The hospital doesn't provide much food, what can you cook? Food for clinics, hospitals, hospitals. Main dish for evening meal

Do you know what they feed you in our hospitals? I didn’t know until I visited it myself. To be honest, I didn’t think it would be like this. When compared with other countries, the contrast of the hospital menu is strikingly different. Now, I understand why relatives bring food from home to their patients.

I looked at the patients’ Instagrams and was surprised.

We meet food from the Jakarta hospital, which is located in Indonesia. Standard noodles, boiled eggs, rice porridge and a piece of chicken.

Japanese cuisine greets patients at a Tokyo hospital with this menu: pickles, miso soup, rice and a piece of chicken.

In America, in the state of California, they serve this classic dish - a hamburger and fried potatoes.

The Malaysian menu is simple - vermicelli and a piece of chicken with sauce

Hospital menu from South Africa - here they will fry eggs and sausages, give you tomatoes, hash browns and toast.

Hospital cuisine in Germany - standard schnitzel, spaetzle (a type of pasta), salad and pie. There's not enough beer.

More from the American menu - vegetable salad and chicken soup, crackers instead of bread.

In Australia everything is much more interesting. For lunch, pumpkin soup with fried chicken in apricot sauce, peas and a scoop of mashed potatoes.

Another Australian hospital, only in the city of Sydney, Australia. Stewed lamb in a pot, fruit, slice of bread, sandwiches

Pork is served in sweet and sour sauce along with rice. Menu for Richmond, Canada.

In England they serve minestrone with beef and onion pie. Banana dessert.

In Estonian hospitals you can dine on potatoes, salad, stewed cabbage with meat, and for dessert they give you a bun with milk.

Native Russia, Tomsk city. For breakfast you will be given porridge with milk, bread with butter and tea.

For lunch they will bring pasta with boiled pink salmon and vermicelli soup.

This is the international menu.

Organization therapeutic nutrition as a whole, consists of the following main sections that require specific implementation in each medical institution:

1. clinical issues of the organization, which include the principles of constructing therapeutic nutrition, the system of its administration, diet and nutritional standards.
2. sanitary and technological issues of the organization, which includes the system for constructing food blocks and transporting food, equipment and supplies, sanitary requirements for the content of the food block.
3. issues of clinical nutrition management and personnel training.
4. technical issues of the organization, covering methods for creating a menu, a system for recording appointments, dispensing products, organizing the technological process in the kitchen, a system for dispensing food from the kitchen, monitoring the quality of food and organizing patient care.

Principles of construction and system of prescribing therapeutic nutrition

In accordance with the physiological principles of constructing food rations, therapeutic nutrition is structured in the form of daily food rations. Each patient’s daily food ration, in other words, his diet, has its own energy value, i.e. calorie content, chemical composition(a certain amount of proteins, fats, carbohydrates, mineral salts, water, vitamins, extractives and other substances), certain physical properties: weight (volume), consistency, food temperature and, finally, specific mode(routine) nutrition. All these are elements of the diet, which are practically implemented in the form of a menu consisting of appropriate products with a certain culinary processing.

When prescribing therapeutic nutrition, two systems can be used: elemental and dietary. When prescribing elemental therapeutic nutrition, a prescription is made for each patient with a specific listing of the indicators of each element of the daily diet; Based on this recipe, the daily menu is compiled. This system is called individual, but this definition is not entirely correct, since properly organized therapeutic nutrition necessarily requires an individual diet. If with the elemental system the doctor develops an individual diet for each patient, then with the dietary system he prescribes individually one or another diet from among those that have been previously developed, clinically tested and have certain medicinal properties. Therefore, it is incorrect to call the dietary system for prescribing therapeutic nutrition “group”.

The main system in medical and treatment-and-prophylactic institutions, i.e. when serving large populations of patients, is the dietary system for prescribing therapeutic nutrition. The elemental system can be practically used only in isolated cases, when many amendments need to be made to a particular diet developed and used in a given medical institution, taking into account the complexity and special conditions course of the disease in the patient.

