menu planning 2

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Carmel Lazarus February 2008Carmel Lazarus February 2008

Menu Planning & AssessmentMenu Planning & Assessment


Keys to Menu Planning & AssessmentKeys to Menu Planning & Assessment

Know your Client preferences & demographicsKnow your Client preferences & demographicsHave Menu Objectives to measure the menu againstHave Menu Objectives to measure the menu againstFamiliarise yourself with the relevant tools & policiesFamiliarise yourself with the relevant tools & policiesUnderstand your budget/food serviceUnderstand your budget/food servicesystem/equipment and storage facilitiessystem/equipment and storage facilitiesEngage staff, involve in processEngage staff, involve in processRecognise the staff skills and staffing levelsRecognise the staff skills and staffing levelsIs your Menu Design relevant & appropriateIs your Menu Design relevant & appropriateUnderstand Menu combinationsUnderstand Menu combinations -- texture / taste / texture / taste / nutrition / presentation / varietynutrition / presentation / variety


STEP 1:STEP 1:RESEARCH YOURRESEARCH YOUR

CLIENT GROUPCLIENT GROUP

Demographic dataDemographic dataSatisfaction Survey resultsSatisfaction Survey resultsNutrition statusNutrition statusDiagnosesDiagnoses


Meeting ExpectationsMeeting ExpectationsPrivate HospitalPrivate Hospital --Pts expect a better food servicePts expect a better food servicethan in a restaurantthan in a restaurantAspects of Client SatisfactionAspects of Client Satisfaction Food quality, appearanceFood quality, appearance Food temperatureFood temperature FlavourFlavour Attitude of staff delivering food & menuAttitude of staff delivering food & menu

Attentive, courteousAttentive, courteous

Timeliness & reliability of serviceTimeliness & reliability of service Menu Flexibility or CustomisationMenu Flexibility or Customisation

Variation of portionsVariation of portions

Choice of foodsChoice of foodsAbility to self selectAbility to self select


MALNUTRITION IN AUSTRALIANMALNUTRITION IN AUSTRALIANHOSPITALSHOSPITALS

Lazarus et al 2005Lazarus et al 2005 Nutr Nutr & Diet & Diet

Found 37% patients were severely or mild toFound 37% patients were severely or mild tomoderately malnourished using Subjectivemoderately malnourished using SubjectiveGlobal AssessmentGlobal Assessment

Middleton et al 2001Middleton et al 2001 Intern Med J Intern Med J

Found 35% pts were severely or mild toFound 35% pts were severely or mild tomoderately malnourished using SGAmoderately malnourished using SGA


Hospital Comparisons

% PTS MALNOURISHED

20

40

60

80

100

61%

16.7%

42.3%37%

18.8%

35%

R N S H, N S

W W E S

L E Y

P R I VA T E,

Q L D S V P H

, N S W S T G

E O R G E,

N S W P R I N

C E S S

A L E XA N D

RA, Q L D

S T V I N C E

N T S,

N S W


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Common BarriersCommon BarriersLack of clearly defined responsibilities inLack of clearly defined responsibilities inplanning/management of nutritional careplanning/management of nutritional care

Nutrition screening 40% of responses (POWH)Nutrition screening 40% of responses (POWH)Lack of sufficient education among all staffLack of sufficient education among all staffgroupsgroupsLack of influence of the ptsLack of influence of the ptsLack of cooperation amongst staff groupsLack of cooperation amongst staff groupsLack of involvement of hospital managementLack of involvement of hospital management


FOOD IS MEDICINEFOOD IS MEDICINE

HENCE LET YOURHENCE LET YOUR

MEDICINE BE YOUR FOODMEDICINE BE YOUR FOOD

Hippocrates 400BC Hippocrates 400BC


Barriers to adequate nutrient intakeBarriers to adequate nutrient intake

Poor choice and availabilityPoor choice and availability Poor menu planning, lack of varietyPoor menu planning, lack of variety Poor cooking methods, nutrient lossesPoor cooking methods, nutrient losses

