Special Diet Request Form System

Special Diet Request Form System
(D1, Chylothorax, Low Allergen, GvHD, Ketogenic)
Patients identified by Dietitian as having a need for specific dietary
requirements.
Dietitian completes Nutritional assessment of patient and identifies
patient’s requirements, documents this and informs ward Nursing staff.
Nursing staff / Dietitian / Dietetic Assistant completes the relevant Special
Diet Request Form and faxes daily to the RADU (Ext 63361) by 11.30am
each day for evening meal and the next days lunch.
Nursing staff / Dietitian / Dietetic Assistant advises WHK of patient’s
special requirements by documenting this on the Ward Dietary Sheet or
the Ward Catering Communication board.
If dietary prescription is advised and requires starting for Lunch the same
day or after 11.30am for Evening meal, the Ward Housekeeper should
source suitable items from the back up stock stored locally in the
RTP (LGI Ext 23799, SJUH Ext 64183)
Picking & Packing - Items for evening meal and lunch the following day
will be delivered at 3pm in the evening meal boxes. All items will be
bagged and labelled for the individual patient and meal period. WHK
should store Lunch items locally until required the next day.
WHK checks delivery of special dietary items and ensures that these are
kept separate and that they are available for the specific patient.
Nursing staff supervise to ensure that patient receives the required dietary
items.
Nursing staff / Dietitian / Dietetic Assistant continue to complete a Special
Diet Request Form and fax to the RADU (Ext 63361) for each day that the
special dietary items are required.
Note - if a Special Diet Request Form is not faxed daily, it will be assumed
that the special dietary items are no longer required.
Nursing Staff
responsibility
April, 2015
Dietitian / DA
responsibility
RADU
responsibility
WHK
responsibility