DI 2.2.1.1 Policy and Procedure Shriners
SHRINERS HOSPITAL FOR CHILDREN SHREVEPORT NUTRITION SERVICES POLICY AND PROCEDURE MANUAL
Reviewed/Revised January 2010
TABLE OF CONTENTS
INTRODUCTION
Mission Statement Vision Statement Shreveport Hospital Organization Chart Nutrition Services Organization Chart Philosophy Nutrition Services Responsibility / Scope of Nutrition Services
POLICIES AND PROCEDURES NUMBER
Patient Meal Service - Refreshments for Activities NTS-01.1.1 Cafeteria Meal Service
NTS-01.2 Cafeteria Meal Service - Catering NTS-01.2.1 Cafeteria Meal Service - Evening and Weekend Meals for Parents NTS-01.4 Cafeteria Meal Service - Complimentary Evening Meals for Parents NTS-01.4.1 Cafeteria Meal Service - Vending Services NTS-01.6 Patient Care - Nutritional Requirements NTS-02.1 Patient Care - Nourishment Requisitions NTS-02.1.1 Patient Care - Screening Nutritional Status NTS-02.2 Patient Care - Therapeutic Diets NTS-02.3 Patient Care - Tube Feeding
NTS-02.4 Patient Care - Peripheral Parenteral Nutrition Intervention NTS-02.5 Patient Care - Nutrition Care Plans NTS-02.6 Patient Care - Diet Orders
NTS-02.7 Patient Care - Communication of Diet Orders NTS-02.7.1 Patient Care - Tray Identification NTS-02.8 Patient Care - Selective Breakfast Menus NTS-02.9 Patient/Family Education - Therapeutic Diet Counseling NTS-03.1 Patient/Family Education - Drug -Food Interactions NTS-03.2 Food Purchasing
NTS-04.1 Receiving Deliveries
NTS-04.2 Storage
Patient Meal Service NTS-01.1
NTS-06.1 Department Sanitation - Cleaning Schedule NTS-07.1 Department Sanitation - Ice Machine NTS-07.2 Dishwashing - General Guidelines NTS-08.1 Dishwashing - Machine Washing NTS-08.2 Dishwashing - Three Compartment Sink NTS-08.3 Waste Disposal
NTS-09.1 Infection Control - Health Requirements and Orientation NTS-10.1 Infection Control - Dress Code NTS-10.2 Infection Control - Equipment and Environment NTS-10.3 Infection Control - Procurement and Storage NTS-10.4 Infection Control - Preparation and Service NTS-10.5 Infection Control - Safe Food Temperature NTS-10.6 Infection Control - General Rules for Employees NTS-10.7 Safety
NTS-11.1 Safety - General Rules for Employees NTS-11.2 Fire Plan - Code Red
NTS-11.3 Disaster Plan - Disaster Alert
NTS-11.4 Disaster Plan - Disaster Alert Feeding NTS-11.4.1 Disaster Plan - Disaster Evacuation Feeding NTS-11.5 Nutrition Services Inoperable
NTS-11.6 Code Grey - Tornado Alert
NTS-11.7 Code Black - Bomb Threat
NTS-11.8 Preventive and Corrective Maintenance NTS-12.1
NTS-05.1 Food Preparation
TABLE OF CONTENTS
Hazardous Materials/Waste NTS-14.1
Personnel Management NTS-15.1
Personnel Management - Attendance and Promptness NTS-15.1.1 Personnel Management - Nutrition Services Designee NTS-15.2 Personnel Management - Employee Conduct and Ethics NTS-15.3 Personnel Management - General Rules for Personal Hygiene NTS-15.4 Employee Orientation
NTS-16.1 Employee Orientation - Training and Education of Staff NTS-16.2 In-Service Education
NTS-17.1 Securing Department
NTS-18.1 Reviewed/Revised January 2010
SHRINERS HOSPITALS FOR CHILDREN
3100 SAMFORD AVENUE, SHREVEPORT, LA 71103
MISSION STATEMENT
The mission of the Shriners Hospitals for Children - Shreveport is to: recognize the physical, spiritual and psycho-social age specific needs of our patients as infants, young children, and adolescents. provide quality care for orthopedic patients ages birth to eighteen to include diagnosis, treatment and rehabilitation. provide nurturing family centered care environment that supports the unique individual needs of each child and family recognizing that the integrity of each family unit must be maintained during hospitalization of the child.
provide comprehensive treatment utilizing a coordinated multi-disciplinary team approach. provide continuity of care for all patients by collaborating with community services and resources. provide education and training for orthopedic surgeons, nurses and rehabilitation therapists and other allied health personnel. perform clinical research related to orthopedic conditions. 11/92
SHRINERS HOSPITALS FOR CHILDREN
3100 SAMFORD AVENUE, SHREVEPORT, LA 71103
VISION STATEMENT
The Shriners Hospitals for Children - Shreveport strives to be an international center of excellence in pediatric orthopaedic treatment, research, and education, utilizing a family centered care approach.
2/94
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PHILOSOPHY
NUTRITION SERVICES
Nutrition Services of Shriners Hospitals - Shreveport accepts the responsibility to work cooperatively with other departments, other health professionals and ancillary services to improve patient care services as a part of the total Hospital Quality Management Program.
Nutrition Services strives to offer the highest level of nutritional care to the patients in order to prevent malnutrition, reduce patient's hospitalization and convalescence and assist each patient to attain his/her optimum health by modification of his/her eating habits through nutrition education.
The Nutrition Services Director participates in Continuing Education Programs in order to keep current on advanced trends in therapeutic diets and new medical technology. The Nutrition Services staff participates in on-going in-service education programs and orientation for new employees in order to maintain qualified personnel.
Robin Wilson, MS, LDN, RD Nutrition Services Director
RESPONSIBILITY / SCOPE OF SERVICE
NUTRITION SERVICES
Nutrition Services of Shriners Hospitals for Children - Shreveport, under the direction of a full- time Registered Dietitian: is responsible for maintaining an effectively organized Food Service Department which provides quality age appropriate nutrition based on knowledge of growth and development for all patients (infants, children and adolescents) in accordance with the current Recommended Dietary Allowances of the Food and Nutrition Board of the National Academy of Science, and in accordance with the physician's orders.
is responsible for providing quality food service in the cafeteria for employees, patient's families and guests.
Robin Wilson, MS, LDN, RD Nutrition Services Director
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT MEAL SERVICE
NTS-01.1
Department: Nutrition Services Date Originated: March 1994 Date of Revision: September 2000 Reviewed: 9/00, 9/01; 9/02; 9/03; 9/04; 9/05; 8/06: 1/10; 1/13
POLICY
Three meals or meal equivalents are served daily to all in house patients, at scheduled meal times, not to exceed 15 hours between the evening meal and breakfast.
PROCEDURES
1. TYPES OF SERVICE USED: a. Tray service to patient’s room at breakfast.
b. Cafeteria style service in the Central Activity Area for lunch.
c. Cafeteria style service in the Dining Room for dinner.
2. SERVING TIME : a. Breakfast will be served at 7:45 A.M. - 8:15 A.M.
b. Noon meal will be served at 11:30 A.M. - 12:00 P.M.
c. Evening meal will be served at 5:00 P.M. - 5:30 P.M.
3. TRANSPORTATION OF TRAYS TO THE PATIENTS:
a. The Nutrition Services staff, transports food using preheated enclosed portable serving tables to and from the designated serving areas at designated times. The portable serving table is preheated 30 minutes before meal service.
b. All foods are served by the Nutrition Services staff in designated meal areas; patient’s, parents or a nursing assistant carry the food tray to the table where the child has chosen to eat, or to the patient’s bedside for breakfast or if the patient is on bed rest.
Attachments: none Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT MEAL SERVICE – REFRESHMENTS FOR ACTIVITIES NTS-01.1.1
Department: Nutrition Services Date Originated: February 1989 Date of Revision: April 1994 Reviewed: 9/94; 9/96; 10/97; 10/98; 11/99; 9/00; 9/01; 9/02; 9/03; 9/04; 9/05; 8/06; 1/10; 1/13
POLICY
To enhance the theme of an activity or to provide appropriate food service for special event, such as birthdays, out-trips, slumber parties, and theme days Nutrition Services will make every effort to provide refreshments as requested.
