Patients ordering their own meals

[cdktRN]

My hospital just changed over from scheduled meals to a new menu system and the patients ordering when they are hungry. This has put a lot of added stress on the nurses because now we have to direct our diabetics when to eat and then juggle their insulin around the time the trays might show up, make sure our elderly patients who can't see the menu or dial the phone get something to eat. In some dream land of management this is ideal, but when you have 8 patients (which is ridiculously high but that's our average), it is very hard to deal with.

Do any other hospitals have this type of meal arrangement? If so, how do you cope with the different meal schedules etc. thanks.

[RNperdiem, RN]

My experience with this comes from my post-partum hospital stay. I called dietary with my order from the menu, and thirty minutes later a dietary aide delivered my tray. I liked the system from a patient point of view.

Of course, I could function independently with my meal tray. I opened my milk, sugar, etc without needing any help.

That system works out more complex on a med-surg floor with diabetics, people needing feeding, patients who cannot order for themselves and people with restricted diets.

[student456]

I think that is a really stupid idea...hopefully itll change back!

[incublissRN, BSN, RN]

We have the same type of system. When we put in the order we can type in select, select assist or non-select. We choose select for patients that are able to order their own tray, select assist for those that can't read the menu or complete the phone call to dietary, and non-select for patients that are confused, etc. so that they get a tray automatically at the normal meal times. I've worked nights for the past year but when I worked days I think dietary called the patient or their nurse if a meal hadn't been ordered by a certain time.

If the patient is diabetic a sign is put on their door and when the aides deliver the trays they hit the call light so the nurse can check the patient's blood sugar and treat it at that time.

I hope it gets better for you!

[mrsraisinkain]

Where do you work? I don't work there anymore but I know the new Atrium Medical Center in Middletown, Ohio, just started their room service program with the opening of the new hospital. If that's not where you work maybe you could post in the Ohio room to ask some of those nurses their opinions.

I was in pharmacy and when they were developing the program it was going to take a whole lot of cooperation with dietary, pharmacy, nursing, and the patient to make sure that the medication administration was scheduled properly.

[Sunflowerinsc, ADN, RN]

Our hospital started "room service" meal ordering about 2 years ago. It had its up and downs and some (allot) of adjustments on our part. But once it got going and everyone kind of had to change their mindset of how meals are severed, it has allot of advantages. It is not suited for all pt's and we don't put everyone on room service. OF course NPO pt's aren't , pt's on clear liquids or pureed diets get standard served meals. Yes, you do have to adjust when insulin is due and it takes some planning on pt and nurses part. When I do my 1st rounds and I ask pt (or family ) if they are going to order and let me know so I can get medications ready. Most room service trays come by 30 mins after ordered. Several good things are that when pt's come back from tests, they can order then. The trays aren't dropped off at routine times and let setting to be cold when pt is out of the room. The assistance that is assigned to pt checks with her pt's if they need help in ordering. Many family's order several days meals from home for their loved one who have problems with calling. They know better what pt would eat. We don't put people on room service that can't manage calling and they get a "standard" tray,typical hospital food that mostly goes uneaten. So most of the staff orders for them, can get soup or something a older pt would be likely to eat and skip a huge plate of "mystery meat". There have been adjustments but the longer we have had the service, the better everyone likes it.

[EmmaG, RN]

I've worked several hospitals with 'room service'. Dealing with diabetic patients was an issue--- no matter how often they were instructed to call before eating, they always seemed to "forget". So some places made it policy that diabetic trays were delivered to the nurses station instead.

I also had problems with patients not ordering before dietary closed for the day, so they'd end up not getting a supper tray and get angry because we had nothing (beyond some crackers and soup) to feed them. Again, this seemed to happen repeatedly with the same patients. :stone

From a patient's perspective, I can see where this type of service would be preferable. For the nurses, it seems to cause a lot of headaches.

[Sunflowerinsc, ADN, RN]

I think that is a really stupid idea...hopefully itll change back!

I don't think it will every change back! Looks to good on Press-Gainey!!!! And it works better the longer you use it and get it worked out for your pt's needs.

[ChocoholicRN]

I've worked in hospitals with both types of meal services-self ordering and scheduled meal times. For the self-ordering the patients loved it because they could pick and choose exactly what they wanted, and if they never called to order they would get the "chef's choice" for each meal. They could also order anything they wanted in-between meals, even just a cookie or bottle of water, as long as it was within their diet restrictions. I could definately see how this would be difficult for nurses (I was an aide at this hospital). Where I work now as a nurse we have scheduled meal times and the food-service workers take the orders for each meal. We always know when each meal will be which is great for diabetics and meds to be given with food. The biggest problem i've noticed is that a lot of patients complain that they got the wrong tray, which I see for myself is true all too often. With the self-ordering, its hard to say you got the wrong meal if you called and ordered it yourself. Both systems have their ups and downs and I'm kind of torn between which one I prefer. Hopefully one day soon they'll work out some sort of universal system for all hospitals.

[michigooseBSN]

Speaking strictly from my fairly extensive experience as a patient, I loved it. I would never know the afternoon before, what I would want to eat the next day. At the hospital where I both worked and patiented (I doubt that's areal word), the dietary service was responsible for helping people fill out menus when they needed help.

[LydiaNN]

It sounds like a system dreamt up by someone with little or known understanding of nursing realities to me. Kind of like the whole "customer service" model of care instead of what's more important, which is the "quality standard" model of care that hospitals should be about!

[Chaya, ASN, RN]

I'm not that fond of it. We have a pretty fast pt turnover and it's hard for staff to keep track of who orders themself and who needs help, who has already ordered and who needs to be prompted before the kitchen closes. Dietary does call most pts if they haven't heard from them in a timely fashion, also checks with nurses if there is a diet discrepancy.