Do they provide food in the hospital? Food in hospitals. Formats of catering in medical institutions

The editorial office receives many letters complaining about poor nutrition in hospitals. It's no secret that often the product does not reach the patient, settling in the kitchen. It happens that food does not seem to cause even a semblance of appetite, and sometimes it is simply tasteless. Instead of five times a day, they can feed in best case three. We decided to check how things really are. Our correspondent went to read the "hospital" menu in Moscow hospitals, choosing three of them at random.

Written one - give another

FIRST on the list is the Road Hospital. Semashko.

The object of my attention is the purulent department. Upon entering the floor, immediately in front of me is a neat dining room. Above the issuance window hangs the coveted menu sheet - the purpose of my visit. But then it turns out that the joy is in vain: one thing is written, but they give something completely different. It is difficult to print the names of different dishes every day, especially since each patient has his own diet. For example, table 15 eats one thing today, while table 9 eats something completely different. The food turned out to be very tasty and interesting. For example, the menu of the 9th table includes a variety of meat products. On Monday they are given cutlets or sausages, on Tuesday - sausages, on Wednesday - chickens, and on Thursday they put fish. In addition to all this, soup is a must every day. Oil is given only in the morning. "For breakfast, eggs or scrambled eggs, that's all, nothing else," says the canteen worker. Without porridge in any hospital - nowhere. Therefore, rice, millet, semolina, oatmeal are always available. More dishes from the menu: apple soufflé, vegetable soup with sour cream, compote, etc., etc. that we don’t need anything, and so we overeat here, ”they tell me. Indeed, patients do not complain about food. Pyotr Nikolaevich says that today he ate "some kind of soup for lunch. They feed more or less, you can eat. And there are very tasty dinners, I eat with pleasure." As Sergey put it: “They don’t feed, of course, but it’s necessary for the sick, we have a diet. Otherwise, everything is fine. If you don’t eat enough, you will always get a supplement.”

It is good when everything is good

IN CITY clinical hospital N 1 im. Pirogov I go straight to the dining room of the cardiovascular department. And here the menu strikes my imagination. There are dishes that you don’t often cook at home, not like in a hospital. The menu is different every day. Recurrence can be only in a week. The chefs list to me what patients usually eat. For breakfast - cereals, cheese, sausage, cottage cheese, cottage cheese casserole. Lunch is not complete without soup: borscht, cabbage soup, chicken, noodles, rice, pickle, beans, peas. Second courses are no less varied: meat goulash, cutlets, boiled chickens, Stroganoff liver, steamed chicken soufflé, pilaf, pasta with meat. In the evening, they usually give a potato casserole, boiled fish, hodgepodge, stew, lazy cabbage rolls with meat, etc. They drink kissel, kefir, compote. Every day the patient is given either an orange or an apple. The 10th and 15th tables are fed 4 times, and the 9th - as many as 5 times a day. Patients benefit from vegetables and lean meat, so there are no pork dishes on the menu. Unfortunately, it is not possible to talk with patients, but the canteen workers assure that no one has yet complained about food in their presence.

Gynecological hospital N 1 is designed for a little more than 100 beds. Therefore, cooks have the opportunity to cook even what in large hospitals will seem too troublesome. For example, they bake pies with meat, and in the summer they stuff peppers and eggplants. “It’s supposed to feed for 39 rubles, and we feed for 53, the hospital adds. And then, after all, our cooks cook with soul. Patients, for example, ask what we add to an omelette, and does it become so airy? And the secret is simple: you need beat it well, with love," says Olga Sergeevna, a dietitian. The menu here is also seven-day, that is, it is not repeated. And they give both meat and fish, sausage, cheese, eggs, fruits, cereals, vermicelli. Even in winter, they try to include tomatoes and cucumbers in the diet every day. They indulge in a sweet and such signature dish as meatloaf. They definitely have an afternoon snack with fruits, and a glass of kefir is put at night. For lunch today, a fragrant mushroom soup and the aforementioned meatloaf are prepared. It's really delicious and homemade. I read the book of reviews and suggestions. In addition to sincere gratitude to doctors, a separate “thank you” to the kitchen and chefs often flashes. They even asked to have a separate book for the dining room.

"We express special thanks to the food workers for love relationship to your work. All dishes are very tasty, hearty and varied. Many thanks!"