Poor accessPoor access High acuityHigh acuity Packaging and presentationPackaging and presentation StaffingStaffing VarietyVariety


International ProgramsInternational Programs

Better HospitalBetter HospitalFood Programme:Food Programme:

Initiative 1Initiative 1 -- ProtectedProtectedMealtimesMealtimes

Periods on a hospitalPeriods on a hospitalward when all nonward when all non --urgenturgentclinical activity stops.clinical activity stops.During these times,During these times,patients are able to eatpatients are able to eatwithout being interruptedwithout being interruptedand staff can offerand staff can offerassistance.assistance.


Benefits of Good NutritionBenefits of Good Nutrition

Reduced infection risk, pressure areas,Reduced infection risk, pressure areas,falls, mortality ratesfalls, mortality rates

Improves immune function, stamina,Improves immune function, stamina,quality of life, potential drug and nutrientquality of life, potential drug and nutrientinteraction, independenceinteraction, independence


STEP 2:STEP 2:

SELECT RELEVANTSELECT RELEVANTMENU OBJECTIVESMENU OBJECTIVES


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Menu Planning ObjectivesMenu Planning ObjectivesMeet customers needs, go beyond expectationsMeet customers needs, go beyond expectations

Meet the budget limitationsMeet the budget limitationsMeet nutritional goals,Meet nutritional goals, see relevant standards see relevant standards

Provide predictability with purchasing, production andProvide predictability with purchasing, production anddistributiondistribution

Provides criteria/standard to meetProvides criteria/standard to meet

May alter with each menu review projectMay alter with each menu review project


Examples of Menu PlanningExamples of Menu PlanningObjectivesObjectives

Improve on client satisfaction scoresImprove on client satisfaction scoresIncrease nutrient density of texture modified mealsIncrease nutrient density of texture modified mealsReduce food service costsReduce food service costsMeet 50% of the RDI for Long Day Care CentresMeet 50% of the RDI for Long Day Care CentresImprove nutrient density of MOW soups and mainImprove nutrient density of MOW soups and mainmeals. Aim for standard of >20g protein/mainmeals. Aim for standard of >20g protein/mainmeal, >5g protein/dessertmeal, >5g protein/dessertSatisfy food preferences of the residentsSatisfy food preferences of the residents


STEP 3:STEP 3:WHAT TOOLS,WHAT TOOLS,

STANDARDS ANDSTANDARDS ANDPOLICIES EXIST ?POLICIES EXIST ?


Menu Planning StandardsMenu Planning Standards

Nutritional Standards for Hospital MenuNutritional Standards for Hospital MenuDevelopment, DRAFT V7, November 2006Development, DRAFT V7, November 2006Department of Human Services (Victoria)Department of Human Services (Victoria)Nutrition Standards, November 2005Nutrition Standards, November 2005Food Service Guidelines for healthcare.Food Service Guidelines for healthcare.NSW Institute of Hospital Catering Ltd, 1997NSW Institute of Hospital Catering Ltd, 1997Hospital Menu Assessment Tool, NSWHospital Menu Assessment Tool, NSWHealth, 1999Health, 1999

Nutrient Reference Values, NHMRC, 2005Nutrient Reference Values, NHMRC, 2005


Menu Planning StandardsMenu Planning Standards

Dietary Guidelines for Australian Adults,Dietary Guidelines for Australian Adults,NHMRC, 2003NHMRC, 2003Dietary Guidelines for Children andDietary Guidelines for Children andAdolescents, NHMRC, 2003Adolescents, NHMRC, 2003Nutrition Policy for Children in Hospital,Nutrition Policy for Children in Hospital,The Childrens Hospital WestmeadThe Childrens Hospital WestmeadWentworth AHS Food and Nutrition Policy,Wentworth AHS Food and Nutrition Policy,Wentworth Area Health Service, 1998Wentworth Area Health Service, 1998


NSW Health Hospital Menu Assessment ToolNSW Health Hospital Menu Assessment Tool


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Menu Planning StandardsMenu Planning StandardsHospital Menu Assessment Tool, NSW Health 1999Hospital Menu Assessment Tool, NSW Health 1999

Assesses nutritional quality of hospital menus (full dietAssesses nutritional quality of hospital menus (full dietmenu) and menus for hospital cafeterias, food courtsmenu) and menus for hospital cafeterias, food courtsand bistros.and bistros.

Advantages:Advantages:Self assessment tool for food service managers/ Self assessment tool for food service managers/ dietitiansdietitians

Highlight areas for improvement in nutrition quality of the menuHighlight areas for improvement in nutrition quality of the menu

Setting a quantitative benchmark, comparisons over timeSetting a quantitative benchmark, comparisons over time

Compare with other hospitalsCompare with other hospitals

Nutrition indicator used with others eg. Budget, pt satisfactionNutrition indicator used with others eg. Budget, pt satisfactionCarmel Lazarus February 2008Carmel Lazarus February 2008

Dunn and Williams AJND (1995) Dunn and Williams AJND (1995)

Availability of breadAvailability of breadAvailability of high fibre breads and breakfast cerealsAvailability of high fibre breads and breakfast cerealsAvailability of fresh fruitsAvailability of fresh fruitsUse of legumesUse of legumes

Cereals, vegetablesCereals, vegetablesand fruitsand fruits

FatFat

VarietyVariety

Nutritional FactorNutritional Factor

Type of fat spreads offeredType of fat spreads offeredPercentage of high fat main menu itemsPercentage of high fat main menu itemsLow fat food choices indicated on menuLow fat food choices indicated on menuAvailability of low fat dairy productsAvailability of low fat dairy products

Menu Cycle and Frequency of revisionMenu Cycle and Frequency of revisionSeasonal variation in menusSeasonal variation in menusNumber of hot meal choices at three main mealsNumber of hot meal choices at three main mealsUse of continental breakfasts and protein alternativesUse of continental breakfasts and protein alternativesNutrition education messages on menusNutrition education messages on menusMeal serving size optionsMeal serving size options

Menu Characteristics and Specific CriteriaMenu Characteristics and Specific Criteriaassessedassessed


Dunn and Williams AJND (1995) Dunn and Williams AJND (1995)

Menu Characteristics andMenu Characteristics andSpecific Criteria assessedSpecific Criteria assessed

Nutritional FactorNutritional Factor

Percentage of goodPercentage of good haemhaem iron mainiron mainmenu choicesmenu choicesAvailability of vitamin C sources atAvailability of vitamin C sources atmealsmeals

IronIron

Average number of serves of calcium atAverage number of serves of calcium ateach mealeach mealAvailability of dairy productsAvailability of dairy products

CalciumCalcium

Percentage of highly salted main menuPercentage of highly salted main menuitemsitemsOptional salt selection on the menuOptional salt selection on the menuOptional addition of sauces and graviesOptional addition of sauces and gravies

SaltSalt

Whether it is offered and what t ypeWhether it is offered and what t ypeAlcoholAlcohol


Food Service Guidelines for Healthcare (1997)Food Service Guidelines for Healthcare (1997)

Wholemeal bread andWholemeal bread andwholegrain cerealswholegrain cerealsshould be offeredshould be offered

1 slice bread1 slice bread180g hot cereal180g hot cereal30g cold cereal30g cold cereal70g rice/pasta70g rice/pasta(cooked)(cooked)

44Breads &Breads &cerealscereals

Should include 1 rich bShould include 1 rich b --carotene sourcecarotene source -- DarkDarkgreen/orange/yellowgreen/orange/yellowvegesveges

90g90g60g60g60g60g

111122

Starchy vegStarchy vegDark greenDark greenleafyleafyOtherOther

One piece of fruit/dayOne piece of fruit/day1 rich1 rich vitvit c source/dayc source/day

