2019 Dietitians Of Canada Best Practices For Nutrition-Books Pdf

2019 Dietitians of Canada Best Practices for Nutrition
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BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES. Acknowledgements, The Ontario LTC Action Group provided their expertise and input to this revision of Best Practices The leadership of these. individuals is gratefully acknowledged for the 2019 revision. Dale Mayerson RD research Julie Urbshott RD, Karen Thompson RD editor Tara Pfab RD. Sharon Armstrong RD Stacey Scaman RD, Alicia Marshall RD Julie Cavaliere RD. Natalie Naor RD Carol Donovan RD, Monique Pigeon RD Leslie Whittington Carter RD. Thanks to Dr Heather Keller for review and guidance and to Jennifer Buccino for supporting the project. The leadership of these individuals is gratefully acknowledged for the 2013 revision. Christine Barker RD, Julie Cavaliere RD, Mary Fitzpatrick RD Past Chair of the LTCAG and lead on the 2007 version.
Margaret Leaver Power RD, Dale Mayerson RD, Marsha Rosen RD. Karen Thompson RD, Leslie Whittington Carter RD, DIETITIANS OF CANADA I PAGE ii. BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES. Table of Contents, ORGANIZATION AND ADMINISTRATION 2. MENU PLANNING 4, STANDARDIZED FOOD PRODUCTION 10, NUTRITION AND HYDRATION CARE 12. MEAL SERVICE AND PLEASURABLE DINING 34, CONTINUOUS QUALITY IMPROVEMENT CQI 42.
CONCLUSION 43, Comments Questions Concerns 43, Sample Forms and Policies 44. RESOURCES and SELECTED REFERENCES 58, DIETITIANS OF CANADA I PAGE iii. BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES. Acronyms used in this document, BMI Body Mass Index. CHO Carbohydrates, CQI Continuous Quality Improvement. CSNM Canadian Society of Nutrition Managers, DRI Dietary Reference Intakes.
EHR Electronic Health Record, GI Gastrointestinal, HACCP Hazard Analysis and Critical Control Points. LTC Long Term Care, MD Doctor of Medicine, NCP Nutrition Care Process. NM Nutrition Manager, OSNM Ontario Society of Nutrition Management. OT Occupational Therapist, PEN Practice Based Evidence in Nutrition. POA Power of Attorney, PES Problem Etiology and Signs and Symptoms.
PT Physiotherapist, QI RM Quality Improvement Risk Management. RAI MDS Resident Assessment Instrument Minimum Data Set. RD Registered Dietitian, RHA Resident Home Area, RN Registered Nurse. SDM Substitute Decision Maker, SLP Speech Language Pathologist. DIETITIANS OF CANADA I PAGE iv, Introduction, Best practices in the nutrition food service and dining program incorporate the home s vision and mission and. provide systems and processes to, Support promote and respect residents rights safety security comfort choice autonomy and decision.
Recognize that quality nutrition hydration and pleasurable dining enhance the quality of life and the. quality of care for residents in LTC, Embrace a holistic approach recognizing that food beverages and pleasurable dining influence residents. psychological and social well being as well as their physical well being. Take into account residents past history and how their history influences their food preferences and how we. address their nutritional needs, Recognize that the ability to feed oneself is a basic component of an individual s feeling of self worth and. autonomy and therefore incorporates a supportive and restorative dining component to maintain support. and or regain residents self feeding skills, Embrace both interprofessional collaboration and an interdisciplinary care team approach to support. residents health and well being, Ongoing consultation with the residents family substitute decision makers powers of attorney SDM POA and. members of the LTC home facility s interdisciplinary care team is required to ensure best practices continue to meet or. exceed residents needs and expectations and continue to reflect the home s philosophy of care. Best practices for the nutrition food service and dining program recognize that quality nutrition hydration and dining. is achieved by meeting the goals of these five components. Organization and Administration, Menu Planning, Food Production.
Nutrition and Hydration Care, Meal Service and Pleasurable Dining. BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES. ORGANIZATION AND ADMINISTRATION, Best practices ensure that the nutrition food service and dining program is organized and administered to effectively. and safely provide resident focused nutrition care and services that reflect the mission and philosophy of the home meet. current residents needs and expectations and are in keeping with professional practice standards of care applicable. governing ministry acts regulations and directives. Best practices require that protocols policies procedures and tools for administration and organization include as a. minimum processes for developing and implementing the following. Mission Goals and Objectives, A program or department mission vision philosophy statement reflecting the home s mission statement. Specific timely and measurable long term goals, Specific timely and measurable short term objectives. Human Resources, Effective allocation of resources and utilization review.
Staffing qualifications required to provide a quality program including. Registered dietitian RD member in good standing of the provincial regulatory body. Nutrition manager NM member in good standing of the Canadian Society of Nutrition Management and or. provincial alternative, Cooks qualified with appropriate trade papers. Food Nutrition department employees have completed or are enrolled in a recognized Certified Food Service. Worker Training program that is completed within 3 years of hire date. Adequate and consistent staffing pattern improves communication with and between residents and staff and. help to know residents and their wishes, Written job descriptions and job routines defining the overall roles functions and specific duties of each. position as well as timeframes for completion of duties. Staff Education, Frequency of training is determined by home priorities by audit and survey results and other feedback. All home staff receive orientation to food and nutrition services upon hire. Staff involved in meal and snack service receive education training on nutrition and hydration Topics may. Basic therapeutic diets, Food texture, Fluid consistency. Food safety, Customer service hospitality training.
