My story is from a Registered Dietitian perspective. Patient X is transferred to an acute medical ward after a long stay in ICU. He is young and alert but has developed a severe sacral wound and is unable to walk due to severe deconditioning. He has very few visitors who could assist him with daily activities. He has been well fed through a tube in the ICU but can now eat orally so the tube is removed. The SLP recommends a minced diet with thickened fluids for meals but he can have thin fluids between meals. I recommend Ensure Plus to the patient and instruct him to remove it from the trays at meals and drink it as a snack to ensure adequate protein and calories to promote wound healing. The patient agrees and fully understands the instructions. Unfortunately the Food Services department refuses to send it on the trays because it is a 'thin' product on a 'thick fluid' tray. The Manager does not want to confuse Food Services staff. They send it to the floor pantry where it sits in the fridge. The patient is unable to get it himself and the nurses are too busy when he asks. Simple things such as these are frustrating to patients and health care providers. Hospital systems become the barrier and can lengthen hospital stay, contribute to poor outcome. I encounter this type of problem on a daily basis.