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Front Line Nutrition Care
Diet Technician and Student Positions
Diet Technician – Responsibilities
Diet technicians can be found in both CSC (Clinical Sciences Center/Adult Hospital) and AFCH
(American Family Children’s Hospital). Their work consists of menu planning, formula mixing,
patient education, teaching classes, patient rescreening, and calorie count calculations.
Student Help in Clinical Nutrition – Position Description
Nutrition students are undergraduate students at UW-Madison mostly studying dietetics with the
intention of becoming a registered dietitian. Students typically work after school and on
weekends to help technicians with menu planning and calorie counts in CSC and formula mixing
in AFCH.
Front Line Nutrition Care
Professional Skills
Difficult Patients
You may interact with some particularly difficult patients or find yourself in an uncomfortable
situation while planning meals. It is important to remain calm and sort out the problem with a
level head. Often times, simply listening to what the patient has to say can make a world of
difference as they may just need to get their frustration off of their chest and will cooperate after
this. It may even be helpful to come back later if the patient is frustrated with other situations and
needs time to cool off a bit.
Patient Privacy
In addition to recognizing patient rights to medical privacy, it is extremely important to
understand and respect a patient’s need for privacy within the hospital. Entering a patient’s room
should be treated similar to entering someone’s home and moving things around without asking
or making them feel like it is not their space in any way is inappropriate.
Entering a Room and Introductions
Before entering a room, it is always good to follow a quick routine in order to provide the best
patient care. Before anything else, check the light above the room door to see if other staff
members are present. If a light is on seemingly for a long time, there is no harm in just knocking
and seeing if it is an okay time to meet. Check the notes in Room Service Choice to learn any
useful information about
the patient before
entering. Once prepared
to enter, look at the door
to see if there are any
isolation precautions to
follow and adhere to their
instructions.
Room Lights and Meanings
Light Color Meaning Best Action
Yellow Nursing Assistant Come back in a few minutes
Green Registered Nurse Come back in a few minutes
Orange Nursing Sitter Knock and proceed
White Paging Knock and proceed
Purple Education Session Come back later

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As stated above, a patient’s room is
their portion of the hospital where they
should feel comfortable. With that in
mind, always make sure to knock
before entering and announce
“Nutrition” so that they know who’s
coming in. Once in the room introduce
yourself and let the patient know what the purpose of the meeting is. This can be something
simple like, “Good morning, my name is _____ and I’m with Nutrition. I’m going to order some
meals with you”.
Patients with Diabetes
Occasionally, a meal or snack will be delivered to a patient’s room without the knowledge of the
nurse or before a nurse has the opportunity to check the patient’s blood sugar. It is important to
have this in mind if you directly provide any food from the kitchen or from a tray in the room
and to double check with the patient and the nurse that the blood sugar check has been done.
Speaking with the RN
The patient’s RN can be a powerful tool as they generally know the patient better than anyone
else in the hospital. They can also be thought of as the patient’s liaison to the rest of the health
disciplines and maintaining communication with them is vital to providing quality patient care.
Some example topics to discuss with the nurse are changing room service class, allergy
clarification, eating habits, patient schedules, etc.
Low Appetites
Many patients are classified as an RS-2 in order to aid with oral intake and low appetite. It can be
very difficult for these patients to order food on their own, talk with someone about food, or even
think about food. While this can be frustrating, maintain compassion and understanding as much
as possible and communicate this to the patient. Be firm in trying to get the patient to order more
food, but don’t force food on them as it can upset patients or overwhelm them. Reinforce the
significance of eating enough in order to get healthy. Often times, the best strategy is to order
smaller meals, but keep them regular and include snacks and supplements whenever possible.
Where Food Fits
Despite the biases that come along with working in nutrition, understanding that at the end of the
day,” it’s just food” is critical to functioning in the greater hospital system. This means it’s not
the end of world if some patients don’t eat much for a day or if they are sent an item that they
may not enjoy. There are many times during inpatient care when food takes the back burner and
knowing when that is will create a better experience for the patient, relationships with other
health disciplines, and personal sanity.
Entry Precautions
Color Procedure
Green Gel-in, Glove, Gown, Gel-out inside room
Red Gel-in, Glove, Gown, Wash hands
Pink Gel-in, N95 Safety Mask, Gel-out
Yellow Gel-in, Surgical Mask, Gel-out

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Front Line Nutrition Care
Special Diets
Planning and Presentation
Most patients that meet with technicians or students are not on a general diet and many need
assistance figuring out how to eat within their prescribed diet. The diet may be completely new
to them or stricter than they may follow at home.
It is very useful to have a general plan of presentation before entering
the room. Having an idea of what the tray will look like will help to
organize your thoughts and suggestions as well as ensure that the
patient receives a balanced, varied, and interesting diet. Using the
outline provided by MyPlate is helpful with this.
When planning menus with patients on special diets, using suggestion
can be very helpful in changing the image of the technician or student from a denier to a
provider. When patients are unfamiliar with a diet and are asked open-ended, they often become
frustrated, because what they want is not available for their diet. If, on the other hand, they are
offered several items that are available on their diet, it is much easier for the patient to decide on
something that they will enjoy.
Diabetes Meal Plan
The UWHC guidelines for carbohydrates at meals on the DM diet are 75g for men and 60g for
women with a contingency of 7g. Many times patients need an HS Snack to maintain their blood
sugar levels over night. It is a good idea to get familiar with patients in order to determine what
their preferred snack is and enter a clinical note in CBORD as a reminder when planning menus.
For snacks, there is a hard limit of 30g, often trying to pair a carbohydrate and protein option
(see attached for a list of snack ideas).
High Protein, High Calorie
A high protein, high calorie diet is often used for patients with severe burns or cystic fibrosis
who need to consume additional protein and calories. It is very important to ensure that patients
receive at least one large serving of high protein foods like eggs, meat, fish, or poultry at every
meal. Milk (preferably whole milk) should also be provided at each meal. If oral intake is low,
offer strong supplements like Ensure, Ensure Plus, Magic Cup, etc.
Low Fat, Low Cholesterol
The low fat, low cholesterol diet is very commonly a part of the cardiac diet (LFLC, NAS,
LowCaf). Make sure to send egg beaters rather than whole eggs and skim milk and avoid high fat
desserts. Whenever available, send a low fat rather than full fat option. Make sure to tell the
patient that the diet is still very open in order to encourage them to work within the diet. Focus
on emphasizing fruits and vegetables rather than leaving space open on the tray to tempt the
patient with noncompliant foods.

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Renal
Patients with kidney complications are often put on a renal diet to control the electrolytic load on
their kidneys by limiting the amount of sodium, potassium, and phosphorous consumed. To do
this, it is important to keep all the major players in mind like tomatoes, potatoes, bananas, dairy
products, and the options that these are a part of. Overall there is a lack of options to choose from
during an extended stay and many portions are halved leading to a lack of calorie consumption as
well as frustration and boredom.
Patient rapport is extremely important in this situation so as to help guide patients through this
difficult diet and determine ways to encourage appropriate and adequate intake. Good ways of
building rapport are spending enough time with patients (especially when frustrated), providing
explanations of the diet and condition, maintaining a degree of flexibility, and being optimistic
and supportive.
Dysphagia Progression
Dysphagia is one of the most common special diets seen by technicians and students and is
therefore critical to have an understanding of the diets and how to work within them.
Furthermore, patients typically will have some pushback, because the modified consistencies are
unappealing to them. For this reason it’s best to try and find options that do not need to be
modified. When in doubt, think about ordering meatloaf, mashed potatoes, oatmeal or cream of
wheat, tomato soup, yogurt, or scrambled eggs. If the patient is having issues keeping their
calorie or protein intake up, offer supplements and emphasize the importance of staying off of
tube feedings.
Minced – The minced consistency is fairly restrictive and many of the options will need
to be modified. It may be difficult to convince patients to order pureed items, however
there will be a greater variety available to them if they are willing to make that sacrifice.
Diced – This is the most common dysphagia diet seen by technicians and students and it
is relatively easy to work within if the patient does not get ahead of themselves. Options
like fish and pastas can be sent without modification and are good selections to use as a
main course.
Advanced – Dysphagia advanced is a very open diet with only minor differences from
the general diet. Similar to dysphagia diced, the main difficulty with this diet is when
patients expect more variety than the diet allows for creating frustration in the patient.
Managing these expectations and making offers rather than simply denying is key to
making this diet enjoyable for the patient.
Thickened Liquids
One thickener packet will properly thicken 4oz of liquid. If a drink is larger than this, as many
are, more than one packet will need to be sent. When sending thin liquids with thickener packets
deliver it to the nurse’s station and enter “RN please thicken _____” in the service notes
(message “Deliver to NS” and “See Notes” in Room Service Choice).

