RUNNING HEAD: Menu Project

Menu Project The University of Southern Mississippi Laura Ewoldt

MENU PROJECT South Central Regional Medical Center (SCRMC) is a small hospital located in Laurel,

Mississippi. SCRMC uses a room service style foodservice from the hours of 6:45 a.m. to 7 p.m. Meals are delivered to patients within 45 minutes of when they place their order. If a patient has any dietary restrictions or is on a certain diet, the computer keeps track of all of the menu items that the patient is allowed to have. For patients who cannot order their own food or choose not to participate in room service, default meals are provided based on a weekly cycle menu. At SCRMC, menus are written based on the Academy of Nutrition and Dietetics Manual. The Nutrition Coordinator/Chief Clinical Dietitian is responsible for writing the menus. The menus are required to meet the nutritional standards established by the National Research Council and published in the Recommended Dietary allowances. In addition, taste, texture, color, flavor, and eye appeal are considered when planning menus in order to provide high patient satisfaction. The room service menu is changed every one and a half to two years to keep up with changing customer preferences. Currently, the menu is being revised to contain more gluten free options. Upon entering the hospital, each patient is assigned a diet prescription by a physician, which will be the patients diet order while he or she is in the hospital. The patients nurse provides the patient with information on the menu and explains how to order meals. SCRMC uses a room service style foodservice, where meals are ordered by patients when they are hungry. Meals are prepared once the order has been taken. Each patient is assigned to a room service style: yes, no, or VIP. Patients who are classified as room service: yes call the hospitality center to order each meal off of the menu provided and may order all three meals of the day at one time. Patients who are classified as a room service: no receive a standard tray for each meal based on the diet prescription provided and the weekly cycle menu. Patients who

MENU PROJECT are classified as a room service: VIP are visited by the dietetic technician who helps them choose their meals for the day that are within their nutrient requirements set by their diet type. If the patient is a Room service: yes or a Room service: VIP, he or she is provided with a restaurant style menu. The menu lists the number of carbohydrate servings in each menu item, and it also denotes which foods are indicated as heart healthy so that patients can make informed meal choices. Patients call the Hospitality Center to order meals, and a hospitality center associate will receive calls and help the patient place his or her meal order. Patients may place their orders for the entire day, or they may call at each meal when they are hungry and request an immediate meal. If patients are on therapeutic diets, the hospitality center associate will help them plan their meals according to their dietary restrictions, which are programmed into the computer. The main therapeutic menus that are available at SCRMC include soft diet, 1800 calorie diabetic diet, low cholesterol diet, two gram sodium diet, renal diet, clear liquid diet, full liquid diet, pureed diet, and low residue diet. These are the most popular diets as SCRMC sees many cardiac and geriatric patients. The soft diet provides only foods that are soft and easy to chew.

The 1800 calorie diabetic diet provides a calorie restricted, carbohydrate controlled diet. The low cholesterol and low sodium diets are available for those patients who require a heart healthy diet. The renal diet is provided for those patients who are experiencing kidney issues. The clear liquid and full liquid diet provides all menu items from liquid sources. The pureed diet is available for patients who need a texture modification. Finally, the low residue diet is provided for patients experiencing gastrointestinal issues. The physician can prescribe any diet or any combination of diets to the patient that he or she deems appropriate.

MENU PROJECT The kitchen staff prepares meals based on the non-select cycle menu as many patients receive a standard tray. In addition, all room service orders that are placed before the meal service times are complied two hours before meal service so that production employees can prepare for the number of meals to be provided. For example, grilled chicken breasts may be ordered off of the menu and are usually cooked when ordered; however, if a patient has ordered the meal before meal service time, the production staff will make the grilled chicken breast in advance. Meals are prepared in waves during each meal period. A computerized system sends information for each patient meal to the hot and cold food lines where employees plate each patients meal. After the meal is plated, meals are placed inside delivery carts and delivered to patients. The diet manual that is used by SCRMC is the Academy of Nutrition and Dietetics Diet Manual. The Academy of Nutrition and Dietetics Manual uses the dietary reference intakes as the standard in planning regular nonselect menus. Depending on patient selections with a select

