Clinical. Food, Fluid and Nutritional Care Policy

Transcription

1 Clinical Food, Fluid and Nutritional Care Policy SECTION 2: PLANNING AND DELIVERY OF FOOD AND FLUID IN HOSPITALS 2.1 PROTOCOL FOR THE PLANNING AND DELIVERY OF FOOD AND FLUID Policy Manager Joyce Thompson Dietetic Consultant in Public Health Nutrition Policy Group Food Fluid & Nutritional Care (FFNC) Policy Review Group Policy Established Policy Review Period/Expiry 31 May 2018 Last Updated 27 February 2017 This policy does / does not apply to Medical / Dental Staff (delete as appropriate) UNCONTROLLED WHEN PRINTED

2 Version Control Version Purpose/Change Author Date Number 1.0 First draft Caroline McKenzie/ 28/08/2012 Victoria Hampson/ Robert Mayes 2.0 Changes made following Expert Caroline McKenzie/ 19/09/2012 Consultation Victoria Hampson 3.0 Changes made following Universal Caroline McKenzie/ 30/11/2012 Consultation Vicky Hampson/ Joyce Thompson/ Kerry Queen 4.0 Formatting Lorna Murray 10/04/ Final amendments Caroline McKenzie 15/07/ Formatting Sue Smart 26/07/ Updated with HIS FFNC Standards Caroline McKenzie 13/01/2016 Reference to Menumark removed Menu Templates and Out of Hours Provision updated Contact numbers updated 7.1 Formatting Sue Smart 25/01/ Final amendments Caroline McKenzie 10/02/ Updates to: quoted references/regulations and systems SOP Additions of SOP and new Appendices 1 & Amendments following Universal Consultation Caroline McKenzie 14/12/2016 Caroline McKenzie 27/02/2017 Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 2 of 42 Review Date: May 18

3 CONTENTS SECTION 2: 2.1 Page Number 1. PURPOSE AND SCOPE 5 2. RESPONSIBILITIES AND ORGANISATIONAL ARRANGEMENTS 5 3. BACKGROUND 5 4. ROLES AND RESPONSIBILITIES Catering Managers Registered Dietitians - Nutritional Analysis Registered Dietitians Registered Nursing Staff Unregistered Nursing Staff Catering or Portering Staff 7 5. CONSENT 7 6. AUTHORISED PROFESSIONALS 7 7. EDUCATION AND TRAINING 7 8. LEGAL LIABILITY 7 9. TROUBLESHOOTING REFERENCES 9 STANDARD OPERATING PROCEDURES Development of standard recipes (excluding non NHS providers) Nutritional analysis of a standard recipe (excl. non NHS providers) Menu planning (excluding non NHS providers) Ordering and receiving patient meals (excl. non NHS providers) Production of patient meals by the Catering Dept (excl. non NHS prov.) Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 3 of 42 Review Date: May 18

4 Ordering missed meals (excl. non NHS providers) Out of hours provision of meals (excl. non NHS providers) Ordering and provision of snacks at ward level APPENDIX 1 - NHS Tayside Caterers Standard Recipe Evaluation Form 35 APPENDIX 2a - NHS Tayside Menu Template - Breakfast 36 APPENDIX 2b - NHS Tayside Menu Template - Lunch 37 APPENDIX 2c - NHS Tayside Menu Template - Evening Meal 38 APPENDIX 3 - Out of Hours Provision of Food 39 APPENDIX 4 - Contact Numbers APPENDIX 5 - Nutritional Content of Biscuits/Toast and Order Codes 42 Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 4 of 42 Review Date: May 18

5 2.1 PROTOCOL FOR THE PLANNING AND DELIVERY OF FOOD AND FLUID IN HOSPITALS 1. PURPOSE AND SCOPE This document outlines the processes required for the planning and delivery of food and fluid to all adult patients admitted to hospital. 2. RESPONSIBILITIES AND ORGANISATIONAL ARRANGEMENTS General Managers/Assistant Directors (or equivalent), Head of Catering/ Nutrition and Dietetic Clinical Leads, Heads of Nursing (or equivalent) have responsibility for distribution of this protocol to staff within their area/directorate/business unit, ensuring that staff have the opportunity to access the Food, Fluid and Nutritional Care Policy. Clinical Directors have responsibility to ensure that this protocol is implemented within their area and to monitor compliance. 3. BACKGROUND It is essential that there are formalised structures and processes in place with regards to the planning and delivery of food and fluid to patients (HIS, 2014). The food and fluid provided needs to meet the nutritional requirements of the population it is catering for, needs to be familiar and appetising in order that patients nutritionally status is not compromised during their stay and periods of illness and recovery (Food in Hospitals, 2016). In 2016, the Scottish Government republished Food in Hospitals: National Catering and Nutrition Specification to support NHS Boards in implementing the Healthcare Improvement Scotland: Food, Fluid and Nutritional Care Standards (2014) and specifically Standards 3, 4 and 5. Food in Hospitals: National Catering and Nutrition Specification aims to address the risk of malnutrition in hospital patients and the delivery of a healthy balanced diet for patients who are considered nutritionally well. It provides guidance on how the standards can be met, through assessment of population dietary needs, menu planning, guidance and practical suggestions on food choices suitable for different dietary needs, including special and therapeutic diets. In order to ascertain compliance with the standards NHS Boards are required to complete the Health Facilities Scotland (HFS) National Nutrition and Catering Monitoring Tool. Results for each 6-month period are submitted to HFS each June and December. As a large-scale provider of meals, NHS Tayside acknowledges its moral and legal responsibilities to provide food and beverages, which are palatable, nourishing and above all, safe for the consumer. Furthermore, NHS Tayside recognises that in a healthcare institution most consumers are infirm, elderly, young or expectant mothers, and are therefore particularly susceptible to food-borne infection or disease. For this reason, the NHS Tayside (2008) Procedures Document for the maintenance of high standards of Food Hygiene and Pest Control, which incorporates the formal HACCP (Hazard Analysis Critical Control Point) System, was developed to ensure Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 5 of 42 Review Date: May 18

