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.

[NurseCard, ADN]

I have never worked anywhere where this system was used, except on the post partum floor. I would think that it would be a good system for independent patients on regular diets, but that's it. You would have problems when you have an independent regular diet in one bed in a semi private room, and an independent brittle diabetic in the other bed.

[P_RN, ADN, RN]

When I had my most recent hospital stay they had this. It was wonderful. You had a menu of what was available and you called dietary from 6a to 11pm and ordered. They had lactose free milk which I hadn't come across at any other hospital. They had hot meals, cold salads, any kind of soft drink etc. All came within 30 minutes. I even requested bottled water that was room temp because the city water was soooooo bad and they brought me a case of it. I love water!. I was quite impressed. And reflected that as an aside on my Press-Gainey. Mostly it was the nursing care I gave all the A+++++ to though.

[Blee O'Myacin, BSN, RN]

The only way this works if dietary comes around and goes over meal selections with the patient for the day, and then delivers at the standard times. This way, the patients get to control *something* during a time where little else is under control, and the staff can standardize medication administration times.

I worked at a hospital that did this, and it worked. I think that leaving the ordering of meal trays to the patients is a tricky thing. If they are at a test, or forget to call, or just don't feel up to eating, then they don't get anything at all. Nurses on the floor can't be expected to follow up on yet another thing.

Besides, it sounds way too much like working at Bennigan's if I have to ask the patient if they are "ready to order".

Don't even get me started about feeding or not feeding people in the ER. We stopped giving out meal trays as a rule, and now it is an exception. (ie - you are there for hours or days waiting for a bed and your admission orders are written with a diet selected by the admitting physician).

I have no problem with making people more comfortable when they have to stay in the hospital, but just as long as the proper hospitality staff is hired and retained for these duties.

Blee

[Mulan]

It sounds like insanity to me.

Sounds like fun trying to work around people eating at all different times, not just the diabetic meds, but the ones that can't be given one hour before or two hours after, and what about other things like dressing changes, etc., oh can't do it now, they're eating!!!!

If where I work goes to that, I guess I'll be gone.

[Altra, BSN, RN]

What makes this work:

1. A sufficient number of dietary staff who physically walk the floors during a 2-hour window around meal times to make sure each patient has ordered/is aware that they need to order/etc.

2. Customized menus for each type of diet: regular, ADA, cardiac, limited sodium, clear liquids, full liquids, mechanical soft, etc.

3. Nurse/patient ratios that are generally within the limits of sanity.

[UM Review RN, ASN, RN]

As a post-procedure patient, I loved this system. I was able to order food and have it hot and fresh every time.

As a nurse, I worked in one place that had this system, and after a few bugs were worked out, it worked well.

I think it would've worked better if we could've used the "assist" function described by one poster. I would also like to see the diet aide signal that a tray has been delivered on the outside of the room -- maybe by putting on the call light for the patient?

So I'm all for it. Standardized trays caused way more complaints, IMO.

[justavolunteer]

The hospital where I'm 'justavolunteer' has pt. ordering. They can only order within their dietary restrictions. If they are listed as NPO, they won't be allowed to order until someone on the unit changes their diet. Most of the stuff at my place is computerized, so it works rather quickly. Confused pts. are flagged as non-ordering, they just get something that fits their diet. Diabetic trays come with a slip that goes to the unit clerk or someone else at the front of the nurses' station. Someone gets called right away to do that person's blood sugar. Even I have learned to call, if I happen to be there at that moment. Some pts. need assistance with ordering, sometimes the someone who helps them is me.

The pts. can call for snacks, coffee, etc. anytime. They like to be able to do that. It is some extra work for us, but it mostly seems to work OK. The main problem with different mealtimes is that sometimes the kitchen has to be called due to trays all over the unit that need to be picked up.

[CuttingEdgeRN]

My SIL had surgery at MD Anderson Cancer Center in Houston last month. My brother and I traveled with her. They had Patient ordering and it was awesome. She could order anytime between 6am and 10:30pm. A menu was provided for her and a guest menu with prices. We could order our meals together (I would pay for mine and it wasn't very expensive) and it was like we were at a resturant for a bit instead of a hospital.

I was very impressed.

[Sunflowerinsc, ADN, RN]

It sounds like insanity to me.

Sounds like fun trying to work around people eating at all different times, not just the diabetic meds, but the ones that can't be given one hour before or two hours after, and what about other things like dressing changes, etc., oh can't do it now, they're eating!!!!

If where I work goes to that, I guess I'll be gone.

One of the things I like for dressing changes and so on, that everyone is NOT eating at the same time!

[Valanda]

Our local hospital was using this service and I have to say it was one of my major sources of complaint when I had surgery last February. I was in the hospital for 7 days, and 3 of those days I missed meals completely. I've worked nightshift for 21 years. Between the pain meds and my usual sleeping schedule, I was not awake to order a meal from dietary for 3 days. I ended up sending my husband to the 24 restaurant to get me food (on the 3rd day) cause all they had on the floor was crackers and juice. I'm still a tad ticked that when I was sick enough to be unable to care for myself, those assigned to care for me completely overlooked my dietary needs.

They have recently abandoned that service and I can only think it's a blessing.

[xptp29a]

The hospital I work at uses an okay method.

One catering associate (dietary staff) is assigned to each unit. That associate prepares, delivers and picks up the trays as well as takes meal orders for about 20 to 25 patients.

Meals are ordered immediately after eating a meal. For instance, after breakfast, lunch is ordered.

The associate goes room to room and reads the cook's special and the alternative choice. The patients also have an extensive al a carte menu to choose from. They basically can order anything that the cafeteria has to offer, if it is within their diets. The associates get preferences for patients regardless of their diet (regular, mechanical soft, dysphagia, clear, full liquid, etc).

During the day, a couple of people serve as runners to expidite meal trays for new admits, diet changes, etc. At night, the catering associate is responsible to monitor diet changes and new admits and run those late trays. This is the real downfall of the process.

Whenever a diet change is made in the electronic chart, the dietary office gets an automatic printout indicating this change. The catering associate or runner then calls the patient to get an order. This is usually a 20 minute turn around time.

The catering associates are required to get an order from each and every patient. If they can't, then they ask family members if they are present. Then they ask nurses and aides if the patient has expressed any preferences. Only as a last resort will the patients be given a non-select meal.

The cutoff period for hot meals at dinner is pretty early so there are a handful of patients every night that have to resort to sandwiches and soups that are stocked on the unit.

Most patients seem to like the control they have over what they are getting to eat. Most also seem to enjoy the interaction with the catering associates.

[lpnstudentin2010, LPN]

As a patient it is so nice to have. I am always a post op patient when I am in the hospital (at least so far) so you never know how you are going to feel day to day. I can look at the menu and order exactly what I want. It comes up with a little reciept that stays on the tray so that the nurse knows what you ordered so she can chart what you eat. I think like every 45 mins to an hour a person from dietary comes and delivers all the trays because she always seems to have a bunch.

On that little receipt it also says what type of diet you are on. Mine has always sad normal because I had no limits, though when he saw what I was eating a couple of days after one of my surgeries this summer I was told by the resident I should be on soft food diet. He told me this when he saw me eating bacon, and I had an incision in my mouth that they had used to build up my cheek bone area.