Sally Grace Reed March 25, 2014 In Service Summary After several complaints from the speech therapist

and 8 tray line accuracy audits, an in service was conducted amongst all kitchen and dietary staff, which highlighted the need to adhere to diet prescriptions. Prior to the in service, a pre-evaluation was given to all staff consisting of 10 questions to gauge each employees knowledge of diet prescriptions and individual compliance (see below for evaluation). Results from the initial survey indicated that only 75% of the staff felt that following diet prescriptions for all meals was important. 50% of employees answered questions 2-6 incorrectly and 25% of staff thought that only the CNAs were responsible for making sure that residents are given the appropriate food items at each meal. The post in-service evaluation showed a huge improvement on staff knowledge; as almost every staff member was able to answer each question correctly. The in service began with a brief review of the Sysco standard LTC diet descriptions and then more in depth conversation about the terms mechanical soft versus chopped. The diet descriptions were given as a handout to each employee and were also posted in the kitchen and dining rooms as a resource file. Emphasis was placed on food as an essential component of quality of life; an unacceptable or unpalatable diet can result in poor intake, weight loss, under-nutrition and a spiral of negative health effects. The staff was then allowed to bring up areas in which they felt needed improvement. Kitchen staff verbalized that the tray tickets were too wordy and it was hard to see the diet order and patient preferences. Dietary employees also complained that because the procedure for carrying out meal service had changed so many times in recent

months that everyone was confused on the way they were supposed to complete their assigned tasks. Ways in which these issues could be solved were discussed and implemented, including clearing menu items from tray tickets and leaving only diet instructions. Although many employees were resistant to change, most everyone agreed that the current method of tray line production was not meeting the facility standards or respecting the patients right to be served the correct food items. