THERAPEUTIC DIETS PROTOCOL –STRATHMARTINE CENTRE.

There is a requirement for a protocol to be in place for the provision of therapeutic diets throughout NHS Tayside(Reference 1 & 2).This protocol contains the procedures to be taken to ensure patients receive the correct food for their dietary needs. It is summarised at the end of this document (Appendix 1).

On admission to hospital all clients should be assessed by nursing staff within 24 hours of admission,using MUST, to see if they have specific dietary needs, e.g. energy dense, texture modified or a cultural / ethnic diet. The Learning Disability Malnutrition Universal Screening Tool MUST documentation is held at ward level in the MUST folder.It is important that the needs identified by the MUST are communicated to the catering and dietetic departments as soon as possible so as to avoid confusion and to prevent possible serious harm or cause offence to the patient.

THERAPEUTIC DIETS

1.Texture modified diet - ward staff should:

-contact the Speech and Language Therapists (SLT) for guidance on the specific texture required (i.e. Textures C, D & Eas per NHS Tayside descriptors for texture modification).

-notify the dietitian and the diet kitchen at RVH to enable the diet to be provided for the first meal and until the menus catch up. Thereafter Staff should use the peach texture modified menu (in the MUST folder) to order all texture modified diets from the catering department.The dietitian will arrange for the provision of appropriate thickening agents if required.

2.Higher energy diet:

–Identified clients will have a MUST score of equal to or greater than 1.

Ward staff should:

- encourage the client to choose the higher energy options from the standard menu.The dietitian will liaise with the kitchen and arrange for the ward to receive appropriate additional items, e.g. double cream, higher energy yogurts, etc.

- reassess the client after 3 days and take appropriate action as per MUST guidelines.

The following information sheets are kept in the MUST folder at ward level:

  • Pictorial information: “How to Enrich Your Food”
  • “Food choices when your appetite is poor”
  • “Nutritional Supplement Drinks – Getting the most from your supplement drinks”

3. For all other therapeutic dietsthe ward staff should notify the dietitian and contact the catering department with the requirement to enable the diet to be provided for the first meal.Thereafter ward staff should clearly mark the bulk menu with the patient’s name, specific dietary requirement and preferred choice e.g. Smith - Gluten free - Lunch - lentil soup, mince and potatoes, peaches and ice- cream. Tea - cheese and tomato sandwich and jelly whip. Supper - ginger cake. The following are examples of other therapeutic diets:-

  • MAOI diets.
  • Reduced Lactose/Lactose Free
  • Reduced Salt/ Sodium.
  • Milk/Dairy/Egg/Nut/Shellfish Free.
  • Gluten/Wheat Free
  • Renal diets.

The disciplines involved for each of the therapeutic diets are listed in the Strathmartine Diet Matrix (Appendix 2)

NON THERAPEUTIC DIETS

1. Weight management – ward staff should encourage the client to choose healthy eating options form the menu and lower fat and sugar options when out shopping.The following weight management guidelines are kept in the MUST folderat ward level:

  • “Supporting Healthier Choices”

2. Halal and vegetarian diets – these should be ordered from the kitchen at RVH for the first meal and until menus catch up.

A Halal menu is available, printed in several languages. This is held at ward level within the MUST folder. To order mark the bulk menu clearly with the client’s name and desired choice, e.g.Lunch: Onion Bhajis, Lamb Daal, Chotta Naan Bread and Green salad. Evening meal: No starter, Keema and peas, mango chutney.

Puddings and snacks should be added on to the bulk menu.

If a patient also requires their Halal meal to be texture modified this can be provided. Due to differences in observance of food laws this may be done in house or by sourcing of an already texture modified Halal meal bought in. NHS Tayside is awaiting confirmation from National Procurement who the provider of this will be as current supplier does not satisfy the religious councils requirements. As soon as there has been a resolution this information will be communicated accordingly.

An à la carte vegetarian menu is also available for patients that do not want the vegetarian selection on the daily menu. This is held at ward level within the MUST folder. To order, refer to the appropriate day and meal and order by marking the bulk menu clearly with the patient’s name and dish required e.g. Jones: Lunch -Baked potato and beans, Evening meal- vegetarian sausage casserole. Soups, puddings and snacks can be added on to the bulk menu. If a vegetarian meal also requires to be texture modified please clearly state the texture needed e.g. Tex C

Vegan diets can be provided for by telephoning the kitchen who will ensure that something suitable is provide. Due to extremely small demand for this currently, choice cannot be guaranteed. However it would be useful if the ward could communicate to the diet cook the patient’s usual dietary intake so this can be taken into consideration when planning meals. If this requires to be texture modified please clearly state the texture needed e.g. Tex C
If the client’s nutritional status is compromised the dietitian should be informed.

