In addition to the patient-specific menus, ensuring patient safety requires tracking all the recipes and ingredients used in all the food items, notes Jennifer Ross, director of nutrition services at Abington (PA) Jefferson Health Hospital.

Each food item or ingredient in purchased food ingredients must be tracked and cross-checked with any patient’s allergies or other limitations. That is a huge task, but one that must be performed correctly to avoid inadvertently providing a patient with a harmful substance, she says.

In one case, Ross noted during the morning’s safety huddle that a patient was allergic to pectin, but no one in the department was quite sure what pectin was or what food it might be in. Some quick research determined that pectin is used in jellied food but also is found naturally in apple skins and other foods.

“We serve a really good chicken parmesan on Friday nights, and our recipe calls for using our usual tomato sauce that has been chosen for specific reasons and we know all about what is in that sauce,” Ross explains. “But it’s not unheard of for our supplier to be out of that particular sauce, and the ingredients in the substitute sauce are not at all the same. The substitute sauce might contain corn syrup but our usual sauce doesn’t, or the same with onion powder.”

Any substitutions of routine ingredients are carefully noted and discussed in the safety briefing and checked against the day’s patient census for conflicts. “We’re all that’s there between the patient and this new sauce,” Ross says.

Even with all the precautions that go into monitoring allergies, menus, and ingredients, the food service department still takes precautions at the bedside. Any patient with an allergy receives a big red slash across his or her menu and tray ticket, which serves to heighten everyone’s awareness. When those trays are prepared in food services, the red slash is a visual cue for each person on the tray line to stop and review what they’re doing with the tray. Additionally, any tray with a red slash must be reviewed by a supervisor before it can be sent to the patient, as a set of fresh eyes to catch any potential problems.

“Our emphasis is on following the right procedures and stopping at every opportunity to confirm that you’re doing the right thing, that no one in the line has slipped up somewhere,” Ross says. “We trust each other to do the right thing, and we trust each other to watch out for anything that might slip by.”