Wednesday, 11 June 2008


It may not be the most glamorous part of the job but ensuring a patients dietry requirements are met and delivered in the most appropriate way has an important and direct effect on a patients wellbeing.

My ward has a variety of dietry requirements - diabetics, clear fluids only, high protein diets, vegetarians and even a vegan. Each day we fill out the patients menus for the next three meals. When we do this we write the patients dietry requirements into the 'dietry requirements' box. This means the kitchen who look at these menu's and create a tray of appropriate food know patient x has requirement x.

One of my patients is on thin fluids only. He has an NG tube in for feeding. This is a tube up the nose down into the stomach through which substances similar in description to gruel are pumped into the stomach. The patient can take thin fluids orally as well. This means he cant even have soup, however he is allowed ice cream if he allows it to melt. Today I nearly served him what the kitchen sent up for him....a large slice of pie. This wasnt too bad because even if I had allowed the food to get as far as the patients bedside he knows that he can not eat this.

Now imagine we have a patient with vascular dementia, or some other condition preventing them understanding or communicating when something isnt right. Say this patient is diabetic and we have requested a sugar free dessert. I cant tell if a desert has sugar in just by sight. This still isnt as bad as it could be. Now say this patient is vegetarian and we have requested quorn mince in his shepheards pie....still not bad enough? Say the patient has a fatal alergy to lemons....

We put a huge amount of faith in the kitchen. We have to believe what we are serving is what they say it is. And they are wrong on a meal to meal basis. The fact that the nurses dont allow incorrect food to get as far as the patients mouths is still bad enough to warrent a clinical incident report in my books!

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