Knowledge of dementia and responsive behaviours, Ability to recognize report and document signs and symptoms of dysphagia. DIETITIANS OF CANADA I PAGE 2, BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES. Eating assistance, Person relationship centered care. Promoting and improving the mealtime experience, All Food Nutrition Staff receive education training on topics such as. Food safety temperature control dining service nutrition related health concerns and other topics as. Proper preparation testing and storage of all levels of texture modified foods and thickened fluids to ensure. production of food and fluids consistent with developed texture expectations. Sanitation and Safety, Policies protocols for all staff involved in food handling dining service.
Housekeeping and sanitation programs to ensure the provision of safe food in a safe sanitary environment. Preventative Maintenance Program for all equipment used in meal preparation and service as well as. equipment required for clinical assessment and monitoring of residents nutrition and hydration care. Communication, Interdisciplinary and Interdepartmental Communication includes. Effective communication and documentation processes and tools that provide new information to. interdisciplinary care team members This may include recent memos minutes of recent team meetings. dining room concerns relating to production guidelines recipes quantities and other pertinent information. Accountability by all appropriate team members for reading the previous communications back to the last. shift they worked and for reporting documenting any incidents or concerns that occurred during their shift. Accountability for taking and documenting corrective actions as required and for following communications. as provided, Policies to ensure that privacy is maintained in all communication in adherence with federal and provincial. Development of interdisciplinary programs involving nutrition hydration and dining e g bowel management. and continence skin and wound care etc, Representation of the Nutrition and Food Service Department by the dietitian NM or delegate at resident care. conferences and interdisciplinary care team meetings including Medical Professional Advisory. Palliative End of Life Care Accreditation Wound Care Dysphagia Restorative Care Pharmacy and. Therapeutics QI RM Quality Improvement Risk Management Infection Control Occupational Health and. Safety and other meetings committees as appropriate. Protocols Policies Procedures and Tools, Policies exist that support the components of Food Service and Dining Programs. Organization and Administration, Menu Planning, Food Production.
Nutrition and Hydration Care, Meal Service and Pleasurable Dining. DIETITIANS OF CANADA I PAGE 3, BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES. MENU PLANNING, The master menu is planned so that residents are provided with appetizing foods and fluids appropriate for their health. and personal requirements cultural and religious needs practices and quality of life Menu planning encompasses all. foods and beverages to be provided daily to residents The master menu includes a minimum of three meals three. additional beverage opportunity passes and two snacks daily. Menus accommodate residents nutrition and hydration needs and preferences as much as possible. Types of Menus, Cycle menus are planned and revised on a regular basis at least annually Menu is 3 to 4 weeks per cycle for. optimal variety unless otherwise requested by residents. There is a menu for mid morning drink mid afternoon snack and drink and evening snack and drink that are. included in the menu cycle Snacks are considered as opportunities to promote hydration and nutrition through. nutrient dense offerings, All menus for meals and snacks include therapeutic and texture modified food and fluid options.
An emergency non selective menu plan is in place covering 3 days at a minimum Texture modifications are. considered by including as many foods as possible that are appropriate for multiple textures. In addition food and beverages are available for residents on a 24 hour basis. Menu and Meal Evaluation, Residents family members SDM POA other designated parties and appropriate team members are consulted. and involved in the menu planning and approval process to ensure menus reflect current residents social ethnic. cultural and religious practices and needs, A residents food committee can be established for planning and approving cycle menus and special occasion. Residents preferences and appetites are routinely assessed This assessment could include information from. residents satisfaction questionnaires Residents Council and or Food Committee comments results of dining. audits feedback from front line Food Nutrition and Nursing staff as well as plate waste records in the menu. planning and evaluation process, Regular observations by dietitian NM and dining room staff and informal conversations with residents are. important components of the evaluation process, Menu Planning Standards Guidelines and Considerations. revised a minimum annually with adjustments made for seasonal preferences Spring Fall. designed to provide adequate nutrition variety and choice for all residents. assessed documented and planned based on residents preferences regarding variety and frequency of menu. items Variety guidelines may be developed and reviewed with the residents prior to each revision. DIETITIANS OF CANADA I PAGE 4, BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES.
planned to meet DRIs and balance and or control the amount of sugars sodium and fats in the diet so that fewer. interventions are required to help maintain good health and control disease Menus include adequate dietary. fibre and fluids, relatively consistent in Calories from day to day served at consistent times with controlled portions and. generally small servings of desserts, planned using meal day patterns and portion sizes for both food and fluids for all textures. planned to include fresh seasonal foods and local foods in keeping with budget limitations and availability. feasible from a labour and production perspective based on collaboration between the dietitian and NM. Therapeutic and Texture Modified Menus, It is widely accepted that the quality of life of older residents in LTC homes may be enhanced by a liberalized dietary. approach In keeping with current practice standard therapeutic diet menus are created using the regular menu as a. base and are used as needed based on the dietitian and interdisciplinary care team s assessment. The dietitian in collaboration with the interdisciplinary care team bases therapeutic menus on the needs of the. resident population i e types of therapeutic diets texture modified foods modified fluid consistencies specific. snacks and supplements required, Therapeutic and texture modified menus follow the regular menu as closely as possible to provide similar choice. variety and palatability based on the dietitian s . BEST PRACTICES FOR NUTRITION FOOD SERVICE AND DINING IN LTC HOMES 2019 DIETITIANS OF CANADA I PAGE ii Acknowledgements The Ontario LTC Action Group provided their expertise and input to this revision of Best Practices

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