Chamber N 11

"Thank you so much for the wonderful food. Everything is so delicious in the hospital, just like at home..."

16th ward

It turns out that this also happens in our hospitals: the doctors are good and the food is excellent.

Homemade crust tastes better than hospital pie

I have come across some fairly well-off hospitals that feed their patients fairly well. But this is rather an exception to the rule. Many of us know firsthand that sometimes it is impossible to eat what is given. Floating sausage in semolina for breakfast, soup from one cabbage leaf and a piece of incomprehensible meat for lunch - a very real picture.

Despite everything, in all hospitals, patients have one distinguishing feature. No matter how tasty the food is, they will still ask you to bring something from home. Apparently, the point here is that you want something native, from the hands of home. It's also important to feel the support of a loved one. About how to diversify the diet of the patient, tells doctor of the clinical nutrition clinic Valentina Nikitichna MATUSHEVSKAYA:

Each patient has his own treatment table. In turn, the tables have an approved diet and nutritional habits, each has its own diet. It happens that formally all the rules are observed: both the calorie content and the ratio of products. But there are certain dependencies. For example, in winter and spring there is a traditional shortage of vegetables and fruits. The social factor plays a role, sometimes there is not enough money for medicines, not to mention a varied diet. Again, the hospital is tied to a specific food base. Well, if there is what you need. And if not, you have to get out, replace the potatoes with pasta and vice versa. Not the last role is played by the human factor: how the chef prepares the dish, how well he succeeds. In connection with geographic location From vegetables, cabbage, carrots and beets are very popular with us. They are definitely helpful. But someone may not tolerate the same cabbage. If possible, you can introduce cauliflower, zucchini, green beans, greenery. It is quite possible to introduce salads, which are rarely found on the menu of hospitals. You can make healthy vegetable casseroles from carrots and beets. All this, of course, in accordance with the diet. If someone can’t do something, then it’s necessary.

Ideally, hospitals should have 5 meals a day in order to restore an exhausted body. In practice, 3 meals a day is common. This, of course, is not enough. Therefore, the relatives of the patient can consult with the attending physician, ask what additional to bring to the patient. Will be very helpful dairy products(cottage cheese, milk, yogurt, cheese). If you are allowed to bring food home cooking, make vegetable stew, cook boiled chicken. A good way out is children's vegetable and fruit mixtures. They contain many nutrients, they can be eaten even by people who have difficulty chewing. Do not pamper the patient with various goodies. For example, if he likes everything salty, peppery, spicy, do not forget that this does not fit into the system healthy eating. Excessive sweets are extra carbohydrates, and they are not always needed.

There is an opinion that the broth is the best thing to bring to the hospital. Much more useful for the patient as additional nutrition will be polysubstrate nutrient mixtures. They are a balanced amount of proteins, fats, carbohydrates. These mixtures are more easily absorbed by the body, the patient spends less energy on digesting food. Polysubstrate mixtures are usually sold in specialized stores in powder form. It must be dissolved in water and drunk, or the drug is sold ready-made. There are so-called modular mixtures, the property of which is to enhance any component of nutrition (proteins, fats or carbohydrates). But few people know about them, and therefore not all doctors can advise them. Remember to talk to your doctor about all dietary changes. Drink depending on the type of treatment mineral water. Diluted fruit drinks, juices, dried fruit compote are useful.

During the time that a person is in the hospital, he has to rebuild the body in a new way. And all because the food in the hospital is not at all like homemade, and the regimen is not the same. Nevertheless, not so little depends on porridge and compote: if the food is full and tasty, then we will recover much faster.

In general, the state allocates 39 rubles for the nutrition of the patient. per day. With this money, you don’t even go to the store once. Nevertheless, this amount is supposed to be fed 4-5 times a day, moreover, satisfying and varied.

Providing food for hospitals, hospitals, clinics, rehabilitation centers and other medical institutions, including specialized and children's, is one of the most intense and long-standing activities of the Vkusny Vybor company. For long work in this area, we have built a flawlessly functioning algorithm for interaction with the management and relevant services of hospitals, mastered all the nuances of preparing, decorating and delivering meals for medical nutrition.