6 that Catering Services throughout NHS Tayside operate to the highest possible standards of food hygiene and safety. The procedures and HACCP system are essential to ensure the protection of our vulnerable client group and compliance with all relevant food safety legislation including: The Food Safety Act (1990) Regulation (EC) 852/2004 European Union Food Information for Consumers Regulation (no. 1169/2011) (EU FIC) The Food Information (Scotland) Regulations 2014 Regulation (EC) 178/2002 NHS Tayside must comply with all related legislation as well as National Health Service guidance. The legislation covers a wide variety of areas including: Contamination of food by physical, chemical or biological substances Purchase and storage of food, temperature requirements for preparation and storage of foods Risk assessment Standards for kitchens and equipment Good hygiene practices and training 4. ROLES AND RESPONSIBILITIES 4.1 Catering Managers are responsible for the development of standard recipes, menu planning based on the populations needs, ensuring cooks and chefs follow the standard recipes, delivery of the meals to the patients, establishing patient satisfaction with the menu, ensuring wastage is within the target set by NHS Tayside and ensuring catering staff follow this protocol. 4.2 Registered Dietitians with a remit for nutritional analysis are responsible for ensuring recipes developed by the caterers are entered into the N4P (Nutrition for Patients) Nutritional Analysis Package for nutritional analysis and meet the criteria listed in Food in Hospitals, are coded for therapeutic diets, are published for use by caterers and dietitians, and any necessary changes to recipes and methods are made within N4P (HIS, 2014). 4.3 Registered Dietitians can assist with the development of standard recipes and menus for specific patients. 4.4 Registered Nursing Staff have a responsibility to identify patients dietary needs on admission using the Multidisciplinary Record of Care Core Data Set (FFNC Policy Section 1.1 Appendix 2) to establish whether they have any specific dietary needs, dietary intolerances or food allergies. This information should be used to ensure patients use the correct menus to order food, or are helped to order the food they require. In addition the registered nurse must ensure that the patients nutritional needs have been communicated to the Catering Department to ensure that patients receive the food they require and that patients are given any assistance, if necessary, to eat and drink. Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 6 of 42 Review Date: May 18

7 4.5 Unregistered Nursing Staff can provide assistance to patients in making and completing menu choices. and to ensure that patients receive the food they require and any assistance to eat and drink. 4.6 Catering or Portering Staff have a responsibility to ensure the food is delivered to the ward. 5. CONSENT Where relevant the patient should be actively involved in their food and fluid choices. 6. AUTHORISED PROFESSIONALS All clinical staff are responsible for their own compliance with the guidance contained within this protocol, identifying their own training needs and attending appropriate training when provided. 7. EDUCATION AND TRAINING All clinical staff are responsible for their own compliance with the guidance contained within this protocol, identifying their own training needs and attending appropriate training where provided. Registered staff (Nurses, Occupational Therapists, Speech and Language Therapists and Dietitians) must complete the learnpro module NHS Tayside Clinical Application of the MUST mandated every 3 years. Following successful completion of the above learnpro module all registered Nursing Staff must undertake the MUST Competency Assessment in order to ensure safe practice and minimise risk and that staff are appropriately skilled and competent in the completion of the MUST. Nutrition Link Nurses are mandated to attend all the Nutrition Link Nurse Forums (3 per year) and in addition to the above, undertake training in the assessment of MUST competencies. These Forums will also update staff on processes and procedures with regards to the planning and delivery of food and fluid. 8. LEGAL LIABILITY NHS Tayside as an employer will assume vicarious liability for the actions of all staff, including those on honorary contracts, providing that: Staff have undergone any training identified as necessary for the process The member of staff is authorised by NHS Tayside to undertake the process. The provision of this policy and the supporting procedure has been followed by the member of staff at all times Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 7 of 42 Review Date: May 18

8 9. TROUBLESHOOTING FOR PLANNING AND DELIVERY OF FOOD AND FLUID IN HOSPITALS Problem Problems with access or inputting data into prodplan+ Problems with access or inputting data into N4P Food does not arrive on the trolley or what arrives is incorrect The trolley arrives late The food on the trolley arrives cold There is a complaint regarding the food The patient is not able to make menu choices independently The patient has missed a meal The patient is transferring to another hospital over a meal time Patient has been admitted and is hungry Action Contact the NHS Tayside Head of Catering Contact the Tayside Nutrition MCN Improvement and Development Manager Contact the Head Chef within the Catering Department (Appendix 4) Contact the Head Chef within the Catering Department (Appendix 4) Contact the Head Chef within the Catering Department (Appendix 4) Contact the relevant Catering Manager (Appendix 3) and complete the relevant Catering Services Complaint Form documentation - see Staffnet\Our Websites\Catering Services\Forms A member of staff, relative or carer should aim to assist Consider use of a datasheet which contains a picture/nutritional analysis per portion - see ion/nutrition-in-care/hospital/cateringinformation/nutritional-analysis-of-hospitalmeals-(1)/nhs-tayside-menu.aspx Contact the Head Chef (Appendix 4) within the Catering Department to establish if a hot meal can be provided If a hot meal cannot be provided by the Catering Department, then use ward provisions, snacks and the Out of Hours Provision (Appendix 3) to provide a suitable alternative Contact the Catering Department (Appendix 4) to arrange the provision of a packed lunch or contact the receiving ward to ensure they order a suitable meal. Cancel the meal due to arrive on the ward transferring the patient Contact the Head Chef within the Catering Department (Appendix 4) to establish if a hot meal can be provided If a hot meal cannot be provided by the catering Department, then use ward provisions, snacks and the Out of Hours Provision (Appendix 3) to provide a suitable alternative Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 8 of 42 Review Date: May 18

9 10. REFERENCES Public Health England (2015) McCance and Widdowsons The Composition of Foods, Seventh Summary Edition. Cambridge: Royal Society of Chemistry Healthcare Improvement Scotland (2014) Food, Fluid and Nutritional Care Standards [online] utritional_care/nutritional_care_standards.aspx NHS Tayside (2013) Food Fluid and Nutritional Care Policy Section 7: Food Safety and Food Hygiene Procedures for Wards [online] NHS Tayside (2008) Procedures Document for the maintenance of high standards of Food Hygiene and Pest Control NHS Tayside (2008), Protocol for the Handling of Complaints Relating to Catering Services in NHS Tayside Nursing & Midwifery Council (2015) The Code: Professional standards of practice and behaviour for nurses and midwives [online] Scottish Government Food in Hospitals: National Catering and Nutrition Specification [online] ba10-4dd1-acb f76a8f.pdf Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 9 of 42 Review Date: May 18

10 2.1.1 STANDARD OPERATING PROCEDURE - Development of standard recipes Policy: Food, Fluid & Nutritional Care Policy Reference: Originator: Caroline McKenzie Operation Part Number/ Name Safety Tools/ Clothing Tools/ Equipment Development of standard recipes (excluding non NHS providers) This procedure details how to develop, review and test a standard recipe for the inpatient menu National uniform for chefs/ catering assistants/ catering production assistants, white coats and hats/hairnets for managers, visitors and contractors. Sensible footwear (no open toes/heels with reasonable slip protection) must be worn by all persons entering production/service areas. Catering Database to enter recipes e.g. prodplan+ No Main Operating Steps Rationale Evidence/support 1 The following information must be included in the recipe: Food in Hospitals a. A title to describe the recipe content b. All the ingredient components of the recipe, including water and seasoning; quantities in metric c. Ingredient names clearly stating name and brand of product, product type/form (fresh/frozen, canned), and any preparation technique(s) (peeled, grated minced and diced. Size for preparation techniques should also be specified. d. Detailed methodology, directions must be listed in the order the recipe is prepared e. Recipe yields i.e. the amount of product available for service at the completion of production in weight or volume and number of servings f. Volume and/ or weight of a single portion and the equipment used to serve this portion; portion size and weight/volume should be based on how the particular product fits with a full meal and how it looks on a plate g. A code number To allow caterers to order the correct ingredients This information is key to identifying the 14 EU allergens To reduce wastage and ensure patients receive the correct portion size based on their nutritional needs To allow dishes to be easily located prodplan+ Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 10 of 42 Review Date: May 18

11 2 The following information is useful within the recipe: a. Equipment and utensils used for preparing cooking and serving food are important. The yield and portion capacity of cooking equipment can change with length, width and depth of pans. There is evidence to demonstrate that providing smaller portions results in patients consuming less energy and protein. It is important that appropriate serving crockery is used and as such all main meals should be served on a dinner plate NHS Tayside (2008) Procedures Document for the maintenance of high standards of Food Hygiene and Pest Control b. Cooking temperature and approximate cooking time c. Different portion sizes and therefore yield To ensure foods are thoroughly cooked To differentiate between a small, medium and large portion d. Critical control points as part of the Hazard Analysis Critical Control Point (HACCP) e.g. safe thawing, internal cooking, holding, serving and storage temperatures 3 Recipe development If the recipe is new then it should be developed containing the information as described above 4 Recipe review If the recipe is a review of an existing recipe then it should be reviewed to ensure it contains the information as described above 5 Recipe preparation Once the recipe has been developed or reviewed, it should be prepared. For reliable testing it is recommended that the first version is made to yield 25 servings. During this process specific notes should be kept on: To prevent food poisoning or harm from allergens, chemicals and foreign bodies etc. To ensure a consistent approach across NHS Tayside To ensure a consistent approach across NHS Tayside To ensure the recipe is correct and the yield is as expected (this approach may vary in smaller catering establishments) Food in Hospitals Food in Hospitals Food in Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 11 of 42 Review Date: May 18

12 Any variations made to the original recipe record directly onto Any missing information i.e. ingredients or method These changes should be made directly onto the Caterers Standard Recipe Evaluation Form (Appendix 1) and given to the Catering Manager for them to pass to the Recipe Review Group. 6 Determination of recipe yield Once the recipe has been prepared the final product should be weighed to determine its volume and yield Factors affecting yield include: Ingredient product quality Preparation techniques Cooking times Temperature Cooking equipment 7 Portion Size Determine the portion size or weight by taking the weight of the total final product and dividing by the number of servings the recipe makes. The portion size should be checked to ensure: It is appropriate for the patient group it is serving It fits well with the rest of the meal If the recipe does not achieve the required portion size, changes in the recipe, portioning or ingredients may be required Any required changes should be made directly onto the Caterers Standard Recipe Evaluation Form (Appendix 1) and given to the Catering Manager for them to pass to the Recipe Review Group. 8 Recipe Evaluation Once the recipe has been tested then it must be tasted and evaluated for its suitability with the patient group. This should involve the Catering Manager, dietitian, cook(s) and patients. A speech and To ensure the yield is as expected and hence the nutritional analysis of the dish is accurate To ensure the patient receives the portion size appropriate for their needs That the meal fits with the eatwell guide To reduce wastage To encourage an adequate nutritional intake To ensure the texture Food in Hospitals Food in Hospitals Food In Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 12 of 42 Review Date: May 18

13 language therapist should be consulted where the dish is being assessed for its suitability for patients with swallowing problems. The following should be considered: Product appearance on the plate and in bulk form as appropriate Product taste and acceptability to the patients Product texture Product suitability to catering production and distribution type The evaluation should be collated and kept by the Catering Manager and shared with all other Catering Managers and the Tayside Nutrition Improvement and Development Manager. 9 Entering onto When the recipe has been developed and fully tested it should be amended on /added to prodplan+ by a designated caterer 10 The designated caterer should advise the Dietitian with a remit for nutritional analysis of any changes to prodplan+ such as: any new recipes to be added any amendments and the nature of these to Menumark changes in commodities used within recipes of the dish will not cause harm to those requiring a texture modified diet To ensure the food is transported without affecting quality and appearance As evidence for the Health Facilities Scotland National Catering and Nutritional Specification for Food and Fluid Provision, to demonstrate patient involvement This will allow other production units to view the recipe Recipes will be entered in a consistent manner Ensures that the recipes contained within N4P are up to date for nutritional analysis and meet relevant criteria Food in Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 13 of 42 Review Date: May 18