PROCEDURE
All food served to patients is wholesome, prepared in a safe manner and is planned into the day's total nutritional intake. No food from an outside source is to be given to patients unless arrangements have been made through the Dietitian. Child Life is to send Nutrition Services Request at least 24 hours in advance for a birthday cake, and no less than 48 hours to request items for any other activity, all requests are subject to the Dietitian’s approval and availability. Attachments: none Professional References: none Regulatory References: none Related Policies: CL 3.1, CL 3.2, CL 3.9, CL 4.2 Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
CAFETERIA MEAL SERVICE
NTS-01.2
Department: Nutrition Services Date Originated: January 1991 Date of Revision: January 2013 Reviewed: 9/94; 9/96; 10/97; 10/98; 11/99; 9/00; 9/01; 9/02; 9/03; 9/04; 9/05; 8/06; 1/10; 1/13
POLICY
The hospital cafeteria will provide breakfast, lunch and refreshment service to employees, medical staff, out patients, volunteers, family members and visitors.
CAFETERIA SERVICE PROCEDURE: A. The cafeteria is open Monday through Friday for Breakfast and Lunch.
CAFETERIA SERVICE HOURS: Breakfast: 7:00 A.M. - 9:00 A.M. Lunch: 11:30 A.M. - 1:00 P.M. The cafeteria provides food service to employees, medical staff, out- patients, volunteers, relatives of patients and visitors.
B. Coffee and tea are available free to all employees.
Attachments: none Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
CAFETERIA MEAL SERVICE CATERING NTS-01.21.1
Department: Nutrition Services Date Originated: January 1991 Date of Revision: March 1994 Reviewed: 4/94, 5/96, 10/97 10/98, 11/99, 9/00, 9/01, 9/02; 9/03; 9/04; 9/05; 8/06; 1/10;1/13
POLICY
Nutrition Services will provide a limited food catering service to departments for Hospital related events and professional organizations as approved by the Administrator and Director of Nutrition Services.
PROCEDURE
The Department Director or their designee completes the food catering requisition and obtains approval signature from Administrator and forwards to Nutrition Services one month prior to event. Questions regarding price and availability should be directed to the Nutrition Services Director.
The Nutrition Services Director will contact the requesting Director if an item is unavailable, for acceptable substitutions. Nutrition Services staff prepares and transports food to location and sets up according to instructions, they are not available for plate service. Nutrition Services staff returns for leftover food and dirty dishes at the end of the scheduled event. Environmental services and Maintenance should be contacted separately if services are required. The Nutrition Services Director completes the cost per unit, total cost and meal equivalent columns after the event and forwards a copy to the requesting Director and to the Director of Fiscal Services for billing back to the requesting cost center.
Attachments: Special Function Catering Request Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision:
__________________________________ _____________________________________
__________________________________ _____________________________________
Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN
Chief of Staff: Dr. Richard McCallShriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
CAFETERIA MEAL SERVICE – WEEKEND/HOLIDAY MEALS FOR PARENTS NTS-01.4
Department: Nutrition Services Date Originated: March 1994 Date of Revision: January 2013 Reviewed: 1/00, 9/01; 9/02; 9/03; 9/04; 9/05; 8/06; 1/10;1/13
POLICY
Continental Breakfast is complimentary for parents daily. The weekend lunch and evening meals are complimentary for 2 parents and/or caregivers. The weekend policy is also used on hospital holidays.
1. Parent's meal will be served after all patient meals are served by the Dietary Aide and delivered by the Nursing Assistant.
2. Eating is not allowed in the patient rooms, except after surgery or when a child is confined to the room (such as an Isolated Patient).
3. Weekend and Holiday lunch and evening meals are served promptly. Parents must follow meal times to receive complimentary trays.
Lunch meal will be served at 11:30 A.M. - 12:00 P.M. Evening meal will be served at 5:00 P.M. - 5:30 P.M.
