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

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Food Service Manual for Health Care Institutions 272 Exhibit 9.3. Nutrition Care Documentation Nutrition Order:_______________________________________________________________________ SCREENING: Completed by: R.D.________ D.T._________ Patient Rep.________ Team_________ Others________ Level 1____________________ Level 2_______________________ Level 3______________________ Intervention: No further screening needed. Yes___ No___ ASSESSMENT: Intervention needed because: Albumin below 3.0 g/dL___________ Weight loss unplanned, 1 month________ 6 months________ Anthropometrics_____________________ failure to thrive_____________ malnutrition____________ Modified diet_________ TPN/EN___________ age___________ transferrin level, mg/dL___________ Disabilities: chewing___________ visual____________ hearing____________ speech_____________ Emotional barriers___________ cognitive limitations___________ physical limitations____________ motivation or desire to learn_____________ other___________________________________________ Needs: cultural___________________ religious____________________ ethnic___________________ REASSESSMENT to be completed by (date)_________________________________________________ CARE PLAN: GOAL(S)______________________________________________________________________________ _____________________________________________________________________________________ Involved: Patient: Yes___ No___ Family: Yes___ No___ Team: Yes___ No___ Patient/family understands plan: Yes___ No___ Will follow plan: Yes___ No___ Critical pathway: Yes___ No___ Food is brought in from other sources: Yes___ No___ What source? (list)_______________________ Modified diet_____________________ Diet orders consistent with diets in approved diet manual: Yes___ No___ Diet individualized for age: Yes___ No___ EDUCATION: Food–nutrient interaction: (list drugs) _____________________________________________________________________________________ Name of modified diet instructions:_______________________________________________________ Individualized and age specific to meet specific needs of patient/family: Yes___ No___ Effectiveness of education: Patient/family: understands instructions and used information to incorporate dietary changes: Yes___ No___ verbalizes the special instructions: Yes___ No___ constructs a sample menu: Yes___ No___ lists foods to include or omit: Yes___ No___ Comments:____________________________________________________________________________ DISCHARGE PLANNING: R.D. phone no. included: Yes___ No___ recommends follow-up appointment with R.D.: Yes___ No___ recommends contacting community source: Yes___ No___ Nutrition care plan forwarded to:_________________________________________________________ Discharge supplies provided: ____________________________________________________________ ________________ R.D. Date:____________________ © Copyrighted by Ruby P. Puckett. Used by permission.
• Assessment: what the data mean • Plan: recommendation of what should be done for the patient Several other methods may be used to document in a patient’s medical record: P: Problem: state in objective terms (data gathered from medical record, dietary order, dietary history, screening and assessment) I: Intervention: care plan, outcome goals, family conference, interdisciplinary input, recommendations, referrals E: Evaluation: method to determine how goals will be met, reassessment P: Problem: same as above A: Approach: how team determines how to approach problem, similar to intervention G: Goal: what outcome is expected E: Evaluation: where goals met, reassessment Other methods include charting by exception, running narrative, and computerized. Medical errors have been identified as the fourth most common cause of patient deaths in the United States. To help reduce the number of errors related to incorrect use of terminology, the JCAHO has issued a “do-not-use” list of abbreviations, acronyms, and symbols to help reduce the incidence of medical errors. This action supports one of JCAHO’s national patient safety goals to improve the effectiveness of communication among caregivers. Nutrition experts working in the clinical area must be aware of this initiative. These goals are not accreditation standards; they are prescriptive accreditation requirements. For nutritional professionals working in JCAHOaccredited systems, meeting the national patient safety goal is required. This action applies to all clinical documentation, including medication orders, other orders, progress notes, consultation reports, and operative reports, as well as educational materials and protocols or pathways. Standards and Regulations Related to Nutrient Care The JCAHO has developed “shared visions—-new pathways,” a project that reflects JCAHO’s commitment to continually improving the accreditation process. It focuses on operational improvement and continuous safe and high-quality care. JCAHO has outlined three core elements: assessment, planning of care, and provision of care. It has established standards of care that define the following: • The time frame(s) for conducting an initial assessment • That initial assessments be performed for patients at risk for nutritional problems and that they be referred to dietitians or other qualified individuals for further assessment • That nutritional intervention, as formulated by goals, be implemented and documented • The monitoring of progress, measurement and evaluation of outcomes, and documentation of results • The preparation and distribution of food that is nutritional for the care and treatment of patients • The honoring of individual cultural, religious, or ethnic food preferences (see the 2003 Accreditation Manual for Healthcare or the JCAHO Web site [http://www.jcaho.org] for the full text). Other standards such as infection control also apply to nutrition services. Quality assessment and assurance is a regulation of the Center for Medicare and Medicaid Services (CMS) (formerly the Health Care Financing Administration) that requires an ongoing program that monitors patient care and outcomes. The program must identify where problems exist and how Clinical Nutrition Care Management 273
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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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Page 277 and 278: Chapter 9 Clinical Nutrition Care M
Page 279 and 280: Planning As already shown, a manage
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Page 285 and 286: among professional staff whose memb
Page 287 and 288: Designing a Nutrition Services Paym
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Page 293 and 294: Figure 9.6. Goal of Nutrition Scree
Page 295 and 296: Table 9.3. Physical Signs Indicativ
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Page 307 and 308: Elements of an MIS In addition to t
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Page 317 and 318: Figure 10.2. Sample Purchase Order
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Page 327: Bibliography Alexander, J. Selectin
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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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