14 2.1.2 STANDARD OPERATING PROCEDURE - Nutritional analysis of a standard recipe Policy: Food, Fluid & Nutritional Care Policy Reference: Originator: Caroline McKenzie Operation Part Number/ Name Safety Tools/ Clothing Tools/ Equipment Nutritional analysis of a standard recipe (excluding non NHS providers) This procedure details how to enter a recipe into N4P and undertake nutritional analysis of the recipe None prodplan+ No Main Operating Steps Rationale Evidence/support 1 Nutritional analysis of recipes should only be undertaken or supervised by experienced Registered Dietitians 2 Obtain the recipe from prodplan+ and determine if this is in N4P 3 If the recipe is not within N4P, then the Dietitian who has Health Board Administrator rights or the person with Dietitian rights for N4P will be able to input the relevant recipe If the recipe is in the system, then only the following relevant steps should be followed to make the relevant updates 4 The name of the recipe must be entered as it appears on the recipe from prodplan+ 5 A hint must be entered which must take the format of TAY followed by the recipe code e.g. TAY mb001. Exceptions to this are items which have been added by Nutmeg as platters e.g. Sandwiches Cereal selection Cake/fancy biscuits Biscuits Yoghurt Drinks Bread/Rolls/Toast Butter/Margarine/ Jam/ Marmalade Individual portions of fruit Dietitians are experts in undertaking this task and the interpretation of the data To avoid duplication of recipes in the system Those with Health Board Administrator/Dietitian rights can only do this to ensure recipes are entered correctly and consistently To ensure recipes are easily located Ensure that the correct products are chosen which will ultimately ensure accurate nutritional analysis Food In Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 14 of 42 Review Date: May 18

15 6 Manufactured products which are to have their nutritional analysis added to N4P must have their name inserted as per the product specification. To obtain the exact name of the product visit and register for the NHS Scotland Dietitians Group where National Procurement load the most recent product specifications. Using the N4P Tutorials (see Help menu of N4P) insert as per product specification product name product code food group/sub group nutritional analysis per 100g allergen information 7 Determine % cooking weight loss from similar recipes or from Public Health England (2015). Where there is no similar model recipe then no cooking loss should be applied. Cooking losses do not apply to vegetables/potatoes/cold puddings e.g. instant desserts and bought in desserts, such as cheesecake and gateaux. 8 Copy and paste the method from prodplan+ into N4P 9 At the end of the method detail who entered the recipe and the date of entry e.g. entered by CM Save the recipe and this will allow for the commodities (ingredients) to be added 11 Commodities (ingredients) are to be chosen from either the MW (McCance and Widdowson) database or the N4P (Nutrition for Patients) database 12 A weight should be entered using the drop down menu for each of the ingredients within the recipe To ensure products are entered in a consistent and accurate manner across NHS Scotland To account for nutrient losses during cooking This is a quicker way to enter the method and avoids the potential for errors Allows for any queries about that recipe to be directed to whoever entered the recipe. It also ensures that other NHS Scotland Boards are not entering TAY recipes This is required in order that commodities can then be added The choice of database allows for the exact product to be added to the recipe or the closet comparable product To ensure accurate nutritional analysis See N4P Help Menu for the Tutorials Public Health England (2015) Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 15 of 42 Review Date: May 18

16 13 The cooking method should be chosen. Where the cooking method in the drop down menu does not fit with the method used it should be left blank. 14 Continue to add ingredients, the weights and cooking methods until the full recipe is entered as per prodplan+ 15 The number of portions should be entered and this will generate a portion size 16 The dish should be analysed per portion 17 The recipe should then be published so it can be used within the menu. The Board Administrator can tick Publish anyway if not all the allergen information is entered 18 A datasheet must be created or updated with the nutritional information per portion and picture which is then uploaded to the Tayside Nutrition website: sidenutrition/nutrition-incare/hospital/cateringinformation/nutritional-analysis-ofhospital-meals-(1).aspx To ensure cooking losses are accurately accounted for in the nutritional analysis To ensure accurate nutritional analysis To ensure accurate nutritional analysis This will allow for coding of the dish for its suitability for therapeutic diets Only published recipes can be entered into menu plans. This also allows other Boards to use the recipe. This override is in place to allow recipes to be placed in menu plans. NHS Tayside are not using N4P to establish the allergen content of recipes as the data can be entered by any Board and governance processes need to be in place to ensure accurate entry. To provide the nutritional information per portion and a picture of the dish to assist staff and patients in menu choice. See N4P Help Menu for the Tutorials See N4P Help Menu for the Tutorials See N4P Help Menu for the Tutorials See N4P Help Menu for the Tutorials Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 16 of 42 Review Date: May 18

17 2.1.3 STANDARD OPERATING PROCEDURE - Menu planning Policy: Food, Fluid & Nutritional Care Policy Reference: Originator: Caroline McKenzie Operation Part Number/ Name Safety Tools/ Clothing Menu planning (excluding non NHS providers) This procedure details how to menu plan None Tools/ Equipment N4P prodplan+ Menu cards No Main Operating Steps Rationale Evidence/support 1 A Menu Review Group must consist of a senior member of catering staff a senior nurse doctor a senior member of the oral health team a senior dietitian other allied health professionals including a speech and language therapist patient representatives appropriate to population need 2 The Menu Review Group must undertake an assessment of the patient population dietary needs, this must include information on: age gender cultural, ethnic, social and religious diversity physical and/ mental health needs food preferences length of stay; and nutritional risk 3 Patients must be broadly categorised into the following groups: Nutritionally vulnerable individuals who have normal nutritional requirements but with poor appetite and/or unable to eat normal quantities at mealtimes; or who have increased nutritional needs A multi disciplinary group are best placed to represent the needs of the population To gather as much information as possible to understand the patient population To help understand the patient population being catered for and that they receive food appropriate to their needs HIS (2014) Food In Hospitals Food In Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 17 of 42 Review Date: May 18

18 Nutritionally well individuals who have normal nutritional requirements and normal appetite or those with a condition requiring a diet that follows healthier eating principles Special or personal dietary needs e.g. religious or ethnic dietary requirements Requirement for a therapeutic diet e.g. texture modified diet, allergy free diet Some groups of the population may need to be considered separately when menu planning: children people with swallowing difficulties people with dementia; and people receiving end of life care 4 Cost and resource constraints must be considered: total budget per patient per day/week method of production kitchen equipment and related budget existing staff levels and rosters staff skill level food storage facilities procurement and sustainability issues; and method of distribution 5 The NHS Tayside menu template must be used to aid the structure of the 3 week cycle ( Appendices 2a, 2b & 2c) and made up of a combination and balance of foods from the 5 food groups 6 The menu should be entered onto an excel spreadsheet which can be shared with the Menu Review Group and then subsequently into N4P when the menu has been agreed 7 The new menu function must be used to enter a new menu or an existing menu copied and pasted and renamed accordingly They may have specific nutritional requirements This will allow Catering Managers to keep within budgetary constraints To ensure patients receive a menu that meets the recommended menu structure This will allow for nutritional analysis to be undertaken as the menu is developed and any discrepancies corrected at an early stage Copying and pasting will save substantial time in entering a menu plan. Food In Hospitals See N4P Help Menu for the Tutorials Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 18 of 42 Review Date: May 18