menu, the dietary reference intakes may or may not be met. The diet manual also stresses the use of the Dietary Guidelines for Americans in menu planning (Academy of Nutrition and Dietetics). In addition, the dietitian planning the menu uses Calorie Count to input recipes. The website provides a nutrient profile of the recipe. The dietitian can then change any ingredients in the recipe so that certain nutrients will be within the desired range. For example, sodium can be reduced by decreasing the amount of salt used or by using a low sodium version of certain ingredients. When menu planning, the nutrients are compared to the recommendations in the diet manual to ensure that patients are receiving the optimal amount of nutrients (caloriecount.com). Each therapeutic menu is programmed into the computer to have limits on certain nutrients, depending on the dietary restrictions. For example, a patient on a two gram sodium diet

MENU PROJECT is only allowed two grams of sodium per day, and a patient on a low cholesterol diet is not allowed to order high cholesterol foods. As patients order meals, the computer counts each food item as part of the daily allowance for each nutrient that is restricted. The hospitality center associates aid patients in ordering so that they will stay within nutrient requirements for their specific dietary prescription. A patient is not allowed to order food items above their nutritional limits. For combination diets prescribed by physicians, the patient will have multiple nutrient restrictions in the computer system.

To assess the main therapeutic menus, a nutrient analysis was completed using the United States Department of Agricultures Supertracker and is available in the appendix. The regular menu was adequate in calories, protein, carbohydrates, and fat when compared to the recommended dietary allowances for a female that is age 22. It was also adequate in folate, niacin, riboflavin, thiamin, vitamin B6, vitamin B12, sodium, and zinc; however, it was not adequate in fiber, vitamin A, vitamin C, vitamin D, vitamin E, calcium, iron, magnesium, and potassium. The 1800 calorie diet had approximately 1816 calories with a consistent level of carbohydrates at each meal. The low cholesterol diet had an average cholesterol level of 195 milligrams. The two gram sodium diet had an average of 2073mg sodium. The renal diet had an average of 713mg calcium, 2457mg potassium, and 2308mg sodium. Although the nutrients of concern for the therapeutic menus were near or within the estimated range, the calorie level was often low. In the renal diet and two gram sodium diet, the average calorie level was below 1800. Depending on the patient, he or she may require more calories than what would be provided. In addition, the regular diet had one gram higher than the recommended amount of saturated fat, 46mg higher than the recommend amount of cholesterol as well as vitamins and minerals out of range, which are listed above. One recommendation

MENU PROJECT

would be to decrease the amount of saturated fat and cholesterol in the regular diet. SCRMC has many patients with cardiovascular disease, so if patients are on a regular menu, it could be harmful to have extra cholesterol and saturated fat in their diets. In addition, the vitamin and mineral level of the menus should be adjusted when menu planning. Many levels of vitamins and minerals were lower than the estimated requirement, so menus could be adjusted to incorporate a higher level of vitamins and minerals, such as fiber, vitamin A, vitamin C, vitamin D, vitamin E, calcium, iron, magnesium, and potassium, which were low in the regular menu. Overall, the regular and therapeutic menus were adequate in calories and macronutrients but were sometimes lacking in vitamins and minerals. When menu planning, different menu items such as fruits and vegetables could be incorporated into the menus in order to provide a larger variety for these nutrients. Providing a balanced, varied diet to patients can help aid in healing and treatment and allow them to have a better overall experience while in the hospital.

MENU PROJECT References Academy of Nutrition and Dietetics. Nutrition Care Manual. http://www.nutritioncaremanual.org. Accessed January 23, 2014. Calorie Count. https://caloriecount.com. Accessed January 14, 2014. United States Department of Agriculture. SuperTracker. https://www.supertracker.usda.gov/default.aspx Accessed January 14, 2014.