With a dietary system, it is also possible to add in connection with special indications certain adjustments to the prescribed diet. Such additional prescriptions or restrictions in the diet should be made by prescribing foods that have certain medicinal properties (cottage cheese, liver, milk, watermelon, apples, garlic, etc.), or by adding or limiting nutrients(proteins, fats, carbohydrates, salts, vitamins). When additionally prescribing special products, it is necessary to correspondingly reduce the content of other products in the diet in order to maintain mainly the chemical composition and calorie content of the diet.

In medical institutions Soviet Union diets developed at the clinical nutrition clinic of the Institute of Nutrition of the USSR Academy of Medical Sciences, approved by the USSR Ministry of Health, are used. The most commonly used diets are indicated by numbers; some diets and so-called contrasting ones, or fasting days are indicated by the name of the product, such as sugar, apple, compote day.

Each diet has its own characteristics (see below). The number of diets to be introduced in a hospital is determined by the profile of the institution, i.e., the main contingent of hospitalized patients. Each hospital should establish basic, permanent diets and contrast days; as necessary, other diets can be used, and in isolated cases, therapeutic nutrition is prescribed according to the elemental system. Almost in a multidisciplinary hospital general type 7-8 diets and contrast days are constantly used.

The regimen, i.e., the diet of patients, is essential for effective action therapeutic nutrition. The diet consists of the number of meals, the time of feeding of patients, nutritional value and the amount of food taken at each time.

The Ministry of Health of the USSR established for hospital institutions at least four meals a day, for some groups of patients (heart disease, peptic ulcer stomach, for infectious patients, etc.) it is necessary to establish a diet of five to six meals a day. You should strive for a more or less even distribution of the daily diet, but in any case do not allow a significant volume with high calorie content for dinner; As a rule, the evening should not account for more than 25-30% of the daily caloric intake. The feeding time of patients is determined by the number of meals and the general daily routine in the medical institution. There should not be a break of more than 4 hours between individual meals. daytime, and between the last evening meal and morning breakfast the break should be no more than 10-11 hours. In this regard, it is advisable to organize the 4th meal not in the form of a second breakfast or afternoon snack, but in the form of a small meal 1-2 hours before going to bed (second dinner). Thus, the basic regimen of four meals a day is presented in the following form.

With five meals a day, a second breakfast is introduced, and with six meals a day, there is also an afternoon snack with a more or less uniform distribution of the daily ration.

Hot food should be included in. each of the meals. The temperature of liquid hot dishes should be about 60°, and second hot dishes - about 55° when serving to patients. The temperature of food in the compartment must be carefully monitored.

The daily dietary allowance is established in the characteristics of each diet. As mentioned above, the chemical composition and caloric content of each diet are provided by the corresponding set of products. Based on the food set and the degree of use of each of the diets used in the hospital, the need of the medical institution for food supplies is determined. The food supply standards for hospitals, which determine food allocations, are established by the USSR Ministry of Health in the following volume.

Nutrition standards in urban and rural hospitals per patient per day

Nutritional value: protein 88 g, fat 66 g, carbohydrates 459 g, which is 2889 calories. The actual nutrition of patients is improved both quantitatively and qualitatively through the development of hospital subsidiary farms. Nutritional value is affected by food “transfers”, which must be strictly regulated.

Sanitary and technological issues of the organization

The organization of the food unit in a hospital can be carried out according to a centralized or decentralized system. The food block, according to its composition, can be divided into the following main groups of premises: 1) for storing food; 2) for cooking (semi-finished and ready-made food); 3) for releasing food from the kitchen; 4) for dispensing prepared food to patients and receiving it in hospital departments. In addition, the food block complex includes auxiliary rooms (inventory, linen, container, waste storage), maintenance rooms (boiler room, workshop), personnel rooms (administrative and sanitary) and a food laboratory.

With a centralized system, the entire food unit, except for the premises for distributing food to patients (pantries) and for receiving it (dining halls), is concentrated in one place. From the central kitchen, prepared food is delivered to the pantry in group transport containers, where it is distributed among the patients. With this system, prepared food is distributed 2 times: the first time in the kitchen in group dishes and the second time in pantries, where food, often reheated, is distributed in individual dishes.