19 8 Where the new menu function has been used the following information must be entered for each of the weeks to be entered: Menu name e.g. NHS Tayside Menu Week 1 Number of days must be set at 7 Meal occasions must be set as 7 Attendance must be set as 100 Start date choose the following Monday The finish date will automatically default Establishment choose the appropriate hospital or leave blank when the menu applies to several/all hospitals Choose the population group i.e. nutritionally well or vulnerable. This procedure should be followed for Week 1/2/3 9 The 7 eating occasions for each of the weeks must be entered as: On awakening Breakfast Mid morning Midday meal Mid afternoon Evening meal Bedtime 10 Foods and drinks must then be entered into the plan for each of the weeks. Only dishes with a code which follows the format of e.g. TAY mb001 must be used for: Soups Main Courses Vegetables Potatoes Hot and Cold Puddings Canned fruits Stewed fruits Porridge The following items should be inserted using the supplier codes as these reflect the actual product: Sandwiches Cake/fancy biscuits To ensure a consistent approach to entering menu plans into the Nutmeg Nutritional Analysis Programme This is as recommended by the menu structure To ensure accurate nutritional analysis See N4P Help Menu for the Tutorials Food In Hospitals See N4P Help Menu for the Tutorials Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 19 of 42 Review Date: May 18

20 Platters have been set up by Nutmeg or NHS Tayside and do not have a supplier code or TAY hint attached to them, which give an average nutritional analysis for: Cereal selection - choose the appropriate milk Bread Rolls Toast Drinks e.g. tea, coffee, milk and diluting juice - choose the appropriate selection and type of milk used. These have a TAY hint. Fruit juice - choose the appropriate selection. These have a TAY hint. Recipes from other NHS Scotland Health Boards MUST NOT be entered into menu plans developed for NHS Tayside 11 As food and drinks are entered into the menu plan, when prompted, standard portion sizes should be chosen and the number of servings left at When all the menu items have been entered it is then suggested that the number of servings are then entered 13 Examples of how to enter servings: If there are 4 main choices and the patient can choose 1 of these then the servings would be entered as 25 each i.e. ¼ = 25% If there are 3 vegetable choices and the patient can choose 2 then each serving would be entered as 66 i.e. 2 3 = 66% The drink platter should be entered as 100 as all patients are offered this 14 The dietitians with a remit for nutritional analysis must ensure that the menu: meets the food based standards and the nutrient based standards based on the population it has been designed for i.e. nutritionally vulnerable or well or both Experience has shown that it is best to do this at the end when all the recipes have been added, and there is less likelihood of errors This is based on nutritional analysis of the menu based on provision Any required changes to a menu based Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 20 of 42 Review Date: May 18

21 on nutritional analysis must be discussed at the appropriate planning group. Changes should be made and the menu reanalysed by the dietitian until it meets the standards. 15 When the menu has been agreed and nutritionally analysed the Menu Review Group should undertake a consultation with patients and staff. 16 When the consultation has taken place and any amendments made the menu should be checked again for nutritional adequacy by the dietitians as described above. 17 When the Menu Review Group has agreed the amendments and the menu has been signed off as meeting the nutritional needs of the population it must be entered into prodplan+ 18 The menu must then be displayed as a menu card for either bulk ordering or a plated service 19 The menu card must contain the following information: Name of the hospital Week number Day For plated service the name of the patient Meal Occasions i.e. Breakfast, Lunch and Evening Meal The dishes and snacks available Space to tick the choice required Coding for the following therapeutic diets HE (healthier eating)/ HC (higher calorie) and V (vegetarian) Portion size small/standard and large (excluding bulk service) To ensure the menu meets the nutritional needs of the population Patient centeredness To ensure the menu meets the nutritional needs of the population To allow all Catering Departments within NHS Tayside view the menu and allow for planning and production to commence Staff and patients are able to view the menu To ensure the correct meal arrives with the correct patient. The correct menu is used on a given day. Patients are presented with a range of choices. Patients can clearly identify the dishes that are appropriate for their dietary needs Patients can choose an appropriate portion size based on their needs HIS (2014) Food In Hospitals HIS (2014) Food In Hospitals For a bulk service nursing staff can provide a portion size that is Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 21 of 42 Review Date: May 18

22 20 An Ethnic menu should be developed, reviewed and nutritionally analysed by the dietitians with a remit for nutritional analysis that meets the needs of the Ethnic population i.e. Halal menu and vegetarian menu, using the principles described above 21 If hospitals identify particular therapeutic dietary needs then menus must be developed, reviewed and nutritionally analysed using the principles described above. This should be developed from the NHS Tayside main menu template, involve the hospitals it concerns and be led by the Menu Review Group. The group must contain experts in the field e.g. development of a renal menu must have input from renal dietitians. appropriate to the patients needs To ensure patients with ethnic dietary requirements have their needs met To ensure patients with therapeutic dietary requirements have their needs met HIS (2014) Food In Hospitals HIS (2014) Food In Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 22 of 42 Review Date: May 18

23 2.1.4 STANDARD OPERATING PROCEDURE - Ordering and receiving patient meals by ward staff Policy: Food, Fluid & Nutritional Care Policy Reference: Originator: Caroline McKenzie Operation Part Number/ Name Ordering and receiving patient meals by ward staff (excluding non NHS providers) This procedure details ordering and receiving patient meals by ward staff Safety Tools/ Universal precautions Clothing Tools/ Menus Equipment No Main Operating Steps Rationale Evidence/support 1 The Catering Department will provide the wards with the menus no more than 2 meals in advance 2 All patients must be offered a menu and allowed to make their own menu choice. The patient s carer, relative or friend may assist with this. 3 There may be times when patients are unable to make independent menu choices due to a cognitive impairment. Nursing staff may order on behalf of the patient taking into account their likes and dislikes (see Getting to Know Me document or All About me document for Adults with a Learning Disability if applicable) and any need for a special or therapeutic diet. 4 If patients have communication difficulties or English is not their first language, or they cannot understand English then the ward staff should consider use of pictures (see sidenutrition/nutrition-incare/hospital/cateringinformation/nutritional-analysis-ofhospital-meals-(1).aspx for a datasheet containing a picture of the dish and the nutritional analysis per portion). Consideration should be given to the Halal menu for patients who require an ethnic/cultural diet. Patients choose their meals as close to the mealtime as possible To ensure patients receive food they enjoy and are more likely to eat, reducing their risk of malnutrition To ensure patients receive food they enjoy and are more likely to eat, reducing their risk of malnutrition To ensure patients receive food they enjoy and are more likely to eat, reducing their risk of malnutrition HIS (2014) Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 23 of 42 Review Date: May 18