Sanitary and hygienic requirements for catering in medical institutions

Nutrition in medical and health institutions- one of the most difficult segments of social catering. Russian law provides the most serious requirements for organizations that ensures this process, regardless of whether it is a department of the hospital or the administration of the medical institution engages a professional contractor. First of all, this the highest level of sanitary and hygienic standards. After all medical institutions- these are places of large concentrations of people, and ensuring sanitary and epidemiological control is the most important task.

In this regard, the production base, factory-kitchen company " Tasty choice» brought in full compliance with the requirements of the legislation. Products are purchased from trusted suppliers ( there are certificates of conformity for all products) and housed in spacious and clean warehouses where all necessary storage conditions, namely - maintaining optimal temperature and humidity, compliance with the rules of the commodity neighborhood, etc.. The entire production cycle and regulations of the enterprise are built in such a way that any factors of negative impact on raw materials and finished products are completely excluded. The factory-kitchen "Tasty Choice" regularly undergoes mandatory and voluntary certification and each time fully confirms the compliance of its production base with all sanitary standards.

Nutrition in medical institutions as the most important factor in recovery

Health food – necessary condition successful process of recovery and rehabilitation of patients. This is an obligatory favorable background for the impact of all medical preparations and procedures. And often in the most clinical nutrition and treatment consists. That is why cooking for patients in medical institutions is a serious professional challenge even for the most skilled chefs.

Regardless of the profile of the medical institution, whether it is children's Hospital or hospital for adults, food must be nutritious. That is, any factors that can cause irritation or increase inflammation are excluded. We cannot use a whole range of spices, as well as sour, salty and spicy foods, as they can cause chemical irritation. A number of products and methods of heat treatment that can cause mechanical irritation are excluded (for example, nuts, coarse cereals, fruits and vegetables with large fibers, fried vegetables and meat, etc.). The temperature factor is also important, because too hot or too cold food can also have a negative effect.

In terms of processing methods, frying, deep-frying is prohibited. Applied decoction, extinguishing, steam or water bath, in some cases, baking is allowed. And at the same time, the food must be delicious! After all, the pleasure of eating, positive emotions are also a powerful healing factor!

There is a collection of recipes for meals in medical institutions approved by the Ministry of Health of the Russian Federation. Our experts prepare lunches, breakfasts, dinners for patients of medical institutions in strict accordance with these regulations. In addition, depending on the disease, patients are prescribed specific diet and diet. There are 15 lists of foods and dishes that are allowed and recommended for certain diseases and conditions. These diets (or tables) were developed by nutritionists back in Soviet times, but even today nutritionists of medical institutions rely on these norms in their prescriptions. And in accordance with the prescribed diets, breakfasts, lunches and dinners are ordered for patients. New people are constantly coming to the hospital, others are being discharged, appointments are changing for someone - all this requires a prompt and flexible response from the organization that provides meals in a medical institution. A whole department of managers is responsible for working with this segment of clients at Vkusny Vybor.
Our experts are constantly in interaction with representatives of the customer and instantly respond to all changing conditions.

Formats of catering in medical institutions

Depending on the tasks and needs of the medical institution, the company " Tasty choice» organizes meals in hospitals, hospitals, clinics and rehabilitation centers in any of three formats:

1. Food preparation at the customer's premises, in a specially equipped catering unit. At the same time, equipment and products are provided by the Vkusny Vybor company.
2. Delivery of prepared food to a medical institution in large thermos flasks for subsequent distribution at the buffet or in the customer's canteen
3. Food delivery in individual containers.

Also possible organizationcanteen or buffetFull construction.

Delivery of food to medical institutions - just in time

According to the requirements of the Ministry of Health, meals for the nutrition of patients of medical institutions should be consumed within 2 hours after preparation. They must not be reheated, as the products may lose their beneficial features. That's why it is extremely important to deliver lunches, breakfasts and dinners just in time, and dishes must be at a strictly defined temperature. Say, first courses and hot drinks - 70-75 degrees, hot second courses - 60-65 degrees, salads, cold snacks and cold drinks - 14-16 degrees. Checking the compliance of the delivered food with these parameters by the customer is provided by a dietitian, dietician or doctor on duty. A thermometer is lowered into ready-made dishes, its readings are recorded in the relevant documents. Our products always meet these stringent requirements. Logistics managers make up the best route, taking into account weather conditions, traffic jams and other factors. Therefore, breakfasts, lunches and dinners from the Vkusny Vybor company arrive on time, and lunch (dinner, breakfast or afternoon tea) in the hospitals working with us is always tasty, hot and right on schedule!

