In­pa­tient food ser­vice sys­tem needs im­prove­ment

Bhutan Times - - Front Page - Sonam Pen­jor

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.

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