24 5 Individual patient menus Ward staff when completing individual patient menus must include: The patients name on the individual menus The ward name/number and hospital Ward staff must not use false names or make up inappropriate names that will cause offence to other staff or patients. Menu items must be chosen by placing a tick in the relevant section. Ward staff must only write in the spaces provided 6 Bulk patient menus Ward staff must offer the patient an individual menu and their name placed at the top of the menu. To ensure that patients receive food they enjoy and have ordered There have cases where offensive names have been used causing distress to Catering Staff To ensure that patients receive food they enjoy and have ordered To ensure that patients receive food they enjoy and have ordered The individual menus are then collated onto 1 bulk menu, which must contain the ward name/ number and hospital. If the bulk menu has been completed by an unregistered nurse then it must be checked and signed by a registered nurse. All bulk menus prior to returning to the Catering Department must be signed by a registered nurse. All bulk menus must be photocopied before being returned to the Catering Department. The ward staff will retain a copy for their own records, and return the collated menu to the Catering Department by the agreed time. 7 Ward staff must ensure that the number of meals ordered does not exceed the number of patient beds. Consideration must also be given to the following to ensure that meals are not over or under ordered: Patients who are to be discharged and therefore will not require a meal Patients on pass New admissions to the ward To ensure that the completed menu is correct and the numbers of meals signed for does not exceed the number of beds on the ward. To prevent over ordering of food which will result in unnecessary food wastage and financial expense to NHS Tayside To prevent under ordering of food which will result in Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 24 of 42 Review Date: May 18

25 Patients nil by mouth either due to swallowing difficulties, who are fasting for procedures or on the advice of medical staff Is there an infective outbreak on the ward impacting on the amount of food patients may eat? The appetites of the patients e.g. would the patient be more likely to eat 2 out of 3 courses? If the ward has 20 patients maybe all eating ½ portions then nursing staff may only wish to order 10 portions of a particular course/dish Any therapeutic diets required should be ordered on the appropriate therapeutic menu or at the bottom of the bulk menu. The number of therapeutic menus plus the other menus should add up to the number of patients who require a meal. If patients are unable to order their meals then nursing staff should give consideration as to the popular items when ordering meals e.g. fish and chips/stovies and the unpopular items such as curries/ pasta. This will depend on the client group and individuals on the ward at the time. If the patients require porridge or not and if they would rather have cereal and bread/toast 6 The individual patient menus must be returned to the Catering Department before 10 am the following day. 7 If the ward has any admissions or discharges which will affect the number of meals provided to the ward then the ward staff should contact the kitchen (Appendix 3) with the amended numbers no later than: 10.00hrs for lunch 14.00hrs for supper patients not receiving a meal from the Catering Department. Porridge wastage and what has been returned to the Catering Department has been reported as high in some areas To allow the Catering Department to calculate the number of each dish required to avoid wastage and ensure patients receive what they would like to eat To reduce food wastage and ensure all patients receive a meal Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 25 of 42 Review Date: May 18

26 For Perth Royal Infirmary - a Menu Cancellation Slip should be placed in the Menu Post Box located outside the Catering Managers Office or taken to the Catering Office. 8 When the ward receives their meals they must check: The number of meals provided corresponds with the number of meals ordered All the items ordered have arrived To ensure patients receive the food they have ordered and like, to promote nutritional intake Staff should contact the Catering Department (Appendix 4) with any queries and have to hand the collated menu or the particular individual menu card The kitchen will make every effort to correct the error and deliver the item(s) if the error is on their part Nursing staff will be asked to collect the items from the Catering Department themselves if the error was made at ward level 9 Ward staff must take all food items and oral nutritional supplements off the trolley before it is returned to the Catering Department 10 The Protocol for the Handling of Complaints Relating to Catering Services in NHS Tayside should be followed if a patient or staff member has a specific complaint about the food. This should be completed at the time of the meal. To reduce wastage returned to the kitchen and ensure patients receive what they require Those complaints are dealt with in a timely manner and to ensure that the Catering Department act on complaints NHS Tayside (2008), Protocol for the Handling of Complaints Relating to Catering Services in NHS Tayside Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 26 of 42 Review Date: May 18

27 2.1.5 STANDARD OPERATING PROCEDURE - Production of patient meals by the Catering Department Policy: Food, Fluid & Nutritional Care Policy Reference: Originator: Caroline McKenzie Operation Part Number/ Name Safety Tools/ Clothing Tools/ Equipment Production of patient meals by the Catering Department (excluding non NHS providers) This procedure details the processes involved in the production of patients meals National uniform for chefs/ catering assistants/ catering production assistants, white coats and hats/hairnets for managers, visitors and contractors. Sensible footwear (no open toes/heels with reasonable slip protection) must be worn by all persons entering production/service areas. Menus prodplan+ No Main Operating Steps Rationale Evidence/support 1 The Catering Staff will check all the wards have returned their menus. Any wards who have not returned their menus will be contacted by the Catering Department. If the ward still does not return their menu then the dishes sent will be based on what has been previously ordered by that ward on that particular day i.e. historical data. 2 The Catering Department will produce a production plan 3 The meals will be produced using standard recipes from prodplan+ which have been nutritionally analysed by a registered dietitian 4 The food will be either: plated using a belt system or put into appropriate containers for bulk service and portioning at ward level 5 The Catering Department must either: check all the meals are contained within the trolley for a plated system or count that the correct number of tins are contained within the trolley for a bulk service 6 The Catering Department will agree with wards the times they can expect their meals to be delivered To ensure patients receive the meal they ordered To allow them to plan the meals required, ensure adequate staffing and reduce wastage To ensure patients receive meals that are nutritionally balanced and meet their needs To ensure the wards receive all that they have ordered and an opportunity to correct any mistakes To fit in with Protected Mealtimes Food In Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 27 of 42 Review Date: May 18

