking and dishing out. They are also reminded to bring their own aprons to use during

food preparation, cooking, and dishing out.

Medical clearance is required and is screening is done every year for all dietary staffs and personnel.

Locker rooms and toilets are available separate for men and women personnel. Uniforms, which consist

of white t-shirt and jeans, are kept clean and hair is trimmed regularly.

Waste Management

Proper waste segregation is being observed in the department, where separate trash cans are provided

for bio-degradable and non-bio-degradable waste products. Trash cans are kept closed and plastic bags

are color coded for spoilers and non-spoiler wastes. Trashes are being disposed of daily.

III. Summary, Evaluations and Recommendations

In summary, I think that the Dietary Department of the Panlalawigang Pagamutan ng Laguna,

also known as San Pablo City District Hospital, is being run by a dedicated Chief Dietitian and

efficient staff and personnel. Given the limited budget, they are still trying to keep in line with

their vision of “a nutritionally healthy client” by providing food that is well balanced and offers

a variety in their menu. The Chief Dietitian is also very open to suggestions on how they can

better improve their service as she continues to accept Nutrition and dietetic students and

volunteers to practice and give her reports on current practices and trends . In her years of

service, she is already well adapted and knowledgeable in the likes and dislikes of their usual

clients and has regularly revised the department’s menu cycle. The staffs and personnel are

good in following the policies and procedures set by the department and the hospital.

Most problems I have seen and encountered in the department are usually brought about by

lack in budget.

For example, some utensils like chopping boards and knives are already worn out and may need

replacement. Better regulation must be implemented to prevent shortage in masks, hair caps,

and dish towels. Since proper hand washing should be a practice especially in the food service

and health institutions, hand soaps and hand sanitizers should be provided by the hospita l. Pest

control should be done at least three times a year, which in this hospital is only being done

once a year. A water heater is needed to supply hot water in at least one faucet/sink to follow

proper manual dishwashing procedure. Sanitizing solutions for trays and utensils must also be

provided.

Menus would offer more variety if additional budget would be provided by the government.

For the mean time, a study or research on patient’s food likes and dislikes in the said institution

can be made to help provide the basis for menu improvement.

Regarding food presentation, soup bowls are not available for non pay wards. A suggestion

would be separating the soup in a thermos or kettle to be distributed to the non pay ward.

Since purchasing disposable cups would mean another expense, patients should be the ones to

provide their mugs or cups. I would also suggest fruit desserts (like bananas) be given to non

pay ward patients as well so they can eat a more balanced diet. An updated manual for running

hospital food service system should be available in the dietary to keep up with recent practices

and development. At the same time, personnel should be informed of any updates and

continuing training in proper food handling and sanitation and safety must be carried out.

Not many food items are being stored since the institution only orders what it needs for the

day, except for staple items like sack of rice. I would suggest that a pallet should be made

available so that sacks of rice would be stored inches above the floor to avoid contamination by

splash or other means.

In the clinical setting, dietitians do bed side counseling on based on the diet ordered by the

doctors. Dietitians sign in the Doctor’s Order Sheet and Compliance in the medical record once

they see the patient. Diabetics have a free once a month check up in the Diabetic clinic which

includes a team of a medical doctor, nurse and dietitian. Hand outs are adapted in Tagalog but

needs to be revised for updates. A standardized dietary manual specific for the said hospital

should also be developed and made available for each department or nurse’s station. Recording

of height and weight, food allergies, and other information pertinent to nutritional health

should be made a standard practice and should be taken note of the dietitians before nutrition

counseling.

The practice of clinical dietetics would be made more efficient and effective in the hospital if

the Nutrition Care Process will be adapted and implemented. In the mean time, it would help if

the hospital would follow the Department of Health’s policy that a 100 bed capacity hospital

should have two items for Nutritionist Dietitian I, one of which is a Clinical Dietitian. Having a

clinical dietitian responsible for counseling and patient education would make the field more

specialized and would improve the quality of care given to patients. Currently the hospital only

has one Dietitian 1 who performs both duties for administrative and nutrition counseling.

In my opinion, since government hospital policies are mandated, national efforts are needed to

improve the food service in the hospitals so that it may follow world class standards and the

practice of dietetics be made more standardized and recognized as part an important part of

the medical team. In the mean time, dietary staffs and personnel must do all they can to

deliver safe, palatable, and nutritious foods within the available resources they have.

Appendices

Sample Forms in Food Production and Service:

Statement of daily Market Purchase

Today’s Menu Form

Sample One Day Menu

Sample Menu Cycle

Sample Forms in Clinical Dietetics

Nutrition History Form

Diet Computation and Sample Menu Form

Diet List

Doctor’s Order Sheet and Compliance

Hand Outs for Diabetic, Low Salt, Low Fat, Low Cholesterol, Low Residue, Low Purine Diet and

Complementary Feeding Sheet