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Low Fiber
The low fiber diet is designed to reduce food residue in the GI tract in order to alleviate
symptoms of GI disorders. This diet can be difficult if people are inflexible in choosing fruits,
vegetables and dairy products, however, by suggesting options that will work well it will be
much easier.
Pureed
Often times, patients with very poor dentition will be assigned a pureed diet and for some it is
not different than eating at home, but for others this may be the first time eating this way. In the
case of the latter, patients will often resist and report the food is unappealing and boring. While
we do have a fairly wide variety of pureed options, like any other diet, the options can get a bit
repetitive after a while. Encouraging the patient to keep trying new options and finding creative
combinations is critical to successful ordering with these patients. Supplement use is also
encouraged, as it can be difficult to get enough calories.
Fluid Restrictions
Fluid restrictions are often put in place in order to aid in the process of reducing the amount of
fluids patients are retaining in their body and can be as general as 2000mL per day to as strict as
500mL per day. The difficulty in meeting these restrictions very much from patient to patient
depending on the amount of fluids and foods they usually consume. Generally it helps the
planning process by steering clear or at least being mindful of food fluids like soup, watermelon,
and yogurt. By reducing the amount of these foods in the day, there will be more room to order
beverages that the patient will drink without overloading the restriction.
Front Line Nutrition Care
Guide for Inpatient Meal Planning
Room Service Class
Every patient in the hospital assigned an oral diet will be designated one of three room service
classes that describes how the patient will be ordering meals.
RS-1 – Patient will order their meals with the diet office clerks via phone, generally on a
meal-by-meal basis. These patients are responsible for ordering their own meals without
the need for reminder. RS-1 patients on units B4/4 (Inpatient Rehab) and B6/5 (Psych)
who do not order their meals will be sent a Non-Select Meal.
RS-2 – Room Service Assist – Patient will meet with a diet technician or nutrition student
daily to order meals ahead of time. Technician or student may need to provide further diet
reminder, explanation, or education.
RS-3 – Patients may not prefer or have the ability to choose their meals and will receive a
Non-Select Meal. Security patients and patients on D4V6 will be assigned this
designation.
Patients may change between these classes throughout their stay, but generally they are quite
stable. It is important to understand these changes though, as they may indicate what the goal of
meeting with a technician or student is.

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Allergies
Wheat, soy, milk, eggs, fish, shellfish, tree nuts, peanuts, how to recognize, work with and
around them, informal/self-reported allergies, avoiding
Being able to recognize the Big 8 allergies and work around them is critical for success as they
are very common among patients. The menu is still very flexible around these and often times
they are not an issue.
Every now and then there will be a patient that does not have a confirmed allergy however they
choose to avoid it; a very common example is gluten. It is very important to respect this choice
and to make the best effort to ensure that they are not given foods containing gluten. At the very
least, be transparent about the ingredients in a certain dish so that the patient is on the same page
and can make informed decisions.
Odds and Ends
23:55 Time Queue – Setting a meal to this time acts as a saving device. If a meal is planned but
not ready to print until an issue has been resolved, queuing the tray for this time will save it for
future editing and ensure it does not print in the kitchen.
Inpatient Rehab – B4/4 uses set meal times in
order to help plan and coordinate patient
therapy. It is very important to set meal
queue in line with the prescribed time.
Patients have busy days filled with therapy
appointments making it difficult to meet with
them to do menu planning. Often times it is
best to see them after 3:00 once therapy is
wrapping up for the day, however, between 11:30 and 1:00 some may be willing to meet and
plan during their lunch. It is important to understand that this is one of the few quiet times that
patients can have on the unit and always check if it’s okay with them to eat and talk.
Supplement Selection – Choice
of supplement should include
consideration from both diet
and patient preference. Each
case is a little bit different,
however generally certain
supplements are fairly reliable
for use with each situation.
Thickened liquids, renal, diabetic, others
Dialysis Patients – If a patient will be going to dialysis in the morning, set their breakfast at
7:00am and enter message “Dialysis Patient”.
B4/4 Inpatient Rehabilitation Set Meal Times
B4/414 – B4/446
B 6:25
L 10:55
D 3:50
B4/448 – B4/480
B 6:40
L 11:00
D 4:05
Supplement Use for Various Diets
Supplement Diets
Ensure Muscle Health All except Clliq
Ensure Plus HiProCal
Ensure Clear Clliq
Magic Cup All, especially LiqNec
Nepro RenwD, RENWOD
Glucerna DM
* There is no absolute correct supplement. Each should be provided on a case-by-case basis

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Special Requests – Patients occasionally make special requests for food preparation or food
items. The kitchen will try to accommodate these requests, however, use judgement in talking to
the patient to avoid any false hopes. When taking special requests, inform the patient that the
kitchen will do its best but it may not be able to accommodate and the item may not be sent. It is
often wise to ask for a substitute just in case.
CBORD Room Service Choice
CBORD Room Service Choice Cheat Sheet
Label Description
1 Patient name
2 Diet order
3 Food or food allergy list
4 See meals, snacks, and set times for the whole day
5 See clinical notes about patient eating habits and preferences
6 Change quantity or remove items
7 See ingredient list and list of all allergens
8 Service notes for the kitchen or nurse
9 Print or queue tickets
10 Non-compliant items appear in red
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