Norms of nutrition in medical institutions.

Meals are organized in medical institutions according to a seven-day menu according to the main options for standard diets, the use of which allows you to comply with the norms of clinical nutrition approved by Order No. 395n.

The main options for standard diets:

• standard diet(previously - the main version of the standard diet (ATD));
• Diet with mechanical and chemical sparing(sparing diet);
• Diet with increased amount squirrel(high protein diet);
• Diet low in protein(low protein diet);
• Reduced calorie diet(low calorie diet);
• High calorie diet(high-calorie diet) (previously - a variant of the diet with an increased amount of protein (HAP (t)).

OUR CLIENTS:

The Vkusny Vybor company organizes catering in many large medical organizations , including in hospitals. Among them -

• MNCC Narcology - Moscow, st. Bolotnikovskaya, 16
• International Scientific and Practical Center for Narcology, Clinical branch No. 2 - Moscow, Varshavskoye shosse, 170 g, building 1
• GBUZ MNTSP Narcology DZM Moscow, st. Lublinskaya, 37/1

Ready-made hot meals are delivered to these hospitals in accordance with the approved seven-day menu. In each department of the hospital there are canteens with convenient distribution lines, where barmaids distribute food to citizens who are being treated.

An example of a one day variant of the standard ATS diet

(Food is supplied to several hospitals on this menu).

GBU ZGM "City Clinical Hospital named after F.I. Inozemtseva
Department of Health of the City of Moscow No. 36 "

City Clinical Hospital named after F.I. Inozemtsev (Hospital No. 36), on average, about 1000 people are treated and, accordingly, about 1000 people eat at the same time 3-4 times a day. There are 28 specialized departments, for most of which meals are prepared in accordance with the requirements of 8 different diets. Hot meals are delivered to the hospital ready. Each compartment has its own labeled thermal containers and tanks. Each department has a canteen where barmaids distribute meals.

Example of a one day menu containing eight diet options

(this menu is used to supply food to the hospital, where more than 1000 people eat daily. The hospital has 28 specialized departments).

buffet products

Nutrition for clinics is justified balanced and partly dietary food for people suffering from a variety of ailments that may be accompanied by certain eating habits.

What kind of food do patients need?

The issue of dietary prescriptions, taking into account the medical process, is fully resolved by doctors. Although to unify this process, diet numbers in the amount of 15 pieces are used. That is why companies, including ours, which provides food preparation and delivery services for clinics, must adhere to the developed programs, taking into account the profile of the healthcare institution.

Since the absence of certain groups of patients is the basis for excluding the provision of food on a specific dietary table. All this requires from the chef and his team when fulfilling the order medical institutions cook food:

• taking into account the sanitary mode of preparation;
• using fresh and natural ingredients;
• with diversity
• delicious food.

The latter aspect is important for compliance with treatment prescriptions, as well as for the patient to receive a full complex. beneficial vitamins and the necessary amino acids - substances that contribute to the speedy restoration of strength. It is very important to take into account the individual characteristics of the patient.

Overweight people, even if they have a prescribed diet, say, according to the kidneys or liver, should eat in such a way that the food contributes to both recovery and the absence of progress in diseases associated with obesity. Therefore, food delivery for hospitals and other institutions where there is day hospital, should occur with monitoring of the category of patients placed in them.

How to organize meals?

Usually, the issue of nutrition of patients and staff is carried out by the Deputy Chief Physician for Logistics. If the health department for veterans is on the balance sheet of any military unit or enterprise, then meals for the hospital are ordered through the main organization, even if the point of preparation or delivery is located at the address of the health care institution itself. At the same time, in an agreement with a company that will organize meals for patients, it is important to stipulate:

• the daily number of servings, taking into account the people lying in the hospital;
• adherence to certain diets;
• Delivery time;
• prices.

These are obligatory conditions of the agreement, allowing to consider the contract valid. Separately, you can take care of the nutrition of the clinic staff. We have been providing this service for 7 years. High-quality and healthy food at the place of work will increase the efficiency of the team, eliminate lateness to work.

