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Quality improvement

By Jonathan Tellier

Introduction.

Several different hospitals were contacted to see what they do in their facilities to

keep patients safe from potential food allergens. St. Bernardine Medical Center keeps a

daily list of allergies, and the diet technicians are the ones who do this. This is pulled

from their food service database called C-Board and includes all food allergies patients

in the hospital currently have. This system is very similar to Computrition. The

ingredients of new food items ordered are put into the C-Board system, so when a

patient has an allergy the food is flagged and removed from the patient meal. Diet

technicians also double check patient tray tickets to make sure no food item with the

food allergen specific to that patient is listed. At Loma Linda all recipes and ingredients

are entered into Computrition, so when an allergy is added to a patient profile any food

containing that allergen is restricted. Pomona Valley Medical Center has a dietetic

technician in charge of inputting all recipes and taking the ingredient list from new

products and entering them into Computrition. Since we have Computrition we could

have similar processes as Loma Linda and Pomona Valley Medical Center in the future.

Methods.

A physical inventory is needed to update the current excel spread sheet

containing food items, and the allergies present in the food items. The physical

inventory was conducted in every refrigerator, freezer, and dry storage area. A lap top

computer was used to input allergen information into the excel spreadsheet and the

Computrition PDF was used as reference for possible allergens.

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Results.

Findings of this quality improvement project on the allergen excel spreadsheet.

Results of physical inventory found 71 different items that needed to be updated or

added to the ongoing list of allergies. These 71 items is out of a total 437 items that

have been reviewed in the past or are currently in stock now. This is roughly 16% of all

the items listed on the excel spreadsheet leaving 84% that were up to date.

Discussion.

I originally came up with the idea that taking a screen shot or picture of the

ingredient list may be a good alternative to doing a physical inventory. But after I went

over with Ray my idea of taking pictures or saving the ingredient list at time of purchase

of previously ordered products. We decided that this would take a lot of their time and

still may not be that much of an improvement from our current process if any. Ray also

indicated that when they order new products the ingredient list is forwarded to the

dietitians for approval. At this point if the dietitians approve the food for order they can

input the item, pack size, and possible allergens on to the excel spread sheet, which

should be entered into a share drive for them to access, this only takes place one to

three times a month. As for updating the ingredients of products that are not new I think

a physical inventory is the best way to collect this information. I used my laptop to enter

the ingredients into the excel spread sheet as I took the physical inventory, I think this

saved me a lot of time and I was able to easily reference the LDAs listed on the PDF

from Computrition. I think this collection of new allergens could be done once a year

without items changing very often.

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Computrition offers label printing and included in this is the nutrient analyses as

well as the ingredient list and associated allergens. If we could create a nutrition label

for recipes that are served in cafes we could much more easily track potential allergens.

On the Computrtion website they have a demo titled nutrition food labeling (NFL). This

program will help meet inspection requirements and provide answers if not to our

patients to at least the staff in the cafeterias so they are fully aware of what is in each

recipe being served. The way this works is sub ingredients are listed by vendor item,

this is important because what is ordered can change depending on what is delivered

by vendor. With NFL you only have to link sub ingredients to vendor item once. When

the recipe is changed, either the products are added or subtracted from the recipe, the

ingredients are automatically dropped from the recipe at this time. This new update of

Computrition is something to look forward to in the future.

Conclusion.

A physical inventory is needed to continuously update the allergy list. The allergy

list should be entered into a share drive that all dietitians have access to. Dietitians

should update this list with food item, pack size, and possible allergens upon approval

of product for purchase. A laptop should be used to update the allergy list.