Attachments: Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
CAFETERIA MEAL SERVICE COMPLIMENTARY MEALS FOR PARENTS NTS-01.4.1
Department: Nutrition Services Date Originated: March 1994 Date of Revision: January 2010 Reviewed: 9/01; 9/02; 9/03; 9/04; 9/05 8/06,1/10;1/13
POLICY
A complimentary meal is provided at supper to two parent/legal guardians of each inpatient for the duration of the hospitalization.
PROCEDURE
1. Nutrition Services staff utilizes diet order sheet and admissions list to calculate number of meals to prepare and serve for the evening meal.
2. Nutrition Services staff will record the number of complimentary meals served each day on the monthly statistics sheet.
3. Parents who have special therapeutic dietary needs will be directed to the Registered Dietitian. Accommodations will be made on an individual basis with considerations made to necessity and availability of products needed.
Attachments: none Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN,MSN,
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
CAFETERIA MEAL SERVICE - VENDING SERVICE NTS-01.6
Department: Nutrition Services Date Originated: January 1993 Date of Revision: January 2012 Reviewed: 1/00, 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06; 1/10; 1/12
POLICY
The vending machines are owned and operated by a contract company. The company will ensure the safe sale of food dispensed through the vending machines. The company will provide a copy of the Inspection Report for Food Establishments conducted by the Department of Health and Human Services to Shriners Hospitals of Shreveport upon request.
PROCEDURE
A. Contract Company 1. The vending company will service all vending machines.
2. The vending machines are cleaned and maintained regularly meeting the vending company’s policies.
3. The preparation, delivery, and storage of food will be done following the vending
O
company’s policies. Temperature of potentially hazardous food is maintained at 45 F
O O O
or below. (35 - 45
F) Should the temperature go above 45
F, all perishable items will be removed by the vending company and they will notify their maintenance department.
4. Expired dated food will be removed and perishable food rotated daily.
5. Cleaning of the exterior of the machines is done by the vending company.
B. Shriners Hospitals The Food and Nutrition Services Department will ensure that the following procedures are met.
1. Provide the company space and utilities to operate the vending machines.
2. Provide the company a place to clean the interior parts of the vending machines as needed. Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ ___________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE - NUTRITIONAL REQUIREMENTS NTS-02.1
Department: Nutrition Services Date Originated: March 1994 Date of Revision: January 2010 Reviewed: 1/95, 5/96, 10/97, 10/98, 11/99, 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06; 1/10;1/13
POLICY
The patients nutritional needs are met in accordance with the current Recommended Dietary Allowances of the Food and Nutrition Board (1989 RDA), National Research Council, and in accordance with physicians orders.
PROCEDURES
MENUS: Menus are planned and/or approved by a Registered Dietitian. Menus are written in advance and posted where they can be seen at all times while food is being prepared. A 4 week cycle menu is presently being used. The menus are updated and revised to reflect seasonal changes and to increase variety. Menu substitutions are of an equivalent nutritional value. PATTERN FOR REGULAR MENU: This pattern follows the current Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. Breakfast Lunch Dinner Fruit or Juice Meat, Fish or Poultry Soup or Juice Cereal (cooked or dry) Potato or substitute Meat or Substitute Meat or meat alternate Green or Yellow vegetable Potato or substitute Toast or other bread Salad Vegetable or Salad Margarine Fruit Bread or substitute Milk Bread or substitute Dessert
Milk Milk NOURISHMENTS : Between meal snacks Completed nourishment requisitions are brought to the Nutrition Services Department by the ward clerk . The request is filled by a Nutrition Services employee, and the nourishment requisition form is initialed when completed. Nutrition Services is responsible for transporting the requisitioned nourishments to the unit kitchens daily. Nursing personnel initial off on the nourishment requisition form for receipt of goods.
