By Michelle Guarnieri
When I stepped into my clinical rotation and Meritus Medical Center, I was expecting feeding tubes, intubations, diabetes education, and a lot of calculations. I was not, however, expecting to have components of foodservice mixed in with my Intensive Care Unit (ICU) rotation. It turns out that these two areas of nutrition crossover frequently, and dietitians play a major role in foodservice and the safety of the patient.
At Meritus, patients receive daily menus specific to their nutrition needs. From this, they choose their breakfast, lunch, and dinner selections; then trays with their desired meals magically arrive at set meal times. Seems simple right? Not so much. Meritus has five floors that hold close to 250 beds and is usually close to capacity. That means a lot of patients need diet-appropriate and safe food served at each mealtime. According to safety protocol, hot food should be kept above 140 degrees F and cold should be under 40 degrees F. Temperatures within this range make a hostile environment for most bacteria that cause foodborne illnesses, so these temperatures are important to keep the patient’s food safe. ICU patients are often immunocompromised, that is, they are at increased risk for foodborne illness and other infections. Therefore, food safety in this population is vital.
This poses the question: how is the hot food going to stay hot and the cold food going to stay cold during delivery? The foodservice staff taught me how they do this. Hot food is kept under a cover on the tray separate from the cold food. This prevents the steam from the hot items from heating up the cold food. The trays are then loaded onto an insulatedcart that is covered on both sides and the top, much like the ones used by flight attendants on airplanes. Trays are sent in batches to each floor, so the second floor is served then the cart is returned to the kitchen to load the third floor, and so forth. However, there’s one more problem. It takes about five minutes to get food to the floor, then each floor has about 50 patients that need meals. I wondered, is it possible to maintain a safe food temperatures even for the very last patient served? It’s possible but not easy, and needs to be monitored. That’s where dietitians and test trays come in. Every month, each of the five dietitians order a meal from the kitchen and report on the temperatures, taste, portion size, and appearance of the food when it’s delivered to them. That’s 60 test trays every year! During my time in clinical, I got to try this out for myself.
It’s getting cold out, so I ordered grilled cheese and tomato soup to warm myself up. I also added Greek yogurt for protein and a side salad to get some vitamins. The ICU is the last floor to be served and I would be the last one given a tray. This is meant to simulate what it’s like for the last patient served to get their food. While I waited for my comfort lunch, I got my thermometer and alcohol wipes ready to check the temperatures. I reviewed guidelines for safe foodservice and looked over the evaluation form.
When my food came, I checked the cold food first, like my preceptor had instructed, then moved on to the hot food. I made sure to document my findings and communicate them with my preceptor and the foodservice staff so they could have feedback and make changes, if desired.
Test trays help to improve both the quality and safety of the hospital’s food, and are a great learning opportunity for everyone involved. I’m glad I got to experience this food service evaluation procedure firsthand!