3. Finger foods

–Finger foods may be considered for clients, such as those with dementia, who have difficulty suing/recognizing cutlery but can eat with their hands

–The finger foods menu contains items that are easy to hold

–The finger foods menu provides and additional two choices of main dish at lunch and evening meal

–It should be used alongside the main menu with items on the Finger food menu selected when there is no suitable main dish for lunch or evening meal on the main menu

–Suitable breakfast items, vegetables, potatoes, fruit. Puddings and snacks should be chosen from the main menu. These are coded F

–The Finger foods menu contains items that may be high in fat, salt and sugar and may not be nutritionally balanced therefore it is important to select a range of items form the main menu also

–The Finger food menu should only be used on the recommendation of the Senior Charge Nurse

–Please write “Finger foods chosen from the finger foods list” on the bottom of the menu

Oral Nutritional Supplements and thickening agents

If a client is admitted and is already receiving a prescribed supplement drink, ward staff should note the name and volume of supplementary drink taken and inform the dietitian. The dietitian will endeavor to make this available within 24hours

The ward and dietitian will liaise to ensure that there is a continuous and appropriate supply for as long as necessary.

Appendix 1 to this document shows a One-page chart of the procedure to be followed.

Appendix 2 to this document shows the Strathmartine CentreMatrix

Reference documents for this protocol are numbered and listed below: -

1. Quality Improvement Scotland(2003) Food, Fluid and Nutritional Care in Hospitals, QIS: Scotland

2. Scottish Executive (2008) Food in Hospitals: National Catering and Nutrition Specification for Food and Fluid Provision in Scotland

N:\Dietetics\Shared dietetics\QIS FFNC\QIS catering\therapeutic diet protocols

Copyright © 2012. Catering Department, NHS Tayside. This publication can be used or reproduced including photocopying, for non-commercial purposes. We request that the source and Copyright owners be acknowledged and that the material is not substantially altered in any way. Applications for use outwith these terms should be forwarded in writing to the Catering Department, NHS Tayside.

Appendix 1 STRATHMARTINE CENTRE- NORMAL / THERAPEUTIC / OTHER DIET PROCEDURE FLOW CHART

Appendix 2 STRATHMARTINE CENTRE - DIET MATRIX

DIET TYPE
/ WARD STAFF
INPUT
/ DIET AUTHORISED BY / PROVIDED BY CATERING DEPT /
COMMENTS
SLT / DIETITIAN
Texture Modified / * / * / * / * / Refer to SLT & notify dietitian.
Order Texture E from main ward menu. Additional choices for Texture E and other modified diets, i.e. Textures C & D ordered from the texture modified menu (peach menu)
Energy Dense / * / * / * / Follow MUST Management Guidelines. Encourage suitable choices from menu. Refer to pictorial information for guidelines on how to enrich food and drink (held at ward level in MUST folder)
Supplementary drinks and thickening agents / * / * / Refer to dietitian
Other therapeutic diet e.g. MAOI, Reduced Lactose/Lactose Free,Reduced Salt/ Sodium,Milk/Dairy/Egg Free,
Gluten/Wheat Free,Renal diets / * / * / * / Refer to dietitian
Normal dietary requirements, including healthy Eating/ diabetic/ weight reduction / * / * / Encourage healthy choices from menu. Refer to “Supporting Healthier Choices” information for weight management guidelines (held at ward level in MUST folder)
Finger food / * / * / Finger food menu held at ward level in the MUST folder.
Select items from the Finger Foods Menu when there is no suitable main dish for lunch or evening meal on the main menu.
Suitable breakfast items, vegetables, potatoes, fruit, puddings and snacks should be chosen from the main menu. These are coded F.
Vegetarians / Vegan / * / * / Vegetarian menu held at ward level in MUST folder. Vegan diets are available on an as required basis. Order from RVH kitchen.
Ethnic, Religious & Cultural / * / * / Halal menu held at ward level in MUST folder in several languages. Order from RVH kitchen.

N:\Dietetics\Shared dietetics\QIS FFNC\QIS catering\therapeutic diet protocols

Copyright © 2012. Catering Department, NHS Tayside. This publication can be used or reproduced including photocopying, for non-commercial purposes. We request that the source and Copyright owners be acknowledged and that the material is not substantially altered in any way. Applications for use outwith these terms should be forwarded in writing to the Catering Department, NHS Tayside.