Inpatient food service system needs improvement
Although the Ministry of Health had developed a guideline for inpatient food service system in 2013, besides positive developments and best practices observed in the hospitals, shortcomings are observed that needs improvement.
The guidelines for inpatient food service system in Bhutan 2013 stated that every six months a meeting should be conducted involving the management, kitchen incharge or store in-charge, cooks and dietician or nutritionist (if available) and other relevant staffs. But it has not happened. This was reflected in annual audit report 2017.
Performance audit report on provision of patient meals May 2017 of Royal Audit Authority of Bhutan stated that the knowledge of food safety in practice by all kitchen staff was poor despite having availed the food handlers training provided by Bhutan Agriculture and Food Regulatory Authority (BAFRA).
The guidelines also stated that the heath facilities should be able to provide regular diet, soft diet, therapeutic diet and special supplements the inpatients.
But the RAA during its auditing period found out that, patient meals were not provided based on nutritional requirements or disease conditions of
the patients. “All inpatients are provided with regular meals regardless of clinical conditions.”
This could result in not meeting the specific nutritional needs of patients thereby deteriorating their disease condition and prolonging hospital stay as well as their recovery.
The report also stated that the food indenting process in the hospitals was found to be inefficient and uneconomical wherein the hospitals account all patients admitted for hospital meals irrespective of whether they want to eat or not.
The food intake by patients was found to be suboptimal raising doubts on the acceptability of hospital meals. Suboptimal intake was caused mainly due to consumption of meals by the attendants, meals for patients brought from home, patients treated with food from hawkers and restaurants, the report states.
The report further stated that the principles of protected and favorable mealtimes were lacking wherein mealtimes coincided with clinical and non-clinical activities such as ward and medicine rounds, and cleaning. Lack of protected mealtimes will result in patients not being able to eat leading to low nutrient intake which might ultimately affect clinical outcomes.
Daily nutrient intakes by patients as per ration scale do not generally met with the World Health Organization (WHO) recommended daily requirement for adults. Inadequate nutrient intakes could develop into malnutrition or nutrient deficiencies, which might deteriorate the disease conditions of the patients.
The report also stated that there were no nutrient criteria for preparing menu and menus were never analyzed for nutritional content. Moreover, there was lack of standardized recipes and menus were repeated, which have resulted in ineffective planning of hospital meal menu.
Meanwhile, Auditor General of Bhutan, Tshering Kezang said during the release of annual audit report 2016 last Tuesday that the trend for irregularity in the country is decreasing yearly because the head of the agencies are doing their own internal audit, but added that any survey had not been done till now.