154
JCPSLP
Volume 16, Number 3 2014
Journal of Clinical Practice in Speech-Language Pathology
Processes in the kitchen
Meetings were held with food services department staff to
discuss the initial audit results and their perceived “high-
risk” areas within the kitchen, plating line, and meal delivery
process. Three key areas were identified as requiring
attention: (1) the lack of cross-checking processes, (2) the
level of level of supervision on the plating line, and (3) the
absence of supervision in the re-therm trolley room.
Changes implemented as a result of these meetings include
an additional food services supervisor was directed to work
on the plating line, enabling further cross-checking of plated
meals and diet/fluid code changes.
New allocation of a food services supervisor who was
directed to work in the re-therm trolley room enabling
cross-checking and system controls to streamline diet/fluid
code changes prior to plated meals being transferred to the
ward. A whiteboard was introduced for all new diet slips to
be affixed to.
Individual meetings were also held with nurse unit
managers (n = 4) to discuss the first audit results. The
discussion included the presence of safe swallowing
bed-signage and the importance of bed-signs moving
with patients who are transferred to other beds or wards.
Education was provided regarding the role of the safe
swallowing bed-sign in the TMD/F provision system.
Actions and implemented changes as a result of this
meeting included:
•
Speech pathologists
1. Adequate copies of bed-signs made available in each
department/ward
2. Verbal and email reminders provided to speech
pathologists quarterly regarding placement of safe
swallowing bed-sign when clinically indicated
•
Nurse unit managers
1. Review bed-transfer processes with staff with
reminders to move bed-sign when patient
transferring to another bed or ward.
Identify special
dietary needs
Recommend
texture
modified
diet/fluid
(TMD/F)
Notify
ANUM/RN
of TMD/F
required
Document
TMD/F
recommendation
in patient’s
medical file
Send DT
referral with
detailed
comments incl.
diet code,
prognosis, d/ch
plan if known
Place
bed-sign
outlining
TMD/F
required
Initiate SP and/or DT Cerner referral if indicated
Instruct ward clerk to
order specified diet
Is it a
complex diet/
fluid code entry on
TrakCare?
No
Yes
Request via
Lanpage that DT
make TMD/F
code entry on
TrakCare
Enter
required
TMD/F
code on
TrakCare
Is the
change a
downgraded
TMD/F code and is
it outside cut-off
time for
next meal?
Yes
No
Notify
MM of
TMD/F
code
order or
change
Conduct interview
with pt. Enter
diet code data
into Chefmax
according to
dietary
requirements
Authorise
& finalise
diet codes
in Chefmax
Crosscheck
diet/fluid
code changes
via TrakCare
prior to
cut-off time
Print TrakCare
report &
give to FP.
Print meal
tray slip &
give to FSA
Verbally notify FP
of TMD/F order
or change
if applicable
Complete new meal
tray slip and give to FSA
TrakCare reports
received from MM
Nurse
(ANUM/RN)
Ward clerk
(WC)
Speech
pathologist
(SP)
Discipline
Prescribing
Ordering
Dietitian
(DT)
Menu
monitor
(MM)
Food service
assistant
(FSA)
Fluid prep
staff
(FP)
Personal
service
assistant
(PSA)
Figure 1. Process map of texture modified diet and fluid provision at Austin Health – Austin Tower and ONJ Wards