11120g can120g canfruit/100ml juicefruit/100ml juice

1111

FruitFruit -- FreshFreshFruitFruit -- otherother

CommentsCommentsMin. serving sizeMin. serving sizeMin. no. ofMin. no. ofserves/dayserves/day

FOOD GROUPFOOD GROUPMinimum daily provision on tray Minimum daily provision on tray


Food Service Guidelines for Healthcare (1997)Food Service Guidelines for Healthcare (1997)

Unsaturated margarineUnsaturated margarineavailable at each mealavailable at each meal

Fat spreadsFat spreads

1 milk based dessert1 milk based dessert2 milk drinks offered/day2 milk drinks offered/dayLF milk available atLF milk available at

each mealeach meal

1 serve = 200ml milk/40g1 serve = 200ml milk/40gcheese/200g yoghurtcheese/200g yoghurt

33Milk, cheese,Milk, cheese,yoghurtyoghurt

1 choice at each meal1 choice at each meal


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Production SystemsProduction SystemsThere are four main types of production systemsThere are four main types of production systems

CookCook --serve or Cookserve or Cook --freshfreshCookCook --chillchillCookCook --freezefreezeConvenienceConvenience

ALL have an impact on the menuALL have an impact on the menu

What are the advantages and disadvantages ofWhat are the advantages and disadvantages ofeach when considering menu planning?each when considering menu planning?


EQUIPMENTEQUIPMENT


PREPARATION AREASPREPARATION AREAS


STORAGE AREASSTORAGE AREAS


Know the Equipment and StorageKnow the Equipment and Storage

Limitations of space and equipmentLimitations of space and equipment

Understand what equipment you have to work withUnderstand what equipment you have to work withand when it is utilisedand when it is utilisedAdequate storage in fridge, freezer and dry storeAdequate storage in fridge, freezer and dry storeBalance complex dishes with pre packaged itemsBalance complex dishes with pre packaged itemsto improve workflowto improve workflow


What are the Staff Skills ?What are the Staff Skills ?

Jamie Oliver School dinnersJamie Oliver School dinners most usedmost usedcooking implement was a razorbladecooking implement was a razorblade

School CanteensSchool Canteens -- buyers guide compatible withbuyers guide compatible withtraffic light guide developed as an educationaltraffic light guide developed as an educationaltooltool


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STEP 5:STEP 5:BUILD THE MENUBUILD THE MENU

USING A TEMPLATEUSING A TEMPLATE


Sample of a menu templateSample of a menu template 7 day cycle7 day cycle

MEAT/ MEAT/ ALTERNATIVEALTERNATIVE

SOUP 2SOUP 2

JUICEJUICE

RiceRicePuddingPudding

DESSERTDESSERT

VEGETABLESVEGETABLES

SANDWICHSANDWICH

MAIN SALADMAIN SALAD

SteamSteamRiceRice

SpiralSpiralPastaPasta

POTATO/RICE/ POTATO/RICE/ PASTAPASTA

LasagneLasagneVEGETARIANVEGETARIANOPTIONOPTION

PorkPorkFishFishChickenChickenBeefBeefLambLambChickenChickenBeefBeefMEAT/ MEAT/ ALTERNATIVEALTERNATIVE

SOUP 1SOUP 1

SATSATFRIFRITHURTHURWEDWEDTUESTUESMONMONSUNSUNFOOD GROUPFOOD GROUP


STEP 6:STEP 6:RECIPE TESTINGRECIPE TESTING

AND MENUAND MENUEVALUATIONEVALUATION


Evaluation of MenuEvaluation of MenuPrior to implementation:Prior to implementation:

Meets nutrition standardsMeets nutrition standardsImpact of special diet menus onImpact of special diet menus onworkflowworkflowFoods in season and withinFoods in season and withinbudgetbudgetPresentationPresentationWorkflow compatible withWorkflow compatible withstaffing, equipment and storagestaffing, equipment and storageVariety/repetitionVariety/repetition


Menu BasicsMenu BasicsNutritional goals & standardsNutritional goals & standards menu assessment toolmenu assessment tool NRV & Dietary guidelinesNRV & Dietary guidelines Proportions of food choices (fat, salt)Proportions of food choices (fat, salt)