Serving time: 10:00 a.m., 2:00 p.m., and 7:00 p.m. or PRN. Foods kept in the unit kitchens include:
Infant formula Rice/Oatmeal Cereal in jars Crackers - graham and saltine Peanut butter Fruit Juices Sprite Soups - Beef Broth, Chicken Broth Sugar Milk Coffee and Tea Ice Cream Popsicles Jell-o Cereal Strained Baby Foods - assorted meat, fruit and vegetables
Attachments: none Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE - NOURISHMENT REQUISITIONS NTS-02.1.1
Department: Nutrition Services Date Originated: March 1994 Date of Revision: June 2013 Reviewed: 10/97, 10/98, 10/99, 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06, 1/10; 6/13
POLICY: Nourishment requisitions will be filled on a daily basis. PROCEDURE:
Completed nourishment requisitions will be placed in the designated file rack located in the Production Managers office. The nutrition aide or weekend foodservice worker is responsible for filling all nourishment requisitions on a daily basis.
Attachments: Patient Nourishment Requisition Professional References: none Regulatory References: none Related Policies: none Replaces : Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________
Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE - THERAPEUTIC DIETS NTS-02.3
Department: Nutrition Services Date Originated: March 1994 Date of Revision: September 1997 Reviewed: 10/97, 10/98, 10/99, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06; 1/10; 1/13
POLICY
Therapeutic diets will be in accordance with physician's orders and in compliance with the established diet principles of the Hospital Diet Manual.
PROCEDURE
A reference copy of the Hospital approved Diet Manual is located in the out patient clinic, on the in patient unit and in Nutrition Services. The therapeutic diet menu patterns are written by the Registered Dietitian following the same pattern as the regular menu. A menu pattern is established for the individual patient's modification by the Dietitian and reviewed with Nutrition Services staff. Changes in the menu pattern are made as often as possible to satisfy the patient’s needs with regard to food preferences or individual eating behavior while maintaining compliance with therapeutic guidelines.
Therapeutic diets requiring in between meal feedings have menu patterns that reflect the feeding time and content of the nourishment. Attachments: none Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE - ENTERAL FEEDING NTS-2.4
Department: Nutrition Services Date Originated: March 1994 Date of Revision: January 2010 Reviewed: 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06, 7/08; 1/10;1/13
POLICY
Enteral feedings are provided by Nutrition Services according to the Physician’s order and in accordance with the Hospital Diet Manual. Enteral feedings must be prepared, handled, and stored according to strict HACCP (Hazard Analysis Critical Control Points) guidelines; including critical control points, hazards, standards, and corrective actions that should be taken if standards are not met.
PROCEDURE
The Medical Staff may order enteral feedings for any patient who is admitted on an enteral feeding at home or considered to be at nutritional risk by classification or other indicators. The Registered Dietitian will calculate the nutritional requirement of the patient and document progress and tolerance on the Nutrition Assessment Form in SHCIS. Ready to use formulas and enteral feedings are requested by Nursing Service by entering an order is SHCIS. If the formula or enteral feeding product is a non-stock item, the Registered Dietitian will special order the product through Materials Management or will obtain the item from a local supermarket. Stock items include Pediasure, Pediasure with Fiber, Ensure and Ensure Plus.
Parents of patients that are on a enteral feeding at home (gastrostomy, etc.) are instructed by the clinic nurse and or Family Services on pre-admission interview to bring special formula product and personal physician's diet instructions upon admission. Every effort will be made to follow established home feeding procedures.
Attachments: HACCP Standards for Enteral Feeding Professional References: none Regulatory References: none Related Policies: none
Replaces:
Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE - PERIPHERAL PARENTERAL NUTRITION INTERVENTION NTS-2.5
Department: Nutrition Services Date Originated: March 1994 Date of Revision: January 2010 Reviewed: 9/00,9/01, 9/02, 9/03, 9/04, 9/05, 8/06, 7/08; 1/10; 1/13
POLICY
Peripheral Parenteral Nutrition (PPN) will be available to those post surgical patients as ordered by the Medical Staff.
