Food-Service-Manual-for-Health-Care-Institutions

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Food Service Manual for Health Care Institutions 250 as a preferred preventive measure for high-risk populations such as women, children, and the elderly. For the elderly, in particular—a population already shown to be growing—improvement in quality of life and minimization of the ongoing need for health care is a decided priority. It is within this context of assessment and intervention that the role of nutrition specialists takes on added significance. Shorter lengths of stay also will increase the number of individuals served by alternative health care delivery systems such as nutrition management. Despite this projection, dietitians have yet to be “legitimized” by the federal government and other third-party payers as a necessary adjunct to the home health team. It is through the support of dietitians that the nutritional needs of home health care patients can be assessed and a plan developed to eliminate or minimize patient readmissions. Dietitians play a major role in long-term care facilities in both the nutrition care of residents and the smooth operation of facilities’ kitchens. Another environmental trend discussed earlier in the book, one that affects nutrition specialists, is the average consumer’s heightened awareness of the nutrition–health ratio. Although selecting healthier foods over nutritionally inferior ones has not yet become routine, today’s health care consumers are asking more questions and requesting more products to meet their nutritional needs. This chapter examines the dual role of the nutrition manager in health care operations: service manager and service provider. The first part of the chapter discusses the management of nutrition services with an emphasis on requirements unique to the planning, organizing, leading, and controlling functions of management. The second segment presents information relevant to providing nutrition services to various customer types. These services include screening for nutritional risks, assessing nutritional status, developing a nutrition care plan (critical care paths, patient education, discharge planning), and documenting nutrition care. Managing Nutrition Care Services The nutrition care manager is responsible for managing human and other resources to accomplish the objective of delivering high-quality and cost-effective nutrition care to patients. The nutrition manager’s roles encompass the following activities and skills: • Ensuring compliance with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other regulatory bodies • Maintaining open lines of effective oral and written communication • Providing leadership as a liaison with medical, nursing, and allied health professionals as a member of the interdisciplinary team • Developing standards of care • Developing patient educational material • Developing long-range plans and implementing objectives • Developing departmental policies and procedures • Applying clinical nutrition training, knowledge, and expertise • Overseeing staff development, evaluation, job descriptions, and counseling • Keeping abreast of departmental productivity, budget, and other control measures • Assisting in marketing of the organization’s nutrition services • Monitoring department operations such as patient tray system, food spoilage and inventory, vendor relations, menu planning, and so forth • Maintaining competency by participating in professional activities, continuing education, literature review, and so forth • Serving as a change agent for improving performance to meet measurable outcome goals Some responsibilities within each of the four management functions—planning, organizing, leading, and controlling—require a unique application of skills. These responsibilities are reviewed here in detail.
Planning As already shown, a manager must develop departmental goals and objectives that are consistent with those of the larger organization. Planning affords an assessment of future needs of the organization’s patient mix and a determination of changes needed in staffing and services. Nutrition care planning assesses the current patient care process and the need for changes based on the evolving standards of practice for the community. Adapting to change includes modifying policies and procedures and standards of nutrition care. Planning efforts include investigating and developing new business opportunities to enhance the distribution of nutrition information and to increase the department’s revenue flow. Responding to changes in the patient mix may necessitate dietitians’ relocating to an outpatient setting, implementing educational classes for the elderly, or meeting the community’s need for better nutrition education by conducting grocery store tours. (Review Chapter 5 for details of the planning function related to writing policies and procedures and developing business plans for new business opportunities.) Policies and Procedures Policies and procedures and standards of care must be maintained to provide effective nutrition services to customers. Policies and procedures should cover at least the following areas: • Diet orders, liberalized orders, and use of seasoning packets • Nutritional status • Nutrition screening, including priority ratings, patients’ preference form • Nutrition assessment and reassessment • Anthropometrics measurement • Nutrition care plans, including need for eating devices and feeding program • Documentation protocols • Instruction and counseling for patients, families, and interdisciplinary team • Education (specific for each type of class offered) • Specialized nutritional support (such as enteral and parenteral nutrition) • Enteral formulary • Recording patient data in patient’s medical record • Discharge planning and referrals • Intervention for patients with NPO (nothing by mouth) orders or on a clear-liquid diet for extended periods • Standards of nutrition care • Nourishment and between-meal supplemental feedings • Education for drug–nutrient interactions • Requirements and protocol for student rotations • Approved clinical nutrition manual • Outpatient education • Nutritional analysis of patient resident menus • Community education programs • Performing calorie counts • Role in the interdisciplinary team adhering to regulatory agencies’ standards • New-admission dietary handout • Hydration program, including fluid-restricted diets • Weight loss protocol • Pressure sore • Dysphagia protocol (may coordinate with speech pathologist and occupational therapist) • Tray identification system • Menu system • Kardex or patient identity system Clinical Nutrition Care Management 251
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Food Service Manual for Health Care
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Contents Figures, Tables, and Exhib
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Figures Figures, Tables, and Exhibi
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8.3. Excerpt from a Performance Eva
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19.1. Flow of Products in Food Serv
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6.2. Sample Job Description and Job
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Foreword It is truly an honor for m
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Preface The health care environment
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Acknowledgments The following indiv
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Introduction This edition of Food S
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Chapter 14 explains safety, securit
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Part One Management of the Food Ser
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Chapter 2 Leadership: Managing for
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oriented or people oriented and tha
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in an orderly manner, to manage the
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so as to anticipate and plan for fu
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Planning Through planning, the futu
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Reward or punitive power is the str
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• Building a team mind-set • Co
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of these three factors jeopardizes
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McClelland claims that “in some b
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• Define limits of what situation
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who have seen programs, processes,
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Leebov, W., and Scott, G. Health Ca
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Chapter 4 Quality Management A prim
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Figure 4.2. Deming’s PDCA Cycle A
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Move to CQI in Health Care The term
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care. Often these choices conflict.