We will not stand behind the price of health

We will be able to order food for hospitals in Moscow, which is seasoned with the professionalism of our chefs and laudatory reviews from patients, but the real advantages of our work are:

• fair prices;
• discounts for large orders;
• reducing the cost of the order while helping to find new customers.

We are open for cooperation!

The organization of clinical nutrition as a whole consists of the following main sections that require specific implementation in each medical institution:

1. clinical issues of the organization, which include the principles of building therapeutic nutrition, the system of its appointment, diet and nutritional norms.
2. sanitary and technological issues of the organization, which includes the system for building food blocks and transporting food, equipment and inventory, sanitary requirements for the maintenance of the food block.
3. management of clinical nutrition and training.
4. technical issues of the organization, covering the methods of compiling the menu, the system of accounting for prescriptions, the discharge of products, the organization of the technological process in the kitchen, the system for issuing food from the kitchen, food quality control and the organization of patient care.

Principles of construction and system of prescribing medical nutrition

In accordance with the physiological principles of building food rations, medical nutrition is built in the form of daily food rations. Each daily diet of the patient, in other words, his diet, has its own energy value, i.e. caloric content, chemical composition(a certain amount of proteins, fats, carbohydrates, mineral salts, water, vitamins, extractive and other substances), certain physical properties: weight (volume), texture, food temperature and, finally, a certain mode (routine) of nutrition. All these are elements of the diet, which are practically implemented in the form of a menu consisting of appropriate products with a certain culinary processing.

When prescribing therapeutic nutrition, two systems can be used: elemental and dietary. With the elemental appointment of therapeutic nutrition for each patient, a prescription is made with a specific enumeration of the indicators of each of the elements of the daily diet; Based on this prescription, a daily menu is compiled. This system is called individual, but such a definition is not entirely correct, since a properly organized therapeutic diet necessarily requires an individual diet. If, with the elemental system, the doctor develops an individual diet for each patient, then with the dietary system, he prescribes on an individual basis one or another diet from a number of pre-designed, clinically tested and with certain medicinal properties. Therefore, it is wrong to call the dietary system of prescribing therapeutic nutrition "group".

The main system in medical and treatment-and-prophylactic institutions, i.e., when servicing significant contingents of patients, is the dietary system for prescribing therapeutic nutrition. The elemental system can be practically used only in isolated cases, when it is necessary to make many amendments to one or another diet developed and used in a given medical institution, taking into account the complexity and special conditions of the course of the disease in the patient.

With a dietary system, it is also possible to make certain adjustments to the prescribed diet in connection with special indications. Such additional appointments or restrictions in the diet should be made by prescribing products with certain medicinal properties (cottage cheese, liver, milk, watermelon, apples, garlic, etc.), or by adding or limiting nutrients (proteins, fats, carbohydrates, salts, vitamins). With the additional appointment of special products, it is necessary to correspondingly reduce the content of other products in the diet in order to maintain mainly the chemical composition and calorie content of the diet.

In medical institutions of the Soviet Union, diets developed in the clinical nutrition clinic of the Institute of Nutrition of the USSR Academy of Medical Sciences, approved by the USSR Ministry of Health, are used. The most commonly used diets are numbered; some diets and so-called contrast, or fasting days are indicated by the name of the product, such as sugar, apple, compote day.

Each diet has its own characteristics (see below). The number of diets to be introduced in the hospital is determined by the profile of the institution, i.e., the main contingent of hospitalized patients. Every hospital should establish basic, continuous diets and contrast days; as needed, other diets can be used, and in isolated cases, therapeutic nutrition is prescribed according to the elemental system. Practically in a general hospital general type 7-8 diets and contrast days are constantly applied.

The mode, i.e., the diet of patients, is essential for the effective action of therapeutic nutrition. The diet consists of the number of meals, the time of eating patients, nutritional value and the amount of food taken at each time.

