- 期刊
運用根本原因分析降低團膳蔬果出現異物之改善專案
The Application of Root Cause Analysis (RCA) to Avoid Foreign Objects in Vegetables during Food Preparation
摘要
近年來食品安全事件頻傳，團體膳食供應的衛生及安全是眾人關注的議題。因大量膳食供應的作業流程乃環環相扣，異常事件涉及人、事、物之複雜層面。臺北市立聯合醫院松德院區為精神專科醫院，病人因使用抗精神藥物造成異物哽塞的風險較高，有些病人對於供餐異物事件較敏感，為避免日後因相關流程執行不當，造成病人之危害，因此如何在錯誤中確實分析發生異物摻雜的根本原因是很重要的議題。本專案運用根本原因分析（root cause analysis, RCA）來改善盤餐蔬菜中出現紙標籤的異常事件。經分析原因包括：廠商因素、食材因素、人員因素、時間因素及作業流程因素等，本專案依據這些因素個別提出解決的改善方案。改善策略包含：廠商送貨不夾帶異物、蔬菜擺放整齊、難處裡的菜不同一天進貨、加強教育訓練、檢討工時安排、更改大量蔬菜送貨時間等。更進一步，研擬行動方案包含：廠商進貨依合約書及退貨標準流程辦理、修改菜單、定期實施在職與新人教育訓練、執行該時段時間研究（time study）及調整各餐蔬菜進貨時間等，各行動方案皆落實執行並且持續修正作業流程及追蹤查核。追蹤10天後也進行滿意度分析後發現，要求食材送貨時間、品質、種類及午餐蔬菜提前一日進貨後，對於工作人員時間壓力大幅減輕，滿意度達90%以上；營養師能確實執行退貨機制，滿意度達90%以上。此專案實施半年來，已無再次發生類似案件。
並列摘要
Food safety incidents have occurred frequently in recent years. The sanitation and safety of group meal are of concern because the operating procedures for handling a large volume of food include complex aspects that can lead to abnormal events. Patients in this psychiatric hospital regularly take antipsychotic medication, leading to a high risk of obstructions by foreign objects. Some of the patients are sensitive to food safety incidents. To avoid food safety hazards caused by improper implementation of food handling procedures, identifying the root causes of foreign objects being mixed in with meals through mishandling errors is imperative. This project conducted a root cause analysis to mitigate the incidents in which paper labels are mixed with vegetables in group meal. The possible factors associated to the aforementioned incident include food suppliers, ingredients, personnel, time, and operating procedures. Improvement measures were proposed individually according to these factors. For example, food suppliers are asked to ensure that no foreign objects are mixed into the food in their shipment; vegetables are arranged neatly; vegetables that are difficult to handle are not shipped on the same day; reinforce kitchen staff professional training and review their labor scheduling; and the delivery times of bulk vegetables are updated. Subsequently, action plans were developed in response to the aforementioned improvement measures. For example, food suppliers are required to deliver and return shipments according to the standard operational procedure written in their contract, food menus are modified, professional training for both new and established employees is regularly implemented, time studies are conducted, and vegetable delivery times are adjusted. In this project, the action plans were fully implemented and the operating procedures were revised accordingly. Tracking and auditing were conducted for 10 consecutive days. The satisfaction analysis revealed that the request of delivering vegetables one day in advance not only improved delivery time, quality, and ingredient types, but also substantially relieved time stress for food handling personnel, as evidenced by a satisfaction score of ≥ 90%. Similarly, dietitians confirmed the implementation of return policy with a satisfaction of ≥ 90%. No such food safety incident has occurred in the 6 months after the implementation of this action plan.