IV.

OPERATIONAL PROCEDURES DISCUSSION A. Menu 1. 2. 3. 4.

Menu Planning Process Menu Pattern Sample Menu Cycle Evaluation of Menu Samples

1. Menu Planning Process The Food and Nutrition Department of Saint Lukes Medical Center in Quezon City offers a wide variety of food items included in their menus. Knowledge in the aesthetic appeal as well as what flavors complement and contrast are highly considered in the menu planning process. It must be carefully carried out for the satisfaction of regular and therapeutic patients. Every detail is scrutinized, and so menus do not repeat very often. The menu planning process starts with the dietician printing the diet cards of the patients. Printed menus for full diet and therapeutic diet serve as the bases of the dietician in planning the diets of the patients. Unless specified, the same diet is given for patients with full diets. Patients with therapeutic diets are classified into codes. Heart -stands for patients with heart illnesses Diab.- For patients with diabetes No dark- For patients refrained from eating no dark-colored foods Bland- For patients who are on bland diet Soft- For soft diet Low-salt, low-fat- For hypertensive patients

MSDB- For Mechanical Soft Diabetic Diet After copying and making adjustments on the diet cards of the patients, the dietician will now make a trip to the kitchen to ask the cooks what the ingredients in the menus were. She will record it and will make and inventory of the count of the ingredients in the dish. She will personally indicate on the dish trays of the ingredients the room number of the patients with that dish to keep tack on the patients meals. The next step is to record it on the ingredient form to be handed out to the cooks.

The cooks will read the specifications on the menus of the patients. This stage is crucial as the dietician needs to inspect whether the cooks made the necessary adjustments or not. In this stage of menu planning, she constantly reminds the cooks to make the correct adjustments. After the cooks are done with their tasks, it is up to the dietician to check whether the menu items for each patient is complete. With this task accomplished, the menu planning process is complete.

2. Menu Pattern The Menu Pattern is the backbone to the presentation of the menu. Menu Patterns are made for breakfast, lunch and dinner. There is no menu pattern made for a.m. and p.m. snacks since these only contain two items, each of which is a rice equivalent and the other one, a fruit juice.

The menu pattern for breakfast is as follows: Egg/ Breakfast Meats Cereal, hot or cold Fruit or Juice Coffee/ Tea or Juice for beverage

The menu pattern for Lunch is as follows: 3 choices for Main Course (Check one) Soup Vegetables Rice Dessert

The menu pattern for dinner is as follows: 3 choices for Main Course (Check one) Soup Steamed Vegetables Rice Fruit/ Dessert

All menus indicate corresponding kcal values for the dietician to have ease of computations.

3. Sample Menu Cycle

BREAKFAST

LUNCH

DINNER

MONDAY

MONDAY
Choice of one main course: (Please mark the corresponding box) Beef Pot Roast with Carrots and Squash with Rich Brown Sauce (Energy 355 kcal/ Carbohydrate 24 g/
Protein 24 g/ Fats 14 g)

MONDAY
Choice of one main course: (Please mark the corresponding box)

Chicken Patty Waffle Butter and Syrup Banana

(Energy 430 kcal/Carbohydrate 40 g/ Protein 4 g/ Fats 28 g)

Pan Seared Fish Fillet with Tofu and Black Beans

(Energy 480 kcal/ Carbohydrate 70 g/Protein 85 g/Fats 15 g)

Stir-Fried Beef Tips

(Energy 594 kcal/Carbohydrate 31 g/Protein 18g/Fats 51g)

Chicken Pastel
(Energy 494 kcal/ Carbohydrate 33 g/ Protein 43 g/ Fats 21 g)

Coffee, Tea or Juice

Served with: Nido Soup

(Energy 256 kcal)

Note: Calorie count includes the set menu selection except for breakfast s beverage choice

Served With: Cream of Spinach Soup

(Energy 187 kcal)

Roasted Mixed Vegetables in Olive Oil

(Energy 104 kcal)

Steamed Corn, Carrots with Hoisin-Garlic Sauce

(Energy 164 kcal)

Steamed Rice
(Energy 206 kcal)

Steamed Rice
(Energy 206 kcal)

Mini Carrot Cake

Lychees
(Energy 65 kcal)

4. Evaluation of Sample Menu A checklist will serve as a guide for menu evaluation.

Put a check mark on the appropriate answer. Criteria 1. Does the menu meet the nutritional guidelines and organizational chart? 2. Are the in-season foods that are offered available and within an acceptable price range? 3. Do foods on each menu offer contrasts of Color? Texture? Flavor? Consistency? Shape or form? Type of preparation? Temperature? 4. Can these foods be prepared with the personnel and equipment available? 5. Are the workloads balanced for personnel and equipment? 6. Is any one food item or flavor repeated too frequently during this menu period? 7. Are the meals made attractive with suitable garnishes and accompaniments? 8. Do the combinations make a pleasing whole, and will they be acceptable to the clientele?            Yes   No

Interpretation: The answers reflect an exceptional menu with variation and complementation of flavors and an even distribution of labor among personnel.

