The Dietitians Nutritionist in the Collective Hospital Restoration

After three years as a Dietitian in the kitchen of a hospital, I wanted to tell you about my experience in this field of Collective Restoration, one of the exits of the profession (if not the only one currently). There have been many people who have asked me: "but what exactly do you do in the hospital if it is not being on the floor visiting patients?" I think that the answer to this question can also be used by future professional colleagues who, if you are lucky, will join the world of work (have hope despite the current times). You will see that I have not specified the figure of the D-N since this job requires exactly a "Specialist in dietetics and nutrition in catering (BUP or equivalent plus 2 years of specialization)", at least according to the Balearic hospitality agreement. Yes, so far, the presence of a D-N is not necessary in Collective Restoration; the post of community dietitian can be filled with a Higher Technician in Dietetics (Be careful, I am not the typical D-N who underestimates their skills, on the contrary, they should go hand in hand with the D-N). Hopefully in a short time, all public hospitals have at least one D-N in the food service, not to mention the need for our figure on the ground (at the same time I want to say, the need also for the D-N at the bedside).

Let's remember the competences in this field:

The collective catering dietitian participates in the management and organization, and ensures the quality and wholesomeness of food throughout the production process. Train food service personnel in food safety, plan menus and assess the nutritional balance of the food supply.

As I told you in my other post in Tell me what you eat about "Do you know who guides your diet in a hospital? All but me ”, our function in the kitchen is mainly to supervise the emplate tape without making a mistake. You better not miss anything; poor you as you get a nursing call even if it was because you forgot a cutlery, you have put a lemon yogurt and he only likes strawberry or in the fish there is a thorn (how strange if everyone knows that fish are born already despined and wand-shaped).

Another of our functions is "menu planning". I put it in quotation marks because currently, in most hospitals, the kitchen service is outsourced, that is, it is run by catering companies, either with a staff who cooks on site, or by bringing food from a central kitchen that is later regenerates. In the latter case, the hospital's dietetic service has little control over the menus since, due to the industrial isothermal tray, you have planned some magnificent menus and they are hanging in the office and in the kitchen, what they serve you from the central kitchen is what they have in stock at that time. For example, dish of the day "Swiss chard with potatoes", they serve you the stalks with potatoes and the justification they give you is because the Swiss chard is expensive (excuse me? all the technical sheets of the dishes). Not to mention the weights of meat and fish; Now you can run the day you touch chicken thighs on the menu, because we have been served 70g servings, we go as if it were a chicken wing. I have to say that despite all these irregularities we always try not to serve the patient, but sometimes there is no possible alternative. For this reason, you will receive enough complaints and claims that the only thing that will be in your hands is to apologize and pass the claim on to your boss. You are going to see claims of all kinds, and the truth that some are to frame them, like this one that I am going to show you now:

"The reason for the complaint is the lack of control in their diet; a season has passed with decomposition, due to the amount of antibiotics that have been administered. During this period the soft diet has not been astringent, each day they gave it applesauce (which is laxative), chamomile and lime, broth soup and fish. It has finished with the intestinal flora, almost disappeared. In the end, I had to give him rice grits, artichokes and bifidus that I brought from home. Right now, he suffers from constipation and now they bring him tea for snacks and cookies sometimes. The kiwis in the dessert are green and the fish usually has complement potatoes, would it be possible to adjust the diet with common sense and according to your needs? There is no tomato or salad in their diet, why? ”

Where do I begin? This claim would be to add to Lucia's post on "Adventures and misadventures of a hospital dietitian." Now it turns out that the apple is laxative and the artichokes are astringent, or how could we have missed not giving her a yogurt with bifidus, surely her intestinal flora would have been intact. The worst of all this situation is that the claim, first has passed through the hands of the nurse, they have given their approval and, since the kitchen service does not belong to the hospital, they have passed the duck to us. Surely if the kitchen had belonged to the hospital, the infirmary would have given the face, because to guide the diet to the patient if they are trained but to argue this, right? I say that for that they have studied a subject in the career that gives them the functions of D-N or am I wrong?

Leaving aside the intrusion of other health professionals, sorry, I meant the interaction with the plant staff for the resolution of requests and inter-consultations, in reality, the range of functions that the D-N of collective restoration encompasses, are many. In addition to checking that each tray is correctly and being the last person responsible, along with the planning of menus and their derivations (adaptations of the menu to different pathologies and many times, to the tastes of the patient), we take care of controlling the preparations in the kitchen, giving support to the production team and specific indications of preparation when necessary (do not forget that your best ally will always be the kitchen staff); account for each of the dishes and special diets for their preparation in the kitchen, in addition to the sanitary control of culinary preparations (HACCP system), that is, control the temperature and take samples of each of the preparations. Also, you can get to assume administrative and personnel management tasks, yes, if it can be unpaid.

Although we are considered hospitality personnel rather than health personnel in this field, let us not forget that we are the only health professional specifically trained to assess the nutritional and nutritional status of the patient and our small criteria, even if it is not reflected in the harsh reality , notably influences the patient's quality of care.