Room Service is an outstanding way to provide meals to patients. I am a huge fan! It’s a win-win situation. Patients enjoy and appreciate the flexibility and control they have to order what they eat and when. Hospital food and nutrition departments enjoy seeing significant patient satisfaction improvements while improving operational issues such as excessive late trays and better control of waste and costs.
I have noticed, however, that organizations are challenged to determine how to coordinate meal delivery with bedside blood glucose monitoring and insulin administration. Although intensive blood glucose management is important patient care, it should not derail or deter an organization from implementing Room Service or excluding patients with diabetes from having the Room Service experience.
The first issue centers around how to communicate the carbohydrate content of the patient’s meal to the patient care staff. The second issue is how to inform patient care staff that a patient’s meal has arrived so blood glucose monitoring can be completed. In addition, finally, organizations struggle with what their policy should be regarding missed meals.
Tackle these issues:
- Organizations are looking to their food and nutrition software system to assist with getting carbohydrate information to the bedside and software systems are making this happen.
- Work with your technology vendor to determine how software can easily assist you in accuracy, efficiency, and seamless operational procedures. A strategic and knowledgeable technology partner will work with you to make this seamless and painless.
- Be sure to proactively engage an interdisciplinary team. Engage your nursing staff and dietitians upfront. Be proactive to come up with a process you can all agree on and KEEP IT SIMPLE.
- Check and adjust medication administration schedules in the EMR. Insulin given off schedule because of the flexible nature of Room Service may be recorded as a “ding” on patient care staff performance.
- Rename food items or portion sizes to include the carbohydrate grams
- Don’t be limited by a diet order but use it to educate the patient and staff.
- Communicate a consistent and accurate way to inform the patient care staff that a meal is on the way or has arrived from the kitchen. Methods organizations use include:
- call center staff paging patient care staff
- call center staff calling the nursing unit
- including a note on the tray ticket or some door/room signage to trigger the delivery staff to call the nurse
- deliver the tray to the nurse’s station and have patient care staff deliver the tray and complete blood glucose monitoring at that time
- script the call center to tell the patient to call patient care staff
There tends to be questions about whether or not to allow the diabetic patient to skip meals. Some organizations do not allow diabetic patients to skip meals, some allow one or two meals to be missed and then they call the patient. Being a Room Service “purist”, I have to say I prefer to let patients order at will – and, yes, I understand all the arguments to send all meals. However, I also think this goes back to some of the reasons you do Room Service – to allow patients the choice. Sending a patient an occasional meal they do not want seems counterintuitive.
So do not let diabetes treatment goals dampen the Room Service experience for you or your patients. Innovative solutions are out there to keep Room Service a winner for everyone.
What challenges have you faced with your diabetic population and Room Service? What ideas can you share for overcoming these challenges? If you could have your food & nutrition software do one task to improve this process, what would it be?
by Donna Quirk, MBA RD LD, Clinical Nutrition Manager, Lexington Medical Center