With a decentralized system, prepared food is released to patients directly from the kitchen in individual containers, which is achieved by maximum approximation the process of preparing food for the place where patients are staying, i.e., for the hospital department. In a single-building hospital, the food unit is set up in the hospital building, and in a multi-building hospital, a prep kitchen is organized in each hospital building with 50 beds or more, and in a separate building or in one of the hospital buildings, centralized storage of food, preparation and distribution of semi-finished products is carried out. A decentralized system has a number of advantages compared to a centralized one: repeated transfer of food, its cooling and loss of shape, secondary heating are avoided, due to which the taste of food and its hygienic properties do not deteriorate and more favorable conditions are created for the organization of therapeutic nutrition. The head of the department and attending physicians have the opportunity to influence the nutrition of patients; workers in the food unit can be responsible for the entire nutrition process, right up to the moment the patients actually eat.

When designing new hospital construction and reconstructing existing hospitals, the USSR Ministry of Health provided for the organization of food units according to a decentralized system. It is necessary that in existing hospitals, in which food units are located in the hospital building, to organize the nutrition of patients according to a decentralized system, i.e., deliver food to patients directly from the kitchen in individual dishes, and not take it to the pantry in group dishes and transfer it there to dishes.

Issues of hygienic maintenance of the food unit and sanitary requirements for the technological process of food preparation are outlined above (page 29).

Clinical nutrition management in hospital

General management of nutrition is carried out in the hospital by the chief physician or his deputy for the medical department, and in departments - by the heads of departments. To coordinate all work on the use of therapeutic nutrition in multidisciplinary hospitals The Council for Medical Nutrition is created, which discusses and outlines activities on the main issues of organizing medical nutrition. The council includes the heads of departments, the caretaker, the dietitian, the dietician (kitchen manager), the senior cook and the department's nutritionist, appointed by the chief physician. The chairman of the council is chief physician hospitals, and the executive secretary is a nutritionist. Direct scientific, methodological and organizational management of therapeutic nutrition in the hospital is carried out by a nutritionist. In hospitals where the position of a dietician is not provided, the management of therapeutic nutrition is assigned to one of the attending physicians.

The management of the hospital kitchen is entrusted to a nutritionist working under the medical direction of a doctor. The functions of the nutritionist (kitchen manager) include monitoring the sanitary, hygienic and technological process in the kitchen, the right vacation food from the kitchen; she organizes the distribution of food in pantries.

Direct food preparation is carried out under the supervision of a senior cook-foreman, who, like the rest of the kitchen production staff, works under the guidance of a nutritionist. The position of a dietitian is established according to the staffing standards of the USSR Ministry of Health for every 200 beds (half the position for every 100 beds), so in large hospitals it is possible to head the work of feeding patients in individual buildings also by dietitians. In departments where there are no diet nurses, the organization of nutrition for patients is entrusted to the senior nurses of the department. In tuberculosis and infectious diseases hospitals, for every 100 beds a position of a nutrition nurse is provided, and from 75 to 100 beds - half the position, i.e. half-time.

Providing the food unit with food, equipment, hiring and firing kitchen staff is carried out by the deputy chief physician for administrative and economic affairs.

The functions of the Council for Medical Nutrition in a hospital, a dietician and a nutritionist (kitchen manager) are provided for in special “Regulations” approved by the USSR Ministry of Health.

Systematic work to familiarize all hospital staff with the basics of clinical nutrition plays a significant role in the organization of hospital nutrition. This work should be organized by a nutritionist with the involvement of a nutritionist and senior cook, as well as hospital doctors.

Doctors, nurses and all kitchen production personnel should be familiarized with the characteristics of basic, permanent diets. It is very valuable to organize special classes demonstrating the technology of preparing main dishes. Junior staff should also be familiar with the basic diets and principles of serving patients with medical nutrition. medical staff hospitals. The training plan for kitchen production personnel must include classes on minimum sanitation.

All newly hired food unit employees who are directly involved in the process of storing and preparing food products must undergo a technical minimum in clinical nutrition and sanitation.

Technical issues of organizing medical nutrition

Menu creation. Requests for meals for patients are drawn up in the reception and hospital departments and handed over to the dietician every day before 13-14 hours. The application from the admissions department is valid on the day the patient is admitted and the next day if the patient was admitted to the hospital after lunch. Based on the applications received for various diets, the nutritionist, with the participation of the senior cook, draws up a portion menu and transfers all the material to the counting department, where the calculation is made necessary products, demanding statements are written to the storeroom.