5. Recommendation The Saint Lukes Medical Center has a wide array of menus which ranges from local food items to international ones. The hospital not only caters to its Filipino patients but also to foreigners. I have been to other hospitals before and I can say that SLMCs cycle menu is far excellent in terms of variability, gustatory factor and nutritional quality. The only thing that was noticed is that the patients sometimes tend to be very picky about the ingredients in the menu. They can call the dietary department and ask for a change in the menu item, exerting another effort in the part of the dieticians and other personnel. I recommend that they restrict phone calls from patients as it could disrupt the working schedule of the employees.

E.

Food Assembly, Delivery and Service 1. Methods and Procedures Used 2. Quantity and Quality Control Systems 3. Evaluation of Practices Used

1.

Methods and Procedures Used Saint Lukes Medical Center uses the Centralized Delivery-Service System. This system

allows careful scrutiny of portion weights of different food items prepared. Different portion servers such as ladles, spoons, soup bowls, rice bowls, mugs and glasses are used to control the quantity and portioning of food items being served. A nutritionist-dietician inspects the assembled meal at the end of the tray line. After the inspection of the dietician, the meals are transported to the rooms by the food servers who also work as bus boys. Meals are put in trays covered in cling wrap for ward rooms, in covered trays for private and semi-private rooms, and a butler service for suite rooms. All of which are under the careful observation of cameras inside the hospital.

2.

Quantity and Quality Control Systems SLMC has a strict rule when it comes to the quality of their meals. A certain time limit of

two hours must be given for every patient to consume his/ her meal. If the patient has to leave his/her room to undergo a surgery or other medical procedures, the nurse at the nearest nurses station is informed and the upcoming meal to be served is withheld. After the time to finish the meal has lapsed, the trays are collected whether the meal is consumed or not. This is done to ensure optimum quality of foods being served to the patients.

There are measures to ensure proper quantity of foods being given to each patient. However, some of these measures are not applicable to some food items, so it is up to the judgment of the dietician at the end of the tray line to check whether the quantity of foods assembled are correct. For milk formulas, a certain number of scoops are put into minimicrowavable plastic containers and are also put together with the meal in trays. Pieces of meat and vegetables are portioned by counting.

Below are the standards in insulated tray use:

Dinner Plate No rice on plate Main Course: Vegetables: Rice on Plate Main Course: Rice: Vegetable Side dish: 6 oclock position 12 oclock position 3 oclock position 12 oclock position 9 oclock position

Cereal Bowl/ Rice Bowl For Salad For rice For saucy vegetables Cover with Polyvinyl Cover with Polyvinyl Whenever possible

Rectangular Dish For fruits Slice all fruits whenever possible.

For cakes

Desserts with paper liner must be placed directly in the tray without the rectangular dish.

Blenderized Meals Strained Viand Strained Vegetable Strained Cereals Juice/ Fruit shake Soup bowl Soup bowl Cereal bowl Mug

3.

Evaluation of Practices Used The measures for quality control of the meals prepared are adequate. This step is very

important for patient satisfaction. The hospital is very careful in the preparation and service of meals as the patients could complain about any form of disappointment be it in the meal or in the service itself. The stamina of the food servers and all employees are impressive. Preparing meals one after another afterwards delivering these to the respective rooms is hard work. The tasks of the dieticians are more tedious- they have to inspect the meals and follow the diet printed on the diet cards in order for the patients to recover easily. One minute mistake and it could endanger the health of a patient. SLMC continues to practice these measures until today because as their institution claims, they are one of the best in the world and of course, they do not want to disappoint their

patients. They believe that their patients- local or foreign should deserve equal attention because they ought to get what they paid for.

5. Recommendation From the preparation to the delivery of meals, there has been a strict rule when it comes to the patients satisfaction. They must be pleased with the food as well as the service. The food servers have two uniforms: one composed of a set of head cap, apron, disposable gloves, mask, white shirt, full-length pants and closed shoes and the other one, a uniform consisting of a vest, a plain white polo shirt, a pair of pants that match the vest and black, polished shoes. Courtesy is practiced as the food servers need to take in to consideration the privacy of the patients. They need not to disturb them at the same time serve them with a smile. Most of the food servers wear the proper complete attire however, a few failed to do such. Some even failed to wear head caps during the preparation of the meals. I therefore recommend strict implementation of complete uniform during preparation of meals as well as during delivery of these.