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Supplier Partnerships A customer or
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analysis. Key benefits to having a
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Exhibit 4.1. Team Documentation For
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Figure 4.3. CQI Flowchart Quality c
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Exhibit 4.2. Inspection Criteria fo
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Once the departmental strategy is w
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Before hiring a consultant, managem
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selected for the issue in question.
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Figure 4.6. Cause-and-Effect Diagra
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not identical. CMS standards vary i
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the concurrent stay using critical
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Garvin, D. A. Managing Quality: The
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Chapter 6 Organization and Time Man
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Figure 6.1. Functional Organization
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Process departmentalization allows
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Characteristics of High-Performance
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outcome. Team building should conce
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necessary to assure that food servi
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Figure 6.4. Organization of a Small
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Figure 6.9. Organization of a Food
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skilled-nursing unit in the hospita
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service operations other than the c
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Distributing Authority Authority, t
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• What types of service does the
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Exhibit 6.1. (continued) Why? Which
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Exhibit 6.2. Sample Job Description
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equires, and the best means of moti
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Calculating FTE Needs Full-time equ
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Exhibit 6.3. Sample Productivity Fo
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Figure 6.10. Example of a Daily Sch
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Figure 6.12. Example of a Work Sche
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Figure 6.13. Example of a Manager
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Figure 6.14. Example of a Food Serv
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Lane, B. Managing People. Sunnyvale
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Excerpt from Annual Food Service De
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Sample Monthly Operating Statement
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Labor Cost Analysis 334 Figure 11.5
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336 Exhibit 11.6. Example of a Mont
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Part Two Operation of the Food Serv
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352 Exhibit 12.2. Selection of Wast
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354 Exhibit 12.4. Selection of Wast
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Figure 13.6. HACCPs for Cook-and-Ch
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Restaurant-Style Health Care Menu f
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Chapter 16 Product Selection Produc
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Figure 16.2. Procurement Subsystem
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The USDA organic seal appears on fo
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Figure 16.5. Grade Stamps and Inspe
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A carcass of good grade is blocky a
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e accomplished by scalping, which p
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Table 16.1. (continued) Meat Descri
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harvesting and processing. This tas
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Poultry Poultry products or domesti
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Weight and Size of Shell Eggs Shell
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Table 16.3. Manufacturing and Inspe
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Eggnog Eggnog contains milk product
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Natural, Processed, and Imitation C
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Table 16.4. Common Cheeses Cheese D
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• Bamboo shoots • Bean sprouts
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Celery Celery, mainly the Pascal va
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Size is another factor that affects
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Fruit and Vegetable Specifications
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Corn, , sunflower, and safflower oi
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Organic Flour Organic flour is from
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Relatively small quantities of wild
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Herbal Tea Herbal teas do not come
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alloy, the result is stainless stee
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Summary Food service purchasers mus
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U.S. Department of Agriculture, Agr
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Chapter 18 Receiving, Storage, and
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Figure 18.1. Receiving System Items
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Merchandise Receipt Receiving, Stor
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Receiving, Storage, and Inventory C
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disposed of promptly. The storeroom
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Issuing of Food and Supplies Receiv
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A perpetual inventory record alone
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Inventory Turnover Slow inventory t
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Figure 18.2. Comparison of Par Stoc
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Receiving procedures must ensure th
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Appendix 19.1 A Culinary Glossary
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Hors d’oeuvre Side dish or relish
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Chapter 20 Distribution and Service
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• What is the best type of servic
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Figure 20.1. Typical Tray Makeup Li
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Tray Delivery Because the point of
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quality. In recent years, food serv
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carrying their filled trays to thei
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plate is not used. Place coffee or
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minimized. The type of meal service
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Standards that should be monitored
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Exhibit 20.2. Sensory Assessment fo
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Herz, M. L. Analysis of Alternative
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Index A ABC method, 603 Absenteeism
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CDC (Centers for Disease Control an
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Delivery of products, 575-576 Deman
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Exit interviews, 239, 240e Exotic v
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described, 461; developing, 461-463
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Horizontal communication tract, 194
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Main-dish salads, 652 Maintenance-m
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Nutrient analysis, 296 Nutrition aw
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PERT (program evaluation and review
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(1993), 4, 203; Federal Employee Po
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Standing operational planning. See
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Waste audit, 349 Waste-handling equ
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