The Ministry of Health of the USSR established for hospitals at least four meals a day, for some groups of patients (with heart disease, peptic ulcer stomach, for infectious patients, etc.), it is necessary to establish a regimen of five to six meals a day. One should strive for a more or less even distribution of the daily ration, but in any case, avoid a significant amount with a high calorie content for dinner; as a rule, the evening should not account for more than 25-30% of the daily caloric intake. The feeding time of patients is determined by the number of meals and the general daily routine in the medical institution. Between separate meals, a break of more than 4 hours in the daytime should not be allowed, and between the last evening meal and the morning breakfast, the break should not be more than 10-11 hours. In this regard, it is advisable to organize the 4th meal with a four-time meal not in the form of a second breakfast or afternoon snack, but in the form of a small meal 1-2 hours before going to bed (second dinner). Thus, the main mode of four meals a day is presented in the following form.

With a five-time meal, a second breakfast is introduced, and with a six-time meal, an afternoon snack is also introduced with a more or less even distribution of the daily ration.

Hot food should be included in. each of the meals. The temperature of liquid hot meals should be about 60°, and the second hot dishes should be about 55° when served to patients. The temperature of the food in the department must be carefully controlled.

The norm of the daily diet is set in the characteristics of each diet. As mentioned above, the chemical composition and calorie content of each diet is provided by the appropriate set of products. Based on the food package and the degree of use of each of the diets used in the hospital, the need of the medical institution for food supply is determined. The guidelines for the food supply of hospitals, which determine appropriations for food, have been established by the USSR Ministry of Health in the following volume.

Nutritional norms in urban and rural hospitals per patient per day

Nutritional value: proteins 88 g, fats 66 g, carbohydrates 459 g, which is 2889 calories. The actual nutrition of patients is improving both quantitatively and qualitatively through the development of hospital subsidiary farms. Nutritional value is affected by food "transfers", which must be clearly regulated.

Sanitary and technological issues of the organization

The organization of the food block in the hospital can be carried out according to a centralized or decentralized system. The food block according to its composition can be divided into the following main groups of premises: 1) for food storage; 2) for cooking (semi-finished and prepared food); 3) to release food from the kitchen; 4) for the distribution of prepared food to patients and its reception in hospital departments. In addition, the complex of the food block includes auxiliary premises (inventory, linen, container, for storing waste), maintenance premises (boiler room, workshop), premises for personnel (administrative and sanitary) and a food laboratory.

With a centralized system, the entire food block, except for the premises for distributing food to the sick (pantry rooms) and for its reception (dining rooms), is concentrated in one place. From the central kitchen, prepared food is delivered to the pantry in group transport dishes, where it is distributed among the sick. With this system, prepared food is distributed 2 times: the first time in the kitchen in group dishes and the second time in the pantry, where food, often reheated, is distributed in individual dishes.

With a decentralized system, prepared food is released to patients directly from the kitchen in individual dishes, which is achieved by bringing the cooking process as close as possible to the place of stay of patients, i.e., to the hospital department. In a single-unit hospital, a food unit is arranged in a hospital building, and in a multi-unit hospital, in each hospital building with 50 beds or more, a pre-cooking kitchen is organized, and in a separate building or in one of the hospital buildings, centralized storage of products, preparation and dispensing of semi-finished products. A decentralized system has a number of advantages compared to a centralized one: repeated rearrangement of food, its cooling and loss of shape, reheating are avoided, due to which the taste of food, its hygienic properties do not deteriorate, and more favorable conditions are created for organizing therapeutic nutrition. The head of the department and the attending physicians get the opportunity to influence the nutrition of patients, the workers of the food block can be responsible for the entire process of nutrition, up to the moment the patients actually eat.

When designing new hospital construction and reconstructing existing hospitals, the USSR Ministry of Health provides for the organization of food blocks according to a decentralized system. It is also necessary that in existing hospitals, in which food blocks are located in the hospital building, to organize the nutrition of patients according to a decentralized system, i.e., deliver food to patients directly from the kitchen in individual dishes, and not distribute it to pantry in group dishes and transfer it to plates.

Questions of hygienic maintenance of the food block and sanitary requirements for the technological process of cooking are set out above (p. 29).

Hospital nutrition management

The general management of nutrition is carried out in the hospital by the chief physician or his deputy for the medical part, and in the departments - by the heads of departments. To coordinate all the work on the use of clinical nutrition in multidisciplinary hospitals, a Medical Nutrition Council is being created, which discusses and outlines activities on the main issues of organizing clinical nutrition. The council includes heads of departments, a supply manager, a dietician, a dietitian (head of the kitchen), a senior cook and a dietitian of the department, appointed by the chief physician. The chairman of the council is chief physician hospitals, and the executive secretary is a dietitian. The direct scientific, methodological and organizational management of clinical nutrition in the hospital is carried out by a dietitian. In hospitals where the position of a dietitian is not provided, the management of therapeutic nutrition is entrusted to one of the attending physicians.