MENU PROJECT Appendix

NUTRIENTS Kcal Protein (g)1035 Carbohydrates (g) 45-65 Fat (g) 20-35 Saturated Fat (g) Cholesterol (mg) Dietary Fiber (g) % of Kcal as fat % of Kcal as sat fat VITAMINS Folate (mcg) Niacin (mg)

RDA's

Regular Diet Average Soft Diet Average Sunday Monday Tuesday Sunday Monday Tuesday 2400 2229 2331 2203 2254.333 2229 2331 2203 2254.333 83 279 91 32 220 20 37 13 329 18 2 1.5 86 306 88 20 341 19 34 8 676 22 2.4 1.8 103 90.66667 241 275.3333 93 90.66667 32 28 83 279 91 32 220 20 37 13 329 18 2 1.5 86 306 88 20 341 19 34 8 676 22 2.4 1.8 103 90.66667 241 275.3333 93 90.66667 32 28

60-210 270-390 53-93 27g less than 300 25-30g 20-35% less than 10% 400 mcg 11 mg

479 346.6667 14 17.66667 38 36.33333 13 11.33333 443 482.6667 30 23.33333 2.3 2.233333 1.3 1.533333

479 346.6667 14 17.66667 38 36.33333 13 11.33333 443 482.6667 30 23.33333 2.3 2.233333 1.3 1.533333

Riboflavin (mg) 1.7 mg Thiamin (mg) 1.5 mg 3000 IU men and 2333 IU Vitamin A (IU) women Vitamin B6 (mg) 1.3 mg Vitamin B12 (mcg) 2.4 mcg 90 mg men and Vitamin C (mg) 75 mg women Vitamin D (mcg) 5 mcg Vitamin E (mg) 15 mg MINERALS Calcium (mg) 1000-1200 mg 8 mg men and Iron (mg) 18 mg women 400-420 men Magnesium and 310-320 (mg) women Potassium (mg) 4700 mg Sodium (mg) 2400 mg 11 mg men and Zinc (mg) 8 mg women

1229 1.7 4.8 76 4 6 1125 13

646 1.5 3 107 5 7 837 13

1309 1061.333 2.1 1.766667 6.6 78 4.8 87

1229 1.7 4.8 76 4 6 1125 13

646 1.5 3 107 5 7 837 13

1309 1061.333 2.1 1.766667 6.6 78 4.8 87

5 4.666667 7 6.666667 856 939.3333 13 13

5 4.666667 7 6.666667 856 939.3333 13 13

303 3173 3288 14

261 2527 4821 7

228 3033 3279 15

264 2911 3796 12

303 3173 3288 14

261 2527 4821 7

228 3033 3279 15

264 2911 3796 12

MENU PROJECT

9
1800 kcal ADA Diet Average Low Cholesterol Diet Average Sunday Monday Tuesday Sunday Monday Tuesday 2400 1859 1855 1735 1816.333 1952 1794 1911 1885.667 82 248 64 21 162 23 31 10 279 18 1.7 1.5 74 270 58 14 284 21 28 7 658 16 2.4 1.7 103 86.33333 200 239.3333 64 62 17 17.33333 312 252.6667 14 19.33333 33 30.66667 9 8.666667 408 448.3333 29 21 2.3 2.133333 1.3 1.5 76 284 61 17 146 25 28.00% 8.00% 251 19 1.7 1.5 82 252 54 14 125 21 27.00% 7.00% 362 18 2 1.4 106 88

NUTRIENTS Kcal Protein (g)1035 Carbohydrates (g) 45-65 Fat (g) 20-35 Saturated Fat (g) Cholesterol (mg) Dietary Fiber (g) % of Kcal as fat % of Kcal as sat fat VITAMINS Folate (mcg) Niacin (mg)