The main document on the basis of which food is issued and prepared is the portion menu (pay slip). The a la carte menu is signed by a nutritionist, under whose guidance the menu is compiled by a nutritionist (kitchen manager), an accountant (calculator) and approved by the chief physician.

The number of products in the a la carte menu is written as a fraction: in the numerator for one serving, in the denominator for all servings. It is not necessary to indicate the number of products per serving if you have a food card index, in which the card for each dish has its own number and set of products; in this case, it is enough to indicate in the portion menu the number of the dish, its name and the number of servings; the counting part, where there should be a copy of the food card index, calculates the required number of products, guided by the number and name of the dish, marked by the nutritionist

As a rule, products that are subject to processing in the kitchen are prescribed according to the a la carte menu; bread, butter, sugar, tea, dispensed to patients without culinary processing, are obtained from the pantry directly by the department's barmaids according to separate requirements drawn up by the counting department; Since the norm of bread, sugar and butter is not the same in different diets, each hospital sets the norm of these so-called buffet products for the main diets: the norm is approved by the chief physician and serves as the basis for issuing requirements for these products.

Each medical institution should develop a planned seven-day menu for basic, permanent diets. It must be consistent with the characteristics of the diets, provide a variety of tasty meals, the right combination of foods at each meal, and be consistent with the food allocations available in the institution.

For each of the main meals: breakfast, lunch and dinner, the menu should include dishes that would ensure the content of proteins, fats and carbohydrates. It is necessary to avoid that both the soup and the side dish for the second course at lunch consist of cereals and flour products (pasta, noodles). Simultaneously with the planned seven-day menu, layout cards for individual dishes are drawn up. The layout cards are compiled on the basis of those given in this manual and other published materials with amendments due to the practice of this medical institution.

The cards are compiled in two copies, one of which is stored in the nurse’s file cabinet, and the second in the counting section.

When creating a menu, you should take into account the time required to prepare the dish and acceptable deadlines storing it after it is ready. This helps cooks plan their work and prevent the loss of nutritional value and taste of dishes from excess storage in ready-made form. For example, legume dishes that require a long cooking time cannot be included in the breakfast menu, and the amount of fried dishes that quickly lose their taste during storage must be combined with the production capacity of the stove. The cook who is entrusted with the preparation of certain dishes must be instructed about the time and sequence of their preparation.

Control over the quality of products and prepared food. Quality control of raw materials and finished food should be carried out systematically at certain stages of the technological process, and at certain stages the test results should be documented.

The first stage of control is checking the quality of products upon their arrival at the warehouse. In addition to the storekeeper, who is responsible for the quality of the products received, all products received at the warehouse are examined by the doctor on duty or a nutritionist, and the results of the inspection are recorded in a special journal of the following form.

The second stage of control is checking the quality of products when they are released from the pantry. When food is released to the kitchen and pantries, the kitchen manager or senior cook and department barmaids are present. No recording is made in this case. If there is any doubt about the good quality of the products, the question is resolved by a nutritionist or the doctor on duty.

During the cooking process, the yield of semi-finished products is checked after primary processing meat, poultry, fish, potatoes and the quality of prepared food before it is given to patients.

The output of semi-finished products is recorded in the production log of the following form.

An entry in the production log is the basis for issuing additional products in case of substandard raw materials and returning excess raw materials received to the storeroom in comparison with the norm for storing the product - net.

Quality control of prepared food is carried out in the kitchen by the doctor on duty together with the kitchen manager. With a centralized system of the food unit, food is also examined in the pantry by a doctor or senior nurse of the department. The results of a sample of ready-made food in the kitchen are recorded for each dish in the portion menu, where special columns are provided for this, and the overall assessment is entered in the prepared food sample log of the following form.

Dispensing food from the kitchen to departments with a centralized food block system. Before each meal, the barmaid or nurse of the department must come to the kitchen expedition to familiarize themselves with the menu, the weight of ready-made dishes and receive instructions on distributing food to patients. It is advisable to deliver food to pantries using the kitchen forces. When sending food to department pantries, it is necessary to stick pre-prepared labels on each dish indicating the diet number and the number of dishes; All food should be sent to each compartment at the same time.

