Theme Meal: St. Patrick’s DayAllison KliewerBaptist Health System Dietetic InternshipWithTexas Center for Infectious DiseaseMarch 6, 2013
Theme Meal Kliewer 2Theme Meal Part OneThe role as a director of dietary services is just one of the many roles that dietitians play.According to the Academy of Nutrition and Dietetics a qualified dietitian must be utilized bylong term care facilities to plan, manage, and implement dietary service activities in order toensure that the residents receive adequate nutrition (2013). The dietitian must have trainingand experience in budgeting and purchasing of food supplies, and in supervising institutionalfood preparation, service and storage (2013). Long term care facilities must also have sufficientdietary support personnel and sufficient staff preparation; there must be enough staff toprepare and serve palatable, attractive, nutritionally adequate meals at proper temperaturesand times to support proper sanitary techniques being utilized (2013). To serve a theme meal, adietitian must be involved in all components of dietary service to ensure all guidelines andpolicies are being followed, to evaluate the success of the meal, and to determine what can bedone to improve the quality and service.The Texas Center for Infectious Disease (TCID) is a long term care facility with a uniquepatient population. The patients suffer from tuberculosis (TB) and most have a drug resistantform of TB. Many of the patients also suffer from psychiatric issues and substance abuse. Dueto their medical condition upon admittance, many patients stay at TCID for many months orpossibly years before they are healthy enough to be released. Therefore, to occupy time,educate, and prepare the patients to be able to live on their own (without state support), thepatients have access to various activities while at TCID.
Theme Meal Kliewer 3Most of the patients admitted are malnourished and very underweight due to thephysiological effect TB has on the body. Nutrition and diet is very important for the patients sothat they may gain weight and recover from their disease/diseases. Dietary service plays a largerole on the patient’s recovery, furthermore, the patient’s interest in the food adds to theirtimely recovery. Dietary services should meet and aim to exceed patient expectations to betterthe food environment and food relationship for the patient.The theme meal lunch provided traditional Irish menu options with the followingnutrient profiles (Table 1). The corned beef is not the healthiest item, however, it was decidedwith the registered dietitian that the beef would be an item the patients had never been servedwhile at this facility. Initially a lamb stew was chosen as the main entrée. However, lamb wasthe entrée for the previous theme meal and was found to be costly. Therefore, corned beef waschosen to offer variety at a lower cost to the facility.
Kliewer 4Table 1Theme meal Nutrient AnalysisServingSizeTotalCaloriesTotalFatSaturatedFatCholesterol Carbohydrates Protein Sodium FiberMustard Glazed CornedBeef198 g 438 27 g 8.6 g 189 mg 13 g 23 g 846 mg 0 gRed Potato Colcannon1 cup 182 4 g 2 g 11 mg 31 g 6 g 653 mg 5 gFighting Green IrishSalad 2 cups 113 7 g 1 g 0 mg 10 g 3 g 152 mg 3 gBrown Soda Bread1 slice 169 1.9 g 0.9 g 6 mg 32.4 g 6.2 g 355 mg 3 gLucky Apple Crumble½ cup 264 5 g 0 g 0 mg 56 g 3 g 75 mg 3 gSilver Oaks Communications. (2009). Nutrition Calc Plus 3.2. The McGraw Hill Companies.
To excite and involve the patients for the theme meal, flyers were posted around thehospital in high traffic areas so that the patients and staff could read and plan for the meal. Thetime, date, theme, and courses being served were included on the flyers. Furthermore, therecreation director was contacted for participation in the theme meal. Ideas of crafts andactivities were provided for the recreation team so that the patients could participate inactivities specifically related to the theme meal. Marketing plays a role in any promotion. Bingo,arts and crafts, and trivia were used for the theme meal marketing. The promotional material,consumer survey, arts and crafts completed by the patients, and the meal can be viewed inAppendix I.The state facility receives budgeted funds every day for 72 people. The rate per person,per day is $5.87 daily for all three meals. Breakfast cost $1.87 per meal, leaving $2.00 for lunch,and $2.00 for dinner each day. Staff is allowed to purchase meals at $3.25 per meal, which isrecorded as profit. Although TCID is given money to provide for 72 patients, there are currentlyonly 44 patients at the hospital receiving meals from the cafeteria. Therefore, there is a cushionfor the cost of meals. The theme meal is given $144.00 (72 pt x $2.00) by the state and hasbeen made to serve 50 people; allowing $2.88 for each theme meal tray.Texas Center for Infectious Disease is unique in many ways, for example, the kitchenoften purchases food from venues that are not in their contract such as HEB. This is due to thefact that many of the patients are from other countries and request food items that are notstandard ordered items. Many patients are underweight, and weight maintenance and gain areimportant to the treatment of the patients: TCID works to provide the patients with their
Theme Meal Kliewer 6individual requests. Based on the monthly food service report from February, 2013, the facilityspent $1655.86 on food items purchased from HEB. Therefore, over ten percent of total foodcost is not on contract, which in turn raises the transportation cost of food because of thenumerous trips to HEB. The facility also has a total cost of $334.59 in stored food items,including frozen, USDA, and dry storage (February, 2013). There were items required in thetheme meal that were not on contract with the facility and had to be picked up from HEB.The total cost of the meal is based on the amount of product used and can be seen inTable 2 along with the ingredient list, standardized amount needed, and amount purchased.The recipes were standardized to fit the facility using Food for Fifty with the help of the headcook. Pricing for the theme meal was solely based on food cost. Pricing excluded labor,transportation, and inventory. The meal was estimated to have a food cost percentage of 163%based on 50 meals served, 20 were staff meals at $3.25 and 30 were patient meals at the statebudgeted $2.00.
Theme Meal Kliewer 7Table 2Theme Meal Cost AnalysisIngredient Amount Neededfor RecipeStandardizedAmountAmountPurchasedCost ofPurchased ItemsTotalFood CostAll Purpose Flour 13 1/2 cup 7 lbs 50 lb bag 13.74 1.92Whole Wheat Flour 10 cup 5 lbs 5 lb bag 2.98 2.98Baking Soda 7 1/2 tsp 0.09 lbs1 case (12 x 2lb bags) 14.43 0.05Salt 21 tsp 0.26 lbs 25 lb bag 3.77 0.04Buttermilk 10 cup 0.6 gallon 2 half gallons 2.15 1.29Small Red Potatoes 13 lbs 13 lbs 50 lb bag 22 5.72Butter 2 sticks, 16 Tbls 0.5 lbs 30 lb case 74.85 1.25Onions, Sliced 6 1/2 cup 3.4 lbs 50 lb bag 15 1.02Cabbage 7 heads 7 heads 7 heads 1.5 1.50low fat Milk 13 cups 6.5 pints 7x ½ pint 1.4 1.30white Pepper 3 1/4 tsp 0.5 oz 1 BLT (4 oz) 2.58 0.32Lemons 8 each 1 box 1 box 22.5 22.50Lemon Juice 1 1/2 cup 0.37 quarts 1 quart 2.47 0.91Canola Oil 15 1/2 cup .97 gallon 1 gallon 3.99 38.70Sugar 6 tsp 0.08 lbs 50 lb bag 26.52 0.04Pepper 1 1/2 tsp 0.02 lbs 4.25 lbs 24.31 0.11Boston or Bibb Lettuce 12 heads 12 heads 1 case (24 ct) 26 13.00Asparagus12 cup (6bunches) 6 bunches 6 bunches 2.98 2.98Peas, Shelled 12 cups 6.25 lbs 20 lbs 13.9 4.34Grape or CherryTomatoes 6 pints 6 pints 6 pints 1.88 1.88Light Brown Sugar 10 1/2 cup 5.5 lbs1 case (12 x 2lb bags) 26.13 5.99Brown Mustard 12 oz 12 oz 1 each (12 oz) 5.4 64.80Corned Beef (Beef brisket,32 lbs) 26.62 lbs 26.62 lbs 4.25 per lb 4.25 4.25Oats (42 OZ) 7 cup 56 oz1 case (12 x42 oz bags) 29.49 3.28Ground Cinnamon 10 1/2 tsp 0.13 lbs 1 lb 4.42 0.57Apple Juice Concentrate,Frozen 12 oz 12 oz1 can (12 floz) 0.97 0.97Apples, peeled, cored,thickly sliced 42 cups 70 each1 case (125ct) 38.5 21.56Total 388.11 203.29
Theme Meal Kliewer 8Theme Meal Part TwoThe theme meal was chosen for Thursday March 14, 2013 in celebration of St. Patrick’sDay. The theme was to bring cultural awareness to the patients by celebrating a familiarholiday. Traditional Irish food was the focus of the menu along with healthy cooking styles andingredients. The meal included red potato colcannon, fighting green Irish salad, brown sodabread, lucky apple crumble, and mustard glazed corned beef. The beef chosen is not thehealthiest cut of meat, however, after communication with the facilities preceptor, corned beefwas chosen for the purpose of can cutting, and to offer the patients a meat that had not beenpreviously available.Production was planned to serve 50 trays. The soda bread was made in four loaves andcut into 12 diagonal slices, producing only 48 slices. The other menu items produced enough for50 trays. The fighting green Irish salad ran out at 12:50 pm, ten minutes before lunch was over.The servings, leftovers, and what was done with the food after the meal can be seen in Table 3.Table 3Production AnalysisServings Made Servings LeftOverActionMustard Glazed Corned Beef 50 12 Save and offer at dinnerRed Potato Colcannon 50 3-4 Throw outFighting Green Irish Salad 50 0 Ran out at 12:50 pmBrown Soda Bread 48 6 Save and offer at dinnerLucky Apple Crumble 50 20 Save and offer at dinner
Theme Meal Kliewer 9The amount of meals served was 46, showing that a meal for 50 is adequate. Theamount of food leftover was predicted as the amount is common for this facility. The saladproved to be liked by the consumers due to the fact that the salad ran out. The apple crumblehad the most leftover, but this can be due to the fact that the consumers had three differentdessert options to choose from. It is important to note that the administration staff was senthome early, before lunch, due to a maintenance issue. Therefore, there could have easily beenover 50 trays served had they been there. The average trays served in the TCID facility is 50 forlunch, however, due to the popularity and success of the previous Navajo theme meal, the staffand patients might have been looking forward to another theme meal so that the turnout wasstill good at 46 trays.The planned budget was less than $400 total for the theme meal. This is over twice asmuch as what is given for a lunch meal by the state ($144). The budget is not strictly controlleddue to the fact that the cafeteria is receiving more money from the state than what they areusing on the patients. As discussed earlier, the facility receives money to provide for 72patients, while there are only 44 patients in the hospital at this time. Therefore, the thememeal was allowed to exceed the $144 budget. The actual food cost was $203.29 going over thestate allotment by $59.29, but under the facilities budget by $196.71. The forecasted food costpercentage was 163 percent and the actual food cost percentage was 177 percent. This isbecause there were only 46 trays served during the meal instead of 50 that was estimated.There were 18 staff trays, out of the 46 trays, served at $3.25 providing a $58.50 profit.However, the profit difference did not make up for the total cost of food, and the meal cost thefacility $88.79.
Theme Meal Kliewer 10A questionnaire was developed to target the consumer population. The purpose of thesurvey was to assess how the consumers perceived the meal and meal service. The survey wasbased on an agreement scale (A= agree, D= disagree, NE= neither agree nor disagree, N/A= notapplicable). The rating scales included neither agree/disagree and not applicable so that theconsumer did not feel pressured into an answer. Compared to other scale surveys, theagreement scale is more difficult and requires the surveyor to completely understand thestatement being rated. The survey developed had seven statements for the consumer to rateand an open-ended option so that comments about the meal experience could be left. Asdiscussed with the facility’s preceptor, the survey might be a little difficult for the patients, butit was agreed that a challenge would be beneficial to the patient population. In other TCIDactivities, the patients are encouraged to practice their English and written communicationskills, so the survey was concluded to be appropriate. The survey was personally handed toeach consumer after the consumer sat down. The consumer was encouraged to take the surveyon their own time and told that there are no right or wrong answers. The surveys were pickedup when finished as indicated by the consumer.The results from the consumer survey can be seen in Table 4. There were a total of 37(80%) surveys completed. There were approximately six people (loose estimate, based solely onobservations) who took the meal tray to-go and did not receive a survey. Two surveys left aquestion blank; therefore, those questions were adjusted for 36 total surveys.
Theme Meal Kliewer 11Table 4Survey ResultsA D NE N/AThe foodservice staff appeared professional 35(94%) 0 2(5%) 0The food was at the proper temperature (whether hot orcold) when served34(92%) 0 3(8%) 0The foodservice staff were polite and responded to anyquestions I had37(100%) 0 0 0Foods on the serving line appeared attractive 32(89%) 1(3%) 3(8%) 0The quality of ingredients meets my expectations 31(86%) 0 4(11%) 1(3%)The flavor of the food meets my expectations 33(89%) 0 3(8%) 1(3%)I would like to have this meal again 31(84%) 2(5%) 3(8%) 1(3%)Results displayed as n(%); number of consumers with percent of total in parenthesis.Of the 37 completed surveys, 27 agreed to every statement on the survey, while eightanswered differently, and two left a question blank. There were eight comments left for thosewho agreed to all seven questionnaire statements. The statements are listed below:Improve tea; too much waterTea too waterySoup is greatString beans need more flavorFun menu today, thank you. Soda bread, pea salad and beef were all very goodI’d like to come againI appreciated the effort that goes into having meals and different foods. ThanksGood survey. Good food, real good job with temperatures, and always good flavorThe consumers were not limited to the theme meal menu options and other options
Theme Meal Kliewer 12were available. The first four statements listed do not apply to the theme meal, rather to thefacility as they are about regular food items and the beverage. The last four statements doapply and reveal an appreciation of the meal. There were four comments left from those whomdid not agree to all seven of the questionnaire statements or who left a statement blank. Thestatements are listed below:Maybe a little more spices, but that’s my opinionLiked the salad with asparagus, meat was great/tenderUniforms would make professionalCook the asparagus longer, and then chill. It was tough.There were three comments left from the ten that did not agree to every statement. Thefirst statement listed was from a survey that agreed to all, but left one question blank andtherefore, was not included with the other agree surveys.Seventy-three percent of those who took the survey agreed to all questionnaire statementsand therefore, agreed that the foodservice staff appeared professional, the food was at theproper temperature, staff was polite, foods were attractive, ingredients met expectations,flavor met expectations, and they would like to have the St. Patrick’s Day meal again. Thequestion that had the lowest amount of agree ratings was the statement that the consumerswould want the meal again (n= 31). This shows that Irish food might not be accepted as well asother food items. This could be due to the lack of exposure, or simply that this population doesnot enjoy typical Irish food.The theme meal went as planned with no surprises or mishaps. The staff working at theTCID facility was very helpful and greatly contributed to the success of the meal. I personally did
Theme Meal Kliewer 13not enjoy much of the meal with the exception of the salad. However, the asparagus was notcut as thin as the recipe suggested, and therefore was a bit tough to eat. Also, the salad bar wasnot large enough to hold the theme salad and was placed on a table rather than ice. I wouldhave liked to have the asparagus thinly cut and the salad served on ice to maintain proper coldtemperatures.
Theme Meal Kliewer 14ReferencesAcademy of Nutrition and Dietetics Quality Management Committee. (2013). Academy ofNutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care andStandards of Professional Performance for Registered Dietitians. Journal of the Academyof Nutrition and Dietetics. In press.Silver Oaks Communications. (2009). Nutrition Calc Plus 3.2. The McGraw Hill Companies.West, B., Shugart, G., & Wilson, M. (1979). Food for Fifty. 6thed. John Wiley & Sons. NY
Theme Meal Kliewer 16oin us for lunch Thursday the 14th of March from11:30 am to 1:00 pm to celebrate a St. Patricks Daymeal in the TCID dining room. We will be servingtraditional St. Patricks Day foods that we hope foryou to enjoy!(Same standard price for staff!)On the Menu:ighting Irish Green Saladed Potato Colcannonoda Breadrown Sugar and Mustard Glazed Corned Beefucky Apple CrumbleJFRSBLFor each petal on the shamrockThis brings a wish your way-Good health, good luck, and happinessFor today and everyday
Theme Meal Kliewer 17Rate the following statements according to the scale by marking:A= Agree D= Disagree NE= Neither Agree nor Disagree N/A= Not ApplicablePlease list anything that would have made this meal and experience more favorable.Thank you for your time and participation. “May your blessings outnumber the shamrocks that grow,and may trouble avoid you wherever you go.” -Irish BlessingA D NE N/AThe foodservice staff appeared professionalThe food was at the proper temperature (whether hot or cold)when servedThe foodservice staff were polite and responded to anyquestions I hadFoods on the serving line appeared attractiveThe quality of ingredients meets my expectationsThe flavor of the food meets my expectationsI would like to have this meal again