RDA's

60-210 270-390 53-93 27g less than 300 25-30g 20-35% less than 10% 400 mcg 11 mg

219 251.6667 68 61 87 39.33333 314 195

15 20.33333 32.00% 29.00% 9% 314 29 8.00% 309 22

Riboflavin (mg) 1.7 mg Thiamin (mg) 1.5 mg 3000 IU men and 2333 IU Vitamin A (IU) women Vitamin B6 (mg) 1.3 mg Vitamin B12 (mcg) 2.4 mcg 90 mg men and Vitamin C (mg) 75 mg women Vitamin D (mcg) 5 mcg Vitamin E (mg) 15 mg MINERALS Calcium (mg) 1000-1200 mg 8 mg men and Iron (mg) 18 mg women 400-420 men Magnesium and 310-320 (mg) women Potassium (mg) 4700 mg Sodium (mg) 2400 mg 11 mg men and Zinc (mg) 8 mg women

2.3 2 1.2 1.366667

1247 1.9 4.4 114 3 5 967 17

920 1.7 2.7 180 4 7 908 10

1256 2.1 5.2 75

1141 1.9 4.1 123

1214 2 3.5 116 3 5 779 16

536 1.6 2 114 4 4 811 8

1281 1010.333 2.2 1.933333 5.3 3.6

75 101.6667 6 4.333333 7 5.333333 886 825.3333 13 12.33333

6 4.333333 7 6.333333 831 902

13 13.33333

314 3280 2514 14

274 2901 3825 7

232 273.3333 3173 3118 2846 3061.667 14 11.66667

326 3401 2686 13

280 2701 4251 8

282

296

3361 3154.333 3336 3424.333 15 12

MENU PROJECT

10
2G Sodium Diet Average Renal Diet Average Sunday Monday Tuesday Sunday Monday Tuesday 2400 1832 1865 1683 1793.333 1817 1809 1594 1740 73 264 59 18 160 24 29 9 257 17 1.7 1.3 73 288 52 10 475 23 25 5 449 17 2.1 1.2 84 76.66667 225 259 50 53.66667 15 14.33333 380 338.3333 15 20.66667 27 27 8 7.333333 330 345.3333 26 20 1.9 1.1 1.9 1.2 63 307 42 10 98 18 21 5 438 17 1.7 1.3 79 262 56 12 481 19 28 6 384 27 2 1.1 82 74.66667 210 259.6667 48 48.66667 14 12

NUTRIENTS Kcal Protein (g)1035 Carbohydrates (g) 45-65 Fat (g) 20-35 Saturated Fat (g) Cholesterol (mg) Dietary Fiber (g) % of Kcal as fat % of Kcal as sat fat VITAMINS Folate (mcg) Niacin (mg)

RDA's

60-210 270-390 53-93 27g less than 300 25-30g 20-35% less than 10% 400 mcg 11 mg

380 319.6667 16 17.66667 27 25.33333 8 6.333333 448 423.3333 23 22.33333 1.9 1.866667 1.2 1.2

Riboflavin (mg) 1.7 mg Thiamin (mg) 1.5 mg 3000 IU men and 2333 IU Vitamin A (IU) women Vitamin B6 (mg) 1.3 mg Vitamin B12 (mcg) 2.4 mcg 90 mg men and Vitamin C (mg) 75 mg women Vitamin D (mcg) 5 mcg Vitamin E (mg) 15 mg MINERALS Calcium (mg) 1000-1200 mg 8 mg men and Iron (mg) 18 mg women 400-420 men Magnesium and 310-320 (mg) women Potassium (mg) 4700 mg Sodium (mg) 2400 mg 11 mg men and Zinc (mg) 8 mg women

1187 2.1 3.6 135 3 4 767 16

844 1.8 2.6 182 5 7 764 10

1165 1065.333 1.9 1.933333 4.7 3.633333 73 130

671 1.3 1.7 86 3 5 797 14

596 1.5 4.4 41 7 9 672 9

1443 903.3333 1.6 1.466667 4.2 3.433333 61 62.66667 4 4.666667 6 6.666667 671 713.3333 11 11.33333

4 4 6 5.666667 680 10 737 12

314 3623 1812 13

313 3033 2041 7

237

288

223 2558 2373 6

234 2462 2656 6

206

221

2783 3146.333 2366 2073 12 10.66667

2351 2457 1896 2308.333 11 7.666667