Distributing food in the pantry. Every pantry should have facilities for heating food. Distributing food quickly is essential to prevent it from getting cold. Therefore, free personnel should be involved in distributing food to the sick, providing them with proper sanitary clothing. It is necessary to ensure separation sufficient quantity cutlery (at least one cutlery for each patient); It is advisable to warm the plates before filling. Individual meals should be distributed first, followed by mass meals. First, bed patients are served, and then patients who eat in the dining room. A menu should be posted in the pantry indicating the weight of portions. To avoid errors when distributing food to bed patients, a label should be hung on each bed indicating the diet number.

With a decentralized system of the food block, food is distributed in the same way from the kitchen or by elevator; food in individual dishes on trays is transported to the buffet departments. The departments organize the supply of vitamin C added to food (100 mg per patient per day), according to the existing instructions.

Regulation of food transfers

Based hygiene requirements and compliance with therapeutic nutrition, it is necessary in every hospital to clearly organize control over food products, brought by patients, the acceptance of food from visitors must be carried out under the supervision of the department nurse, who has with her a list of patients indicating the number of the diet received by each of them. In the rest areas of patients, in the hospital reception area and in places where “transfers” are received, instructional posters should be posted indicating the products that are allowed and prohibited for transfer when the patient is receiving a particular diet. Attending physicians must, in addition, instruct each patient about recommended and prohibited products.

In each department, proper conditions should be organized for storing transferred products and especially perishable ones (cabinets with shelves, refrigerated cabinets).

Providing food to hospitals, in-patient clinics, rehabilitation centers and other medical institutions, including specialized and children's, is one of the busiest and longest-standing areas of activity of the Tasty Choice company. Over our long years of work in this area, we have built a flawlessly functioning algorithm for interaction with the management and relevant services of hospitals, and have mastered all the nuances of preparing, designing and delivering meals for medical nutrition.

Sanitary and hygienic requirements for catering in medical institutions

Food in medical and health institutions– one of the most difficult segments social nutrition. Russian legislation requires the most serious requirements for organizations ensuring this process, regardless of whether the hospital department is engaged in this or the administration of the medical institution engages a professional contractor. First of all this the highest level of sanitary and hygienic standards. After all medical institutions- these are places large cluster people, and ensuring sanitary and epidemiological control is the most important task.

In this regard, the production base factory-kitchen company " Delicious choice» brought into full compliance with legal requirements. Products are purchased from trusted suppliers ( There are certificates of conformity for all products) and are located in spacious and clean warehouses, where all necessary storage conditions, namely - maintaining optimal temperature and humidity, compliance with the rules of commodity neighborhood, etc.. The entire production cycle and operating regulations of the enterprise are designed in such a way that any factors are completely excluded negative impact for raw materials and finished products. The “Tasty Choice” kitchen factory regularly undergoes mandatory and voluntary certification and each time fully confirms the compliance of its production base with all sanitary standards.

Nutrition in medical institutions as the most important factor in recovery

Medical nutrition – necessary condition successful process of recovery and rehabilitation of patients. This is a mandatory favorable background for the impact of all medicinal drugs and procedures. And often the therapeutic nutrition itself is the treatment. That is why preparing food for patients in medical institutions is a serious professional challenge even for the most skilled chefs.

Regardless of the profile of the medical institution, whether children Hospital or hospital for adults, food must be nutritious. That is, any factors that can cause irritation or increase inflammation are excluded. We cannot use a wide range of spices, as well as sour, salty and spicy foods, as they can cause chemical irritation. A number of products and methods are excluded heat treatment that can cause mechanical irritation (for example, nuts, coarse grains, fruits and vegetables with large fibers, fried vegetables and meat, etc.). The temperature factor is also important, because too hot or too cold food can also have a negative effect.

In terms of processing methods, frying and deep-frying are prohibited. Boiling is used, extinguishing, steam or water bath cooking, in some cases baking is allowed. And at the same time, the food must certainly be delicious! After all, the pleasure of eating positive emotions– also a powerful healing factor!