FundamentalsFundamentals

VarietyVariety CombinationsCombinations ColourColour TextureTexture ConsistencyConsistency TasteTaste Menu descriptionsMenu descriptions PopularityPopularity Know your customersKnow your customers



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Menu ControlsMenu ControlsStandardised recipesStandardised recipesPortion controlPortion controlIngredient SpecificationsIngredient SpecificationsProduction schedules revisedProduction schedules revisedStaff training on new menu andStaff training on new menu andworkflowworkflowRevision of work schedulesRevision of work schedulesDeveloping new purchasing plansDeveloping new purchasing plansBudgetBudget


Menu Evaluation postMenu Evaluation postimplementationimplementation

Patient Satisfaction SurveysPatient Satisfaction SurveysTaste TestTaste TestFeedback from FS & NutritionFeedback from FS & Nutritionsupport staffsupport staffMicrobiological testingMicrobiological testingPlate waste surveysPlate waste surveys Digital photographyDigital photography VisualVisual ScalesScales


Thickened Fluid Wastage SurveyThickened Fluid Wastage Survey

Provide 6 xProvide 6 x tetrapakstetrapaks per pt per dayper pt per day($8.40)($8.40)Wastage is measured over 7 daysWastage is measured over 7 days25% consumed25% consumedInterviewed ptsInterviewed ptsReasons for non consumptionReasons for non consumption 31% of pts dislike the flavour31% of pts dislike the flavour 15% need assistance15% need assistance 15% couldnt open the packaging15% couldnt open the packaging


Activity 1Activity 1

You are working as a new graduateYou are working as a new graduate DietitianDietitian in ain arehabilitation hospital. The menu has not beenrehabilitation hospital. The menu has not beenchanged for a number of years and patients do notchanged for a number of years and patients do notreceive a menu. Thereceive a menu. The DietitianDietitian visits pts daily to takevisits pts daily to taketheir food preferencestheir food preferences

The demographics of the pts have changed. The pts areThe demographics of the pts have changed. The pts areDischarged early from hospital, stay a minimum of 3Discharged early from hospital, stay a minimum of 3 --44weeks, are elderly, and at risk of poor nutritionweeks, are elderly, and at risk of poor nutrition

Where do you start?Where do you start?What information given is useful?What information given is useful?What could theWhat could the DietitianDietitian change?change?


Activity 2Activity 2A private hospital has asked you to review the menu as they haveA private hospital has asked you to review the menu as they have

had very negative feedback from recent patient satisfactionhad very negative feedback from recent patient satisfactionsurveyssurveys

The patients are short stay; 2The patients are short stay; 2 --3 days and the average age is 403 days and the average age is 40 --55 yrs55 yrs

The menu is currently selective and there are menu staff whoThe menu is currently selective and there are menu staff who

deliver and collect the menu.deliver and collect the menu.The menu has not been reviewed for more than 10 years, whenThe menu has not been reviewed for more than 10 years, when

the hospital was refurbished from an aged rehabilitation facilitthe hospital was refurbished from an aged rehabilitation facilit yyto a short stay, acute care facility. It i s the same menu withto a short stay, acute care facility. It is the same menu with alotalotof offal and wet dishes.of offal and wet dishes.Where do you start?Where do you start?What are your menu objectives?What are your menu objectives?What are the issues you need to consider when redesigning the meWhat are the issues you need to consider when redesigning the me nu?nu?How would you evaluate the success of the new menu?How would you evaluate the success of the new menu?


Activity 3Activity 3You have been asked to review the menu for aYou have been asked to review the menu for a

mental health unit for residents with age rangemental health unit for residents with age rangeof 4of 4 --94 yrs old.94 yrs old.