The management of the hospital kitchen is entrusted to a dietitian working under the medical direction of a physician. The functions of a dietitian (head of the kitchen) include control over the sanitary and hygienic and technological process in the kitchen, the correct release of food from the kitchen; she organizes the distribution of food in the canteens.

Direct cooking is carried out under the guidance of a senior cook-foreman, who, like the rest of the production staff of the kitchen, works under the guidance of a dietitian. The position of a dietitian is established according to the staffing standards of the USSR Ministry of Health for every 200 beds (half of the position for every 100 beds), so that in large hospitals it is possible to lead the work on feeding patients in separate buildings also by dietitians. In departments where there are no dieticians, the organization of food for patients is entrusted to the elder sisters of the department. In tuberculosis and infectious diseases hospitals, for every 100 beds, a position of a dietitian is provided, and from 75 to 100 beds - half the position, i.e., half-time.

Provision of the food block with products, inventory, hiring and dismissal of kitchen staff are carried out by the deputy chief physician for the administrative and economic part.

The functions of the Council for Clinical Nutrition in a hospital, a dietitian and a dietitian (head of the kitchen) are provided for in special "Regulations" approved by the USSR Ministry of Health.

Systematic work to familiarize all hospital staff with the basics of clinical nutrition plays an essential role in the organization of hospital nutrition. This work should be organized by a nutritionist with the involvement of a dietician and a senior cook, as well as hospital doctors.

The characteristics of the basic, permanent diets should be introduced to doctors, nurses and all kitchen production personnel. The organization of special classes with a demonstration of the technology of preparing main dishes is very valuable. The junior medical staff of the hospital should also be familiar with the basic diets and principles of serving patients with therapeutic nutrition. It is necessary to include classes on a sanitary minimum in the training plan for the production staff of the kitchen.

The technical minimum for therapeutic nutrition and sanitation must be passed by all newly hired employees of the food unit, directly related to the process of storing and preparing food products.

Technical issues of the organization of clinical nutrition

Menu compilation. Applications for food of patients are made in the reception and hospital departments and daily until 13-14 hours are transferred to the dietitian. The application from the admission department is valid on the day of admission of the patient and the next day, if the patient was admitted to the medical institution in the afternoon. Based on the applications received for various diets, the dietitian, with the participation of the senior cook, draws up a menu-portion and transfers all the material to the counting department, where the necessary products are calculated, and demanding statements are written out to the pantry.

The main document on the basis of which the extract and cooking is made is the menu-portioner (pay slip). The menu-portioner is signed by a nutritionist, under whose leadership the menu is compiled by a dietitian (head of the kitchen), an accountant (calculator) and approved by the chief physician.

The number of products in the portioning menu is written as a fraction: in the numerator for one serving, in the denominator for all servings. It is not required to indicate the number of products per serving if there is a card file of dishes, in which the card of each dish has its own number and set of products; in this case, it is enough to indicate the number of the dish, its name and the number of servings in the portioning menu; the counting part, where there should be a copy of the card index of dishes, counts the required number of products, guided by the number and name of the dish, affixed by the dietitian

According to the menu-portioner, as a rule, products are prescribed that are to be processed in the kitchen; bread, butter, sugar, tea, sold to patients without cooking, are obtained from the pantry directly by the barmaids of the departments according to separate requirements, compiled by the counting part; since the norm of bread, sugar and butter is not the same in different diets, each hospital establishes the norm of these so-called buffet products for the main diets: the norm is approved by the head physician and serves as the basis for issuing requirements for these products.

In each medical institution, a planned seven-day menu should be developed for basic, permanent diets. It should correspond to the characteristics of diets, provide a variety of delicious meals, the right combination of foods at each meal, and be in line with the food allocations available in the institution.