There is a collection of recipes for food in medical institutions, approved by the Ministry of Health of the Russian Federation. Our specialists prepare lunches, breakfasts, dinners for patients of medical institutions in strict accordance with these regulations. In addition, depending on the disease, patients are prescribed specific diet and diet. There are 15 lists of foods and dishes that are allowed and recommended for certain diseases and conditions. These diets (or tables) were developed by nutritionists back in Soviet times, but even today nutritionists in medical institutions rely on these standards in their prescriptions. And in accordance with the prescribed diets, breakfasts, lunches and dinners are ordered for patients. New people are constantly being admitted to the hospital, others are being discharged, someone’s appointments are changing - all this requires a prompt and flexible response from the organization providing nutrition in the medical institution. A whole department of managers is responsible for working with this segment of clients at Tasty Choice.
Our specialists are constantly in interaction with customer representatives and instantly respond to all changing conditions.

Formats of catering in medical institutions

Depending on the objectives and needs of the medical institution, the company " Delicious choice» organizes meals in hospitals, hospitals, clinics and rehabilitation centers in any of three formats:

1. Cooking food at the customer's premises, in a specially equipped catering unit. At the same time, equipment and products are provided by the Tasty Choice company.
2. Delivery of prepared food to a medical institution in large thermoses for subsequent distribution at a food service point or in the customer’s canteen
3. Food delivery in individual containers.

Also possible organizationdining room or buffetFull construction.

Delivery of food to medical institutions - just in time

According to the requirements of the Ministry of Health, meals for feeding patients in medical institutions must be consumed within 2 hours after preparation. They must not be heated, as this may cause the food to lose its beneficial features. That's why It is extremely important to deliver lunches, breakfasts and dinners on time, and dishes must be at a strictly defined temperature. Let's say, first courses and hot drinks - 70-75 degrees, hot second courses - 60-65, salads, cold appetizers and cold drinks - 14-16 degrees. The customer's verification of compliance of the delivered food with these parameters is ensured by a nutritionist, dietitian nurse or doctor on duty. A thermometer is placed into the prepared dishes and its readings are recorded in the relevant documents. Our products always meet these strict requirements. Logistics managers create the optimal route taking into account weather conditions, traffic jams and other factors. Therefore, breakfasts, lunches and dinners from the Tasty Choice company arrive on time, and lunch (dinner, breakfast or afternoon snack) in the hospitals working with us is always tasty, hot and exactly on schedule!

Nutrition standards in medical institutions.

In medical institutions, meals are organized according to a seven-day menu according to the main options of standard diets, the use of which makes it possible to comply with the norms of therapeutic nutrition approved by Order No. 395n.

The main options for standard diets:

• Standard diet(formerly the main version of the standard diet (STD));
• Diet with mechanical and chemical sparing(gentle diet);
• Diet with increased amount squirrel(high protein diet);
• Low Protein Diet(low protein diet);
• Reduced calorie diet(low calorie diet);
• High calorie diet(high-calorie diet) (previously - a variant of the diet with an increased amount of protein (HPD(t)).

OUR CLIENTS:

The Tasty Choice company provides catering services in many large medical organizations, including in hospitals. Among them -

• MNCC Narcology - Moscow, st. Bolotnikovskaya, 16
• MNPC Narcology, Clinical branch No. 2 - Moscow, Varshavskoe highway, 170, building 1
• GBUZ MNCP Narcology DZM Moscow, st. Lyublinskaya, 37/1

Ready-made hot meals are delivered to these hospitals in accordance with the approved seven-day menu. Each department of the hospital has canteens with convenient distribution lines, where barmaids distribute food to citizens undergoing treatment.

An example of a one-day variant of the standard OVD diet

(this menu supplies food to several hospitals).

State Budgetary Institution ZGM "City Clinical Hospital named after F.I. Inozemtseva
Department of Health of Moscow No. 36"

In the city clinical hospital them. F.I. Inozemtseva (Hospital No. 36) on average, about 1000 people are treated and, accordingly, eat 3-4 times daily at the same time. There are 28 specialized departments, most of which are prepared according to the requirements of 8 different diets. Hot meals are delivered to the hospital ready-made. Each compartment has its own labeled thermal containers and tanks. Each department has a dining room where barmaids distribute food.

Example of one day menu containing eight diet options

(this menu supplies food to the hospital, where more than 1000 people are fed daily. The hospital has 28 specialized departments).

Buffet products