The current menu is nonThe current menu is non --selective. The kitchenselective. The kitchenstaff are unskilled and the menu consists mainlystaff are unskilled and the menu consists mainly

of pies/pasties and quiches.of pies/pasties and quiches.Nursing staff have reported weight gain amongNursing staff have reported weight gain amongsome residentssome residents

How would you assess the menu?How would you assess the menu?What changes would you make to the menu?What changes would you make to the menu?Who would you involve in the changes?Who would you involve in the changes?What are the main issues you need to considerWhat are the main issues you need to considerwhen making these menu changes?when making these menu changes?


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ReferencesReferencesInstitute of Hospital CateringInstitute of Hospital Catering NSW Branch. Food Service Guidelines for healthcare. IHC,NSW Branch. Food Service Guidelines for healthcare. IHC,Sydney 1997Sydney 1997KennewellKennewell S,S, KokkinakosKokkinakos M, Food Preferences of Inpatients in an Australian teachingM, Food Preferences of Inpatients in an Australian teachingHospitalHospital what has happened in the last 12 years? AJND 2001;58:1, 15what has happened in the last 12 years? AJND 2001;58:1, 15 --2222Stewart L,Stewart L, HunwickHunwick H, Nutrition in Foodservice. Hospitality Press, Melbourne 1988H, Nutrition in Foodservice. Hospitality Press, Melbourne 1988Hospital Menu Assessment Tool: manual version. NSW Department ofHospital Menu Assessment Tool: manual version. NSW Department of HealthHealthLazarus C andLazarus C and HamlynHamlyn J. Prevalence and documentation of malnutrition in hospitals: aJ. Prevalence and documentation of malnutrition in hospitals: a

case study in a large private hospital setting.case study in a large private hospital setting. NutrNutr Diet 2005; 62:41Diet 2005; 62:41 --77Middleton MH,Middleton MH, NazarenkoNazarenko G,G, NivisonNivison --Smith I,Smith I, SmerdelySmerdely P. Prevalence of Malnutrition andP. Prevalence of Malnutrition and12 month incidence of mortality in 2 teaching hospitals. Intern.12 month incidence of mortality in 2 teaching hospitals. Intern. Med J 2001;31: 455Med J 2001;31: 455 --6161Spears MC,Spears MC, GregoireGregoire MB. Food service organizations: a managerial and systemsMB. Food service organizations: a managerial and systemsapproach (4approach (4 thth ed). Prentice Hall: Upper Saddle River NJ. 2000ed). Prentice Hall: Upper Saddle River NJ. 2000Better Hospital Food WebsiteBetter Hospital Food Website -- www.betterhospitalfood.comwww.betterhospitalfood.comMcClelland A., Williams P., Trend to better nutrition on AustraMcClelland A., Williams P., Trend to better nutrition on Austra lian hospital menus 1986lian hospital menus 1986 --2001 and the impact of cook2001 and the impact of cook --chill food service systems. J Humchill food service systems. J Hum NutrNutr DietetDietet , 2003; 16, 245, 2003; 16, 245 --256256Williams P, Nutrition and patientsWilliams P, Nutrition and patients whose responsibility?whose responsibility? NutrNutr Diet, 2002 59:4, 229Diet, 2002 59:4, 229 --230230National Health and Medical Research Council, Dietary GuidelinesNational Health and Medical Research Council, Dietary Guidelines for Australian Adults,for Australian Adults,AGPS, 2003AGPS, 2003Dunn G, Williams P, The trend to better menus in New South WalesDunn G, Williams P, The trend to better menus in New South Wales :1986:1986 --1993. Aust J1993. Aust JNutrNutr Diet 1995;52:36Diet 1995;52:36 --4242NSW Department of Health. Hospital menu assessment tool: manualNSW Department of Health. Hospital menu assessment tool: manual version. State Healthversion. State HealthPublication no. (HP) 990199. Sydney: NSW Department of Health; 1Publication no. (HP) 990199. Sydney: NSW Department of Health; 1 999.999.Allison SP. Hospital Food as Treatment.Allison SP. Hospital Food as Treatment. ClinClin NutrNutr 2003;22: 1132003;22: 113 --114114

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