For each of the main meals: breakfast, lunch and dinner, the menu should include dishes that would ensure the content of proteins, fats and carbohydrates in it. It is necessary to avoid that both the soup and the side dish for the second course at lunch consisted of cereals and flour products (pasta, vermicelli). Simultaneously with the planned seven-day menu, layout cards for individual dishes are compiled. The layout cards are compiled on the basis of the materials given in this manual and other published materials, with amendments due to the practice of this medical institution.

The cards are compiled in two copies, one of which is stored in the dietitian's file cabinet, and the second in the counting part.

When compiling the menu, you should take into account the time required to prepare the dish, and the permissible shelf life of it after readiness. This helps cooks plan their work to prevent the loss of nutritional value and taste of dishes from excess storage in the finished form. So, for example, legume dishes that require a long cooking time cannot be included in the breakfast menu, and the number of fried dishes that quickly lose their taste during storage must be combined with the production capacity of the stove. The cook who is entrusted with the preparation of certain dishes should be instructed about the time and sequence of their preparation.

Quality control of products and prepared meals. Quality control of raw materials and finished food should be carried out systematically at certain stages of the technological process, and at individual stages the results of the check should be documented.

The first stage of control is to check the good quality of products when they arrive at the warehouse. In addition to the storekeeper responsible for the quality of the products received, all products received at the warehouse are examined by a doctor on duty or a dietitian, and the results of the examination are recorded in a special journal of the following form.

The second stage of control is to check the quality of products when they are released from the pantry. When food is dispensed to the kitchen and pantry, the head of the kitchen or the senior cook and barmaids of the departments are present. No recording is made. In case of doubts about the good quality of the products, the question is resolved by a dietitian or a doctor on duty.

In the process of cooking, the yield of semi-finished products after the primary processing of meat, poultry, fish, potatoes and the quality of the finished food before it is released to the sick are checked.

The output of semi-finished products is recorded in the production log of the following form.

An entry in the production journal is the basis for issuing additional products in case of substandard raw materials and returning excess raw materials received to the pantry in comparison with the norm for laying the product - net.

Quality control of prepared food is carried out in the kitchen by the doctor on duty together with the head of the kitchen. With a centralized food block system, food is also examined in the pantry by a doctor or the head nurse of the department. The results of a sample of prepared food in the kitchen are recorded for each dish in the portioning menu, where special columns are provided for this, and overall rating are entered in the prepared food sample log of the following form.

The release of food from the kitchen to the departments with a centralized food block system. The barmaid or the nurse of the department should, before each meal, appear at the kitchen expedition to get acquainted with the menu, the weight of the prepared dishes and receive instructions on distributing food to the sick. It is advisable to carry out the delivery of food to the pantry by the kitchen. When sending food to the pantry at the departments, it is necessary to stick pre-prepared labels on each dish indicating the number of the diet and the number of dishes; all food should be sent to each compartment at the same time.

Distribution of food in the cafeteria. Each pantry should have facilities for heating food. The rapid distribution of food is essential to prevent its cooling. Therefore, free personnel should be involved in the distribution of food to patients, providing them with proper sanitary clothing. It is necessary to provide the department with a sufficient number of cutlery (at least one cutlery for each patient); it is advisable to heat the plates before filling. First of all, individual dishes should be distributed, and then mass ones. At first, bed patients are served, and then patients who eat in the dining room. In the pantry, a menu should be posted indicating the weight of the portions. In order to avoid errors in the distribution of food to bed patients, a label should be hung on each bed indicating the number of the diet.

With a decentralized food block system, food is distributed from the kitchen or through the elevator in the same way, food in individual dishes on trays is transported to the pantry departments. The departments organize the release of vitamin C added to food (100 mg per patient per day), according to the existing instructions.

Food transfer regulation

Based on hygiene requirements and adherence to medical nutrition, it is necessary in each hospital to clearly organize control over food products brought to the sick, the reception of products from visitors should be carried out under control nurse department, which has a list of patients with an indication of the number of the diet received by each of them. In the places of rest of patients, in the emergency room of the hospital and in the places of reception of "transfers", posters-instructions should be posted indicating the products that are allowed and prohibited for transfer when the patient receives a particular diet. Physicians should also instruct each patient on recommended and prohibited foods.

In each department, appropriate conditions should be organized for the storage of transferred products, and especially perishable ones (cabinets with shelves, refrigerated cabinets).