Holding Meals at Ward Level
We all do our best to serve our meals to patients at the correct temperature – hot food hot and cold food cold. It is a huge challenge which can often be overcome by using a state of the art meal delivery system that provides active temperature maintenance.
When we say ‘active temperature maintenance’ we essentially mean that we use a system that has an integrated heating and cooling mechanical system that transfers heating and cooling to the food constantly. This is usually done by plugging the system into some form of power while the food is inside of the system cart. The alternative is passive heating and cooling and while this method does transfer heating and cooling to food, the medium used to do so is not connected to a power source and thus, once the temperature is transferred the propensity to influence temperatures ceases. So, an example of an active temperature maintenance system could be a trolley that holds a food tray and heats the hot food while keeping the cold food cold using convected chilled air. The food can be held for an indefinite period of time while the cart holding the tray is plugged in. An example of a passive system may be placing a plate of hot food atop a metal heated base and covering the food – the food will stay warm for a definite period of time before the base chills and the food then chills down.
Regardless of the meal delivery system, once a meal arrives at ward level it is always best to serve that meal as quickly as possible. Of course, with an active meal delivery system one has a bit more time to serve meals as the system is more forgiving than a passive style system. But, we often run into that patient or patients on the wards that are not there in the room when meal service is happening. Perhaps they are at a test or attending a therapy session or maybe even asleep and not wanting the meal at that time. What do we do? We rarely have the luxury of being able to leave the meal in a cart for an extended period of time because that cart needs to be brought back to the kitchen for a next meal. We could leave the meal in the room but then we run the risk of the hot food getting cold or the cold food getting warm. Food temperature has been cited as a major criterion for patient satisfaction and we want patients to consume our meals so serving food at the wrong temperature will inevitably end in unhappy patients and more waste. Maybe there is a way to hold the food at ward level until the patient is ready to eat that will not impact on the operation of food service?
Some hospitals have opted to have a food holding system at ward level. In some cases, the food holding system holds only hot foods while others have decided to use an active temperature maintenance system that holds both cold and hot foods. Some food holders are conduction while most are convection. It is important to take note of the differences here between conduction and convection as this will impact the overall outcome and flexibility of the ward holding process.
Conduction – a conduction system heats or keeps food warm. It does not keep food cold. A conduction system works by heating a metal plate or platform. Food plates are placed onto that platform and the heat is transferred to the plate which in turn transfers heat to the food. To really work, food plates must have a flat bottom and this limits the operator to purchasing specific china, which can be costly. To really work, foods need to be plated in a specific way to ensure contact with the plate. Hot food on a tray will have to be removed and then individually placed into the holding system onto the conduction plates or platforms. The platforms can be quite hot and so care is needed to avoid burning one’s hands. This is not appreciated by nursing staff who often become the person who interacts with the holding oven at ward level. Even if there is a perceived ease of placing a plate in the holding oven, the real challenge comes when the plate needs to be removed and here many people have to use a small metal shovel. Like ice scoops at a hotel ice machine, the metal shovel can be misplaced from time to time adding to the frustration at ward level. And, while we talk about the hot food here, let’s not forget the cold food. What has happened to that while we are holding the hot food hot? Is it on the tray still? If it remains on the tray, then we are not really keeping it cold. The option around this is to perhaps take the cold food off the tray and place it in a fridge at ward level and then place the entire tray into the conduction system. This could work but we end up with a lot of wasted space in the oven, a tray that may become discoloured due to the heat below, a frustrated staff member who must reassemble everything and the potential for a completely warm tray at the end that will suddenly have cold food placed onto it for service. Lastly, we need to address other hot foods such as soup and hot beverages which will need hot holding as well and to be successful in a conduction system, they will need to be inside very special flat bottomed containers and stirred well before service to ensure evenness of heat.
A conduction system will be very quiet at ward level this is true and more than likely be on wheels for ease of movement between pantries if the need arises. The system may have a glass door which is a nice feature so people can quickly see if there are meals inside.
Convection – a convection heating and cooling system allows the operator to store any type of container so long as it is heat stable. Most containers are heat stable as the holding temperature will more than likely be no more than 90 C. So, this means that the operator can be confident that the paper plate, the china plate, the aluminum container, and the plastic plate can all be used and they are not tied to one style of dish that must have a flat bottom. A convection system that has on-board refrigeration is an ‘all-in-one’ solution that will allow the operator to simply take the patient tray and place the entire tray into a holding cart at ward level. The tray slides into the system centre wall thus separating the hot and cold side of the tray and keeping hot food hot and cold food cold. There is no need for shovelling food plates and bowls to the hot holding system, no need to reassemble trays, and no risk of burning one’s hands on hot platforms. Being able to use a one step process also eliminates any errors occurring when reassembling trays – the patients get what was ordered for them instead of someone making a mistake when taking individual plates from a conduction system to reassemble a meal tray.
A convection system that accepts the whole tray for holding may take up a little more room than a convection system and if the refrigeration system is being used, may be a little louder than a conduction system but, the benefits of efficiency and overall temperature maintenance of hot and cold are far greater.