28 7 The meals will be delivered to the wards by the General Porters or the Kitchen Porter as per the delivery schedule 8 The Catering Department will advise of planned monthly visits to the wards to complete the QA1 to ensure quality and temperature of the food on arrival at the ward To ensure food arrives safely, without spillage and is in good condition To ensure the food arrives at the correct temperature and is of high quality NHS Tayside (2008) Procedures Document for the maintenance of high standards of Food Hygiene and Pest Control Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 28 of 42 Review Date: May 18

29 2.1.6 STANDARD OPERATING PROCEDURE - Ordering missed meals Policy: Food, Fluid & Nutritional Care Policy Reference: Originator: Caroline McKenzie Operation Part Number/ Name Safety Tools/ Clothing Tools/ Equipment Procedure for ordering missed meals (excluding non NHS providers) This procedure details what to do if a patient misses a meal or is likely to miss a meal due to transfer to another hospital None Clean trolley to transport tray/s to and from Catering Department to ward No Main Operating Steps Rationale Evidence/support 1 If the patient misses breakfast, then bread and a variety of spreads and preserves held routinely at ward level can be offered or cereals if available. 2 If lunch or evening meal are missed: Contact the Head Chef (Appendix 4) If the Catering Department is open then the Head Chef will arrange for a replacement meal to be sent to the ward. For areas where the Catering Department is not within the hospital, this may require a meal from the staff canteen, delivered by a porter or taxi. If the Catering Department is closed the ward staff should refer to the Out of Hours Provision of Food (Appendix 3) and prepare a snack for the patient 3 If a patient misses a texture modified meal then: Contact the Head Chef (Appendix 4) If the Catering Department is open then the Head Chef will arrange for a replacement meal to be sent to the ward If the Catering Department has closed the ward staff can provide one of the following options: Texture B/C (and D/E if absolutely necessary) Neutral Complan Shake thickened to the correct texture with Nutilis, if required To ensure adequate nutritional intake To ensure adequate nutritional intake To ensure adequate nutritional intake These foods are of smooth consistency and HIS (2014) HIS (2014) Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 29 of 42 Review Date: May 18

30 Or Forticreme Or A custard pot which can be added to Forticreme if required, to make the desired texture 4 For patients who are transferring to another hospital over mealtimes then it may be appropriate to request a packed lunch from the Catering Department Ideally this must be requested the day before and will be delivered to the ward Alternatively ring the ward where the patient is being transferred to and ask them to order a meal. Cancel the meal due to arrive on the transferring ward. can be thickened as required To ensure adequate nutritional intake HIS (2014) Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 30 of 42 Review Date: May 18

31 2.1.7 STANDARD OPERATING PROCEDURE - Out of hours provision of meals Policy: Food, Fluid & Nutritional Care Policy Reference: Originator: Caroline McKenzie Operation Part Number/ Name Safety Tools/ Clothing Tools/ Equipment Procedure for out of hours provision of meals (excluding non NHS providers) This procedure details how to access and prepare a nourishing snack for a patient who misses a meal Sensible footwear (no open toes/heels with reasonable slip protection) must be worn by all persons entering production/service areas Out of hours provision of food (Appendix 3) No Main Operating Steps Rationale Evidence/support 1 The Out of Hours Provision is for patients who have been admitted when the catering department has closed and are in need of a nourishing snack 2 There are 6 options within the Out of Hours Provision and any of these can be used depending on the availability of items at ward level and patient preference 3 Wards should source these items from ward provisions. In addition, items which have arrived on the patient meal trolley can be held back if they clearly date marked, have been unused and must be stored in the refrigerator or cupboard as appropriate. All other items should be returned to the Catering Department for disposal. Hot food should not be kept back or reheated at ward level 4 The out of hours provision must provide a minimum of 300kcal and 18g protein, assuming patients have only missed one meal 5 Nursing staff must ensure they have a system in place to record and manage consecutive missed meals To ensure patients do not go hungry and have access to a nourishing meal replacement To give adequate choice to ensure patients likes and dislikes are considered To ensure a consistent supply should a patient require it To ensure that no out of date food is held at ward level To ensure patients are provided with a nourishing meal meal replacement To ensure patients do not miss consecutive meals Food In Hospitals NHS Tayside Food, Fluid and Nutritional Care Policy - Food Safety and Food Hygiene Procedures for Wards Food In Hospitals Food In Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 31 of 42 Review Date: May 18

32 2.1.8 STANDARD OPERATING PROCEDURE - Ordering and Provision of Snacks at Ward Level Policy: Food, Fluid & Nutritional Care Operation Policy Reference: Originator: Kerry Queen/Fiona Kimmet/ Caroline McKenzie/ David Bayne/ Bruce Shepherd Procedure for the ordering and provision of snacks at ward level Part Number/ Name This procedure details the ordering systems and provision of snacks at ward level Safety Tools/ Clothing Universal Precautions Blue Aprons Tools/ Equipment Tupperware containers (non catalogue item rectangular tub EE289) Tongs (PECOS Black polycarbonate tongs D8485) Biscuits Appendix 5 Nutritional Content of Biscuits and Order Codes No Main Operating Steps Rationale Evidence/support 1 The Catering Department will supply two Tupperware containers to each ward for biscuits to be stored in. Only one type of biscuit should be stored in each container and the label retained. 2 Ward staff can order additional Tupperware containers and tongs by contacting the Catering Department and providing a financial code to charge the items to. 3 Ward staff will offer patients biscuits/snacks to nutritionally vulnerable patients on two occasions either at mid-morning, mid-afternoon or at suppertime along with a hot/cold drink to the value of 300kcal over the day (Appendix 5). Good practice is to offer a third snack for nutritionally vulnerable patients. 4 Ward staff will offer patients who are nutritionally well e.g. are eating well, or are overweight/obese/ have diabetes the fruit options for a snack To prevent cross contamination reallergen contents and adherence to infection control Wards will not be able to order Tupperware containers and tongs as these items are non-catalogue. To prevent cross contamination reallergen contents and adherence to infection control To ensure energy and nutrient requirements are met A variety of snacks must be provided a minimum of twice a day To prevent weight increase in patients who are nutritionally well NMC Code (2015) Food in Hospitals Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 32 of 42 Review Date: May 18