PROCEDURE
Medical Staff may order a Dietary Consultation for PPN in any case where a patient is considered to be at nutritional risk by classification or other indicators. The Registered Dietitian will calculate the nutrition requirement of the patient and document progress and tolerance on the Nutrition Assessment Form in SHCIS. Attachments: none Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE NUTRITION ASSESSMENT NTS-02.6
Department: Nutrition Services Date Originated: March 1994 Date of Revision: November 2010 Reviewed: 9/03, 9/04, 9/05, 8/06, 7/08; 10/09, 11/10
POLICY
Nutrition assessments will be done by a Registered Dietitian who meets state licensure requirements. The assessment will be age appropriate as determined by the practitioner’s knowledge of growth and development and age specific nutrient and feeding needs for infants, children and adolescents.
PROCEDURE
Patients are screened by nursing staff as a part of the admission assessment within 24 hours of admission. Nutrition risk factors (as noted in Nutritional Screen in SCHIS) include:
Constipation Drooling Eating disorder Enteral feedings Impaired nutrition Intake Intake <50% normal in last 3 days Problem with sucking/chewing/choking Problem with swallowing Nausea/vomiting/diarrhea Skin breakdown/decubitus ulcers Special diet TPN feedings
th th
percentile or >95 percentile Weight <5 The nursing staff enters an order for a nutrition consult. Nutrition consults are completed by the Registered Dietitian within 72 hours. The Registered Dietitian completes a nutrition assessment form in SHCIS that will encompass the patient’s nutrition care plan. Nutrition care plans may document any or all of the following:
Current diet order NCHS growth curve percentiles for height and weight for age Usual weight and suggested weight for height % difference in usual and suggested weight for height Food allergies/intolerances and/or drug -food interactions Therapeutic diet modification Nutritional supplements Evaluation of usual diet Evaluation of eating behavior Modified feeding requirements Tolerance and/or acceptance of hospital diet Recommendations for nutrition intervention Patient/family education and understanding of material presented Expected compliance to diet modification Follow-up progress and reassessment Attachments: none
Regulatory References: none Related Policies: none Replaces: NTS 02.2 Author: Jamie Shaw LDN, RD 7/08 Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE - REASSESSMENT NTS-02.6.1
Department: Nutrition Services Date Originated: March 1994 Date of Revision: July 2008 Reviewed: 9/03, 9/04, 9/05, 8/06, 7/08, 1/10; 1/13
POLICY
Patients who met the criteria for further assessment and/or who were referred for assessment and/or nutrition intervention are periodically reassessed by the Registered Dietitian. .
PROCEDURE
Patients who are receiving PPN or enteral nutrition or are being monitored while they are on a nutrition intervention program are documented under Nutrition Reassessent is documented in SHCIS. Attachments: none Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Jamie Shaw LDN, RD 7/08 Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE - DIET ORDERS NTS-2.7
Department: Nutrition Services Date Originated: March 1994 Date of Revision: July 2008 Reviewed: 10/98, 10/99, 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06, 7/08, 1/10
POLICY
All in patients will have a physician's order for an appropriate diet before receiving meals from Dietary.
PROCEDURE
1. Diet order is ordered by the physician and entered into SHCIS by the nursing staff.
2. All post-op clear liquid diets will be initiated by the physician and will progress to the pre-op diet as tolerated at the discretion of nursing service.
3. The usual progression of diets is as follows: Clear liquid Full liquid Surgical soft Regular (Infant, Toddler, Chopped, Blended) Full liquid and/or Surgical soft may be skipped for patients who are able to go directly to a Regular diet at the discretion of nursing service.
Attachments: Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE – COMMUNICATION OF DIET ORDERS NTS-2.7.1
Department: Nutrition Services Date Originated: January 1991 Date of Revision: July 2008 Reviewed: 5/96, 10/97, 10/98, 10/99, 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06, 7/08, 1/10; 1/13
POLICY
Nursing service will communicate each patient’s current diet order to Nutrition Services by entering the order in SHCIS. Diet sheets are generated and sent to the printer in Nutrition Services.
PROCEDURE
Each patient will have a diet order on the medical record upon admission and throughout their stay. Nursing Service enters the diet order in SHCIS. and revises the order throughout the patient’s stay as the order changes. Diet sheets are sent electronically to the printer in the nutrition service department three times daily with revisions as need prior to breakfast, lunch, and dinner. Patients who are not receiving oral intake are identified by Nursing Service on the Daily Diet Sheet as N.P.O.
