1. Food and Nutrition Services: Dining with Dignity
Image accessed 3/7/17:
Revised by Rebekah Hilfiger, DTR, CDN 3/7/17

2. Group Diet Technicians Registered Dietitian
Jillian Esposito, NDTR (covers 2nd, 5th & 6th floor)
Rebekah Hilfiger, NDTR, CDN (covers 3rd, 4th & 7th floor)
Registered Dietitian
Ginger Pratt, RDN

3. Diet Order – 3 Parts 1) Diet Type Regular House Diet (RH)
Limited Carbohydrate Diet (LC)
Sugar Substitutes instead of regular sugar, sugar free drinks and desserts.
No Free Salt Diet (NFS)
Do not receive salt on their tray and other modifications specific to resident.
Lactose Restricted (LR)
Receive Lactaid milk and do not receive cheese and other forms of dairy.
RHD: This diet is given to resident’s who do not need any modification.
LCD: This diet is given to residents who have diabetes.
NFS: Residents who have CHF and Hypertension.
LR: Residents who are Lactose Intolerant.

4. Diet Order – 3 Parts 2) Diet Texture Regular Consistency
Ground Consistency
Puree Consistency
Solid Texture
Regular consistency
Ground
Pureed

5. Diet Order – 3 Parts 3) Fluid Consistency Regular (Thin) Nectar Thick
Honey Thick
Pudding Thick
Image accessed 3/7/17:

6. The Menu and Food Preferences
Menu is a four week cycle.
Weekly Menu is displayed on dining room wall.
Meal has a main entrée and two alternative entrée options.
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7. The Menu and Food Preferences
Residents menu is selected based on their food preferences obtained and updated by Nutrition group.
If resident does not want the entrée served, offer the alternatives on the menu for that meal.
If they do not want alternatives offer PB&J or Grilled Cheese.

8. The Menu and Food Preferences
Call kitchen and let them know:
The Kitchen extension is
Resident’s Name
The Floor Number
The Resident’s diet order and consistency
The food item they are requesting.
The meal ticket has all this information on it, so take it to the phone with you and then return it to the resident.

9. The Menu and Food Preferences
Try to gather all requests together to limit multiple calls to the kitchen and special trips to the floors are avoided.
Let the Diet Techs know about any food preferences changes based on resident’s requests.

10. Meal Ticket Information
Resident Name and Room Number
Diet Type, Diet Texture and Liquid Consistency
Food Allergies

11. Meal Ticket Information cont.
Aspiration Precautions
Residents who have a history of Dysphagia.
Fluid Restrictions
Special utensils / Adaptive equipment

12. Aspiration Precautions
Residents on Aspiration Precautions must eat in the dining or be supervised by an appropriate staff member.
Typically straws should not be used since the quick intake of liquid can cause aspiration.
Some residents are allowed to use straws still.
Water cups/pitchers, meal trays or any other food/beverages cannot be left in resident’s room when resident is unsupervised.

13. Fluid Restrictions
Fluid Restrictions are noted on the Kardex and on Meal Tickets if applicable.
Common Fluid Restriction is 1500mL (6 ¼ cups) per day.
Total amount of fluid allowed per day is divided among Nutrition and Nursing.
Resident receives a specific amount of fluid at each meal and should not be provided more.

14. Fluid Restrictions Cont.
Substituting a beverage is allowed as long as it is the same amount and inline with the diet order.
Amount of fluid consumed for each meal and with each med pass is recorded by Nursing.
Water cup/pitcher should not be in resident room.
Non-compliance needs to be reported and documented.

15. Dining Room Procedures
Meal Times are posted on each floor on the bulletin board next to the elevator.
Encouraged residents to eat meals in the dining room.
Please have residents in the dining room minutes prior to the scheduled meal time to ensure food is served quickly and at appropriate temperatures.
All meals must to be served within 20 minutes from the time the cart arrives.
2nd Floor: 7:30AM, 12:06PM, 5:35PM; 3rd Floor: 8:18AM, 12:18PM, 6:23PM; 4th Floor: 7:54AM, 11:42AM, 5:59PM;
5th Floor: 7:42AM, 11:30AM, 5:47PM, 6th Floor: 8:06AM, 11:54AM, 6:11PM; 7th Floor: 8:30AM, 12:30PM, 6:35PM.

16. Dining Room Procedures
All items should be taken off the trays.
Some Residents prefer food left on the tray this is in their Kardex.
Each item listed on tray ticket should be checked against what is on the tray to make sure it is accurate.
You are the final check to make sure the proper food/beverage is being served!!

17. Dining Room Procedures
All trays must be removed from resident’s rooms after meal is complete.
Any trays that are not on the tray cart when kitchen staff come to pick up the tray cart MUST be taken to the kitchen BEFORE the start of the next meal.

18. Clothing Protectors
Clothing protector may be offered to the residents during meals.
You must ask the resident if they would like to wear a clothing protector prior to placing it on the resident.
If a resident is unable to give permission it will be indicated on Kardex to place a clothing protector on resident.

19. Serving in the Dinning Room
Serve all of the residents at one table before serving another table of residents.
Do not place a tray on the table unless the resident is at the table ready to eat.
The dinning room should be a pleasurable place to eat and social event for our residents.
You must wear gloves when touching the resident’s food.
DO NOT touch food with you bare hands
Please keep conversations pleasant and centered on the residents. Ask the residents questions about themselves and engage in conversations with them. This helps promote a more pleasurable dining experience and promotes better food intake.

20. Meal Completion Documentation
Nursing documents the percentage of the meal that was consumed for breakfast, lunch and dinner for each resident
Completion ranges are: 0-25%, 26-50%, 51-75% and %.
Meal completion info for solids and fluids should be electronically entered in the resident’s record right after the meal so the info is not forgotten.

21. Meal Completion Documentation
Meal completion should be documented from the computer kiosk in the dinning room.
Enter the amount consumed as you collect the resident’s trays.
Trays that are collected from resident’s rooms amount should be documented before placing the tray back in the carts.
Or write the amount consumed on the resident’s meal ticket, save the tickets until you are able to complete your documentation.

22. Weights
Body weight is an extremely important piece of info to assess nutritional and medical status.
If a resident is weighed in a wheelchair, the wheelchair weight must be obtained and subtracted from the total weight.
If a resident is unable to have items removed such as a cast or brace when being weighed, a note should be made so it is known.
Weight should be entered electronically into the resident’s record immediately so it is not lost and that the info is readily available.

23. Monthly Weights
Residents’ weights are obtained by Nursing starting on the 1st of each month and must be completed by the 8th of the month.
If there is a 5# difference (+/-) in weight compared to the last recorded weight, resident must be re-weighed to confirm the weight is correct.

24. Weekly Weights
When a resident is admitted to facility or re-admitted from the hospital his or her weight is monitored weekly for 4 weeks.
A resident’s weight may also be monitored weekly if he or she has weight loss, weight gain, or CHF.
Weekly weights are to be obtained by Nursing on Wednesdays.
Sometimes resident may be weighed more frequently.

25. Nourishments
Nourishments are scheduled snacks and should be served at times noted on the Kardex (10AM, 3PM, and HS).
Snacks should not be served with meals since they serve to help regulate blood sugar, improve PO intake and satisfy hunger in-between meals.
Document the amount consumed in tasks.
Please notify Nutrition Group if resident is typically not eating or enjoying what is provided.

26. Conclusion
Nursing and Nutrition work closely together to make sure our residents are eating well and are healthy.
Meal times are very important to the nutrition and social wellbeing of our residents and YOU play a very important role in this!
If you have questions or notice something different about a resident’s intake, weight, etc. let us know!!