33 or the biscuits that are lower in kilocalories (Appendix 5) 5 All patients must be offered a bedtime snack if evening meal and breakfast are more than 14 hours apart 6 Patients on a therapeutic diet will continue to order their snacks via the appropriate daily menu 7 Ordering of snacks will be either by: ward staff ordering biscuits via the PECOS System using the order codes as described in Appendix 5 (Ninewells Hospital, Perth Royal Infirmary, Dundee Hospitals, Whitehills Health and Community Care Centre and Arbroath Infirmary) a top up system whereby the stock levels are agreed between the Catering Department and the ward staff and are topped up once per week by the Catering Department (Perth Community Hospitals and Stracathro Hospital) a top up system whereby stock levels are agreed between the Catering Department and the ward. Ward staff will order the required biscuits when they order provisions (Montrose Royal Infirmary) 8 Ward staff must use different tongs when distributing each variety of biscuits to patients 9 Ward staff must ensure that the lids on the Tupperware containers are securely replaced when finished 10 Ward staff must retain the label from the biscuits should a patient enquire about the allergen content of the biscuit. Allergens are highlighted on the ingredients list on the label in bold. To ensure patients are not hungry and achieve adequate nutritional intake The snacks offered at ward level may not be suitable for certain therapeutic diets The snack items are items that have been agreed nationally and offer best value Minimise wastage To prevent crosscontamination of allergens between biscuits To prevent biscuits from becoming soft Nursing staff have a responsibility to provide information on the allergen content of food provided at ward level to ensure compliance with the EU FIC (2014) HIS (2014) Food in Hospitals See Tayside Nutrition website EU Food Information for Consumers Regulation (EU FIC) Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 33 of 42 Review Date: May 18

34 11 Ward Assistants will escalate to registered nursing staff, if any patients require allergen information 12 Any patients who require a therapeutic diet e.g. gluten free or texture modification will receive their snacks from the appropriate menu 13 Ward staff should contact the Catering Department regarding any patients who have an allergy/ intolerance towards an ingredient within the biscuits so a suitable alternative snack can be offered and that an appropriate menu is offered 14 If patients are on a food record chart, ward staff will record accurate intake of snack To allow the nursing staff to provide this information to patients To ensure the snack is appropriate for the patients therapeutic dietary needs To ensure that patients with an allergy/intolerance to an ingredient within the biscuits receive an appropriate snack/ menu to enable their dietary needs to be met To adhere with record keeping NHS Tayside Policy for Records and Record Keeping for Nursing and Midwifery Staff NMC Code (2015) Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 34 of 42 Review Date: May 18

35 APPENDIX 1: NHS Tayside Caterers Standard Recipe Evaluation Form Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 35 of 42 Review Date: May 18

36 APPENDIX 2a: NHS Tayside Menu Template - Breakfast BREAKFAST Fruit Juice/Fruit Porridge Cereal Selection cornflakes/wheat biscuits/rice crispies Wholemeal Roll White Roll Butter Portion Sunflower spread Jam or Marmalade DIET CODE HC HE HC Higher Calorie HE Healthy Eating Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 36 of 42 Review Date: May 18

37 APPENDIX 2b: NHS Tayside Menu Template - Lunch LUNCH Soup Sandwich on white bread Sandwich on wholemeal bread Sandwich on white bread - vegetarian Sandwich on wholemeal bread - vegetarian Hot Dish ¹ Cold Dish ¹ Potatoes or equivalent ² Vegetable Hot Pudding Milk Pudding/Yoghurt Tinned or Fresh Fruit Cake (snack) Fruit (snack) DIET CODE V V HC/HE HC/HE HC HC/HE HE HC HE HC Higher Calorie HE Healthy Eating ¹ When planning the hot and cold dish one must be vegetarian. One of the dishes must be suitable for higher calorie diets and the other suitable for healthier eating diets. ² Potatoes/rice may not be required depending on the choice of the hot and cold dish as this may already be contained within the dish. Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 37 of 42 Review Date: May 18

38 APPENDIX 2c: NHS Tayside Menu Template - Evening Meal EVENING MEAL Soup Main Course 1 ¹ Main Course 2 ¹ Main Course 3 ¹ Potatoes or equivalent Potatoes or equivalent Vegetables/Salad Vegetables/Salad Cold Pudding Yoghurt Crackers and Cheese Cake (snack) Fruit (snack) DIET CODE HC HE HC HE HC HE HC Higher Calorie HE Healthy Eating ¹ One of the main course options must be vegetarian. Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 38 of 42 Review Date: May 18

39 APPENDIX 3: Out of Hours Provision of Food OUT OF HOURS PROVISION It is a requirement that patients admitted to hospital when the kitchen is closed have access to nourishing food. A range of options are listed below which have been nutritionally analysed to ensure they meet the necessary criteria. The ideas have been developed from foods that should be available at ward level that nursing staff can easily make for the patient. This provision can either be obtained from the Catering Department, ward provisions or surplus snacks from the trolley. It is important to note this service should only be used when the hospital kitchen is closed. It must provide a minimum of 300kcal and 18g protein OPTION 1 OPTION 2 Banana Sandwich Cheese Sandwich (2 slices bread, butter/margarine and (2 slices bread, butter/margarine and 1 banana) 40g cheese) Glass of milk Glass of milk Pot of yoghurt 504kcal, 22g protein 563kcal, 18g protein OPTION 3 OPTION 4 Jam or Marmalade Sandwich Weetabix x 2 (2 slices bread, butter/margarine and 220ml Milk jam/marmalade) Pot of yoghurt Glass of milk 403kcal, 18g protein Pot of yoghurt 486kcal, 18g protein OPTION 5 20g Cheddar Cheese and 2 Crackers or 2 Digestives or 2 Oatcakes Glass of milk Pot of yoghurt 561kcal, 20g protein A glass of milk is 220ml of full fat milk Full fat or low fat yoghurt can be offered Copyright Tayside Nutrition Managed Clinical Network, NHS Tayside. This publication can be used or reproduced including photocopying, for non-commercial purposes. We request that the source and Copyright owners be acknowledged and that the material is not substantially altered in any way. Applications for use outwith these terms should be forwarded in writing to the Tayside Nutrition MCN Manager (Food, Fluid and Nutritional Care), Directorate of Public Health, NHS Tayside, Kings Cross, Clepington Road, Dundee, DD3 8EA. Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition Page 39 of 42 Review Date: May 18