Attachments: Patient Diet Order Guide Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
PATIENT DIET ORDER GUIDE
Regular The regular diet is adequate in all nutrients. It is suitable for children capable of chewing, swallowing and eating a variety of texture. Toddler Diet This is a regular diet with modifications to suit the needs of children who are developing self feeding skills. This diet is adequate in all nutrients. Infant Diet The infant diet is for children unable to chew and to digest foods. Diet includes infant formulas, strained baby food and infant cereals. This diet is adequate in all nutrients. Chopped Diet A regular diet with each item chopped individually to specified requirements. Used for patients with moderate chewing and/or swallowing abilities. Pureed Diet A regular diet with each item homogenized in the blender individually. Used for patients with difficulties chewing and/or swallowing. Surgical Soft An adequate diet designed to be mechanically, chemically, and Diet thermally non-irritating and non-stimulating for patients with GI disorders, gastritis, ileitis and peptic or duodenal ulcers. May be used as a post-operative or transitional diet. Bland Diet Adequacy depends on patient tolerance of various foods. Diet is basically the soft-bland diet with modifications for individual patient tolerance. High Protein, An adequate diet, higher in protein than regular diet. High Protein, An adequate diet with increased protein and calorie value. Used High CHO, for patients that are underweight, malnourished, hyperthyroid, have cirrhosis, infectious hepatitis, mononucleosis. Low Protein Diet Inadequate in protein. For use in chronic renal failure, cirrhosis or chronic liver disease. Low Cholesterol Adequate diet low in fat, saturated fats and cholesterol. Low Fat Used for the treatment of elevated blood cholesterol . Low Fat Diet Adequate diet, high in CHO, normal protein and low in fat. Used for weight control and disturbances of biliary tract, hepatitis, and patients with high serum cholesterol. Weight Reduction An adequate diet with restricted calories. Based on the Low Diet Fat Diet. Used in conditions where weight loss is desired. 1200 and 1500 calorie diets are available. Less than 1200 calories is not recommended for a growing child or adolescent. Consult with dietitian if calorie level greater than 1500 is required.
PATIENT DIET ORDER GUIDE
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DIET DESCRIPTION OF COMMON DIETS AVAILABLE
Diabetic Diets Adequate in all nutrients. Regular diet with no concentrated sweets, calorie and fat restriction. Please indicate insulin dosage if necessary so appropriate patterns can be planned. 1200, 1500, 1800, 2000, 2200 and 2500 calorie levels are available. Please indicate if another calorie level is needed. Hypoglycemic Diet Adequate in all nutrients. A high protein, restricted CHO, moderate fat diet used in the treatment of functional hypoglycemia, reactive hypoglycemia. Dietary treatment of hyperinsulinism due to organic causes has only short term benefits.
2 gram Sodium An adequate diet with a moderate reduction in the use of salt and omission of foods high in Na+. Used in cardiovascular disorders with moderate heart damage or patients unable to tolerate a more rigid restriction.
1 gram Sodium An adequate diet using no salt in food preparation and foods of low to moderate Na+ content. Used in cardiovascular and renal diseases when edema is present. 500 mg Sodium An adequate diet with the lowest possible Na+ content.
Used in congestive heart failure, severe edema or hypertension. Lactose Free Deficient in calcium, riboflavin and vitamin D. Used in the treatment of Diet galactose intolerance. A lactose free formula or milk substitute should be used to replace milk.
High Fiber Diet Adequate diet high in residue and fiber. Used for constipation in children with spina bifida and myelodysplasia. Low Fiber, Adequate diet low in residue and fiber. Little seasoning is Low Residue Diet used. Used for disturbances of GI tract, ulcerative colitis, colostomies, inflammatory diseases of large or small intestine, obstructive bowel lesions or diverticulosis. PKU Diet Inadequate in protein, most vitamins and minerals. A low protein diet using a protein substitute (lofenalac). Used in children with phenylketonuria (PKU). A vitamin and mineral supplement is necessary. Low Copper Diet An adequate diet eliminating foods with high copper content.
Used in the treatment of Wilson’s Disease. Low Potassium Diet Adequate with careful planning. Very monotonous and low in calories.
For patients with Addison's Disease and other conditions characterized by retention of potassium. Low Calcium Diet Inadequate if continued for extended period. Very unpalatable.
Contains no more than 550 mg. of Ca+. Used for hypercalcemia, hyperparathyroidism and high serum calcium.
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT CARE – TRAY IDENTIFICATION NTS-2.8
Department: Nutrition Services Date Originated: January 1991 Date of Revision: January 2010 Reviewed: 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06; 1/10; 1/13
POLICY An organized system of identifying meal trays is established and utilized. PROCEDURE
Nutrition Services employees prepare trays utilizing the diet order sheets generated from SCHIS for each patient at each meal. The diet order sheets are queued to the printer in the Nutrition Service Department and are automatically printed for each meal.
The diet order slip includes the patient’s name age and special instructions to the server based on the diet order received from Nursing Service. Attachments: Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT/FAMILY EDUCATION – THERAPEUCTIC DIET COUNSELING NTS-3.1
Department: Nutrition Services Date Originated: March 1994 Date of Revision: July 2008 Reviewed: 9/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06, 7/08; 1/10; 1/13
POLICY
Therapeutic diet counseling is provided by the Registered Dietitian to patients and/or families when a physician's order requests patient/family education.
PROCEDURE
Printed educational material and individual diet instruction will be presented to patients/
families following the physicians order. Therapeutic diets presented will be in compliance with the hospital approved diet
manual. Documentation of patient/family education will be entered as part of the nutrition
assessment and will also be documented on the multidisciplinary patient/family education form. Entries will include an evaluation of patient/families understanding of the material presented, as evidenced by the ability to verbalize therapeutic guidelines, and expected level of compliance with recommended treatment. It is the patient/families responsibility to comply with the recommended therapeutic
guidelines. Attachments: Professional References: none Regulatory References: none Related Policies: none Replaces: Author: Denise P. Smith, MS, LDN, RD Stakeholders Involved in Development, Review, and or Revision: __________________________________ _____________________________________ __________________________________ _____________________________________ Administrator: Kim Green Director of Pt. Services: Gail Rains, RN, MSN Chief of Staff: Dr. Richard McCall
Shriners Hospitals for Children 3100 Samford Avenue, Shreveport, Louisiana 71103
PATIENT/FAMILY EDUCATION – FOOD DRUG INTERACTIONS NTS-3.2
Department: Nutrition Services Date Originated: March 1994 Date of Revision: September 1997 Reviewed: 10/97, 10/98, 10/99, 9/00, 11/00, 9/01, 9/02, 9/03, 9/04, 9/05, 8/06; 1/10; 1/13
POLICY
Patients/Families discharged on medication will receive information on potential drug-food interactions associated with the medication that has been prescribed.
PROCEDURE
Resource notebooks will be available in the Pharmacy, Nutrition Services , Inpatient Unit and the Outpatient Clinic with guidelines for all oral medications listed on the hospital formulary, plus any additional medications that are identified as patients are admitted on medications not included on the formulary.
The Pharmacist will send printed guidelines for Dulcolax tablets, Iron products, Furoxone, Fulvicin P/G, Reglan, Donnatal, Tetracyclines, and Zantac ( and any others as deemed appropriate by the pharmacist) to the Nursing Unit for staff education purposes when the initial dose of an oral medication is sent to the In Patient Unit.
The Pharmacist will notify the Registered Dietitian when a patient is admitted on a medication identified as needing nutrition intervention based on the identified high risk group of medications. Identified high risk medications include; MAO inhibitors (Furoxone, Isoniazide), Iron preparations, and Tetracyclines. The patients’ diet will be modified appropriately.
Nursing Service will identify patients being discharged on medication and will counsel patients and/or family on potential drug and food interactions utilizing medication information sheets provided by the pharmacy. Nursing staff will document that the information sheets have been given on the Nursing Discharge Summary.