Off the Clock
Flexibility, snacks and speed answer needs of oncology and maternity patients.

By Margaret Sheridan, Senior Editor

Though in many ways as different as happy and sad, patients in hospital maternity and cancer-treatment wards do have something in common: appetites with attitude.

Babies arrive on their own schedules, not the foodservice department’s. Reaction to some cancer treatments can temporarily diminish the heartiest of appetites. In both cases, the need for flexibility—with or without 24-hour kitchens—challenges and inspires creative thinking to meet the needs.

Oncology (cancer) patients at Chicago’s Northwestern Memorial Hospital and their families are invited to weekly educational seminars. Medical professionals address topics from nutrition and exercise to pain management and support groups. On the subject of eating and nutrition, Tina Ban, patient/family education coordinator for oncology services, explains how treatment affects eating, appetite and taste.

Mayo Eugenio Litta Children’s Hospital encourages parents and friends of patients to assemble and serve foods from the pantry.

Powerful treatments such as radiation and chemotherapy attack fast-growing cancer cells in the body. In the process, healthy cells are damaged. The production of saliva, for example, is often reduced or eliminated, temporarily, increasing the need for fluid intake, says Ban. Getting oncology patients to take more fluids, which can include frozen treats, is important.

When patients want something in the middle of the night and foodservice is closed, nurses rely on supplies that can be kept close at hand, including protein bars, puddings, soups, cookies and crackers, cans of nutritional supplements and fortified juices.

“Supplements store easily. They’re high in calories and protein and fortified with vitamins and minerals. Nurses get very creative,’’ she says. “Add vanilla ice cream or soft-serve to juices and a flavored supplement for a drink that tastes like a smoothie.”

Well stocked
An inventory of snacks close at hand works for many patients at Clark Memorial Hospital in Jeffersonville, Ind. Nutrient-dense bars and fluids, small portions of protein-rich foods (such as cheese and crackers or peanut butter) store well and satisfy oncology and maternity patients, says Bruce Key. The director of food and nutrition services maintains a standing inventory of 24 food and beverage items for oncology and 12 for maternity.

The University of Texas M. D. Anderson Cancer Center’s Jolly Trolley is one of the facility’s eight retail carts.

Changes in taste, even loss of appetite, cause friction for families unfamiliar with how cancer treatments work. “A favorite soup or dessert brought from home is rejected by the patient,’’ says Key. “The family feels like a failure.’’ The staff needs to be sensitive to such changes. “The window to serve that person is small. What a patient ordered for lunch at noon might be repulsive when the tray arrives. Appetites change that fast.’’

What is selected for those pantries is important in getting young patients to eat. “Kids love popular brands of foods, ones they see on television,’’ says Diane Olson, dietician in oncology at Mayo Eugenio Litta Children’s Hospital, an 85-bed facility in Saint Marys Hospital, a facility of the Mayo Clinic in Rochester, Minn. “Kids love colorful packaging. They like to play with their food.’’

Untangling string cheese, pressing yogurt from a tube or gnawing graham crackers shaped like teddy bears provide high-protein and calories. Olson encourages parents and friends to assemble and serve foods from the pantry. “Getting parents involved makes them feel essential to the child’s care. It reinforces family.’’

Swaddling tastes
When the new Prentice Women’s Hospital of Northwestern Memorial Hospital, Chicago, opens in April 2007, maternity patients will get 24-hour room service from a state-of-the-art restaurant-style kitchen. “Babies never arrive on demand. But food will,’’ says Kirk McKie, director of Women’s Health.

The 256-bed facility will cost $502.5 million and replace the existing 159-bed Prentice. It will have capacity to handle 13,600 births a year versus 9,000 currently. The convenience of 24-hour roomservice will allow greater flexibility over the current program with set delivery hours, says Sonia Alexander, director of food and nutrition for Morrison Healthcare Food Services.

An inventory of snacks kept on floors serves patients at Clark Memorial Hospital.

Depending on hospital rules and the patient, most expectant mothers are allowed only ice chips during labor and delivery. After giving birth, most are ravenous. “New moms with a craving for burgers and fries at 3 a.m. can have it,’’ says Bruce Key. Clark Memorial Hospital’s cafeteria operates 22 hours instead of the more typical 16.

Patient satisfaction at Clark is up since he expanded cafeteria hours four years ago. The only foods available for new moms were cold turkey sandwiches, applesauce and chips from the pantry. Improving food choices and delivery are part of the hospital’s plan to market its maternity care.

Upper crust
Maternity is an opportunity for foodservice to show off. “Maternity is fun because the patients are not sick and those women want to be spoiled,’’ says Milagros Plagata, manager of nutrition services at Geauga Regional Hospital, Chardon, Ohio.

The hospital upgraded space and services last year with a $2 million renovation for its Center for Women’s Health. It was marketed through tours, open houses, parties and story placements in local papers.

“The obstetrics population here is younger. Most women are in their 20s,’’ she says. This generation would rather have a cheeseburger with fries than stuffed chicken breast or steak. What’s hard to resist are the luxury of desserts and seeing a lavish spread arrive at bedside.

Plagata introduced tea service last year. A cart with 15 to 20 items makes the rounds daily at 2 p.m. A waitress serves tea sandwiches, pastries and pies from a three-tiered plate, gratis. Her audience is demanding, she says.

“Many come from the Amish community. They’re repeat customers and excellent bakers. They know their pies,’’ says Plagata. The hospital’s apple and butterscotch praline varieties earn the most praise.

la carts

The convenience of snacks delivered bedside is matched by the importance of snacking for oncology patients. Appetites are unpredictable. Tastes change. Favorite foods, even their aromas, can provoke nausea, temporarily. It depends on how individuals handle cancer treatment. But the more calories introduced into diets, the better for strength building and healing, according to the American Cancer Society and National Cancer Institute.

One solution to encourage snacking at Northwestern Memorial Hospital, Chicago, is the Jolly Trolley. A mahogany-colored cart with striped canopy and chimes, it brings cookies and frozen treats to patients and family, compliments of the hospital. The cart, introduced in fall 2001, is funded by a gift from a former patient. Managing it is a collaborative effort between oncology and the Volunteer Department, says Dolly Johnson, director of volunteers. It operates Wednesday evening and Sunday afternoon. Ten, from a pool of 900, rotate duty.

“The trolley is a bright spot for patients and family,’’ says Jillian Miller, oncology recreation therapist. “Patients know volunteers aren’t there to poke or prod.’’ The idea is not original, however. Northwestern adapted it from a similar program at University of Texas M. D. Anderson Cancer Center in Houston. Their program dates back to the mid-’70s.

Volunteer Services at Anderson use eight carts to sell popcorn, coffee, crafts, videos, music, books and hats. Its Jolly Trolley, stocked with sandwiches, bagels, doughnuts, hot chocolate, fruit and beverages, makes the rounds daily of the 465-bed facility, according to Gail Goodwin, senior communications specialist.

Other than free coffee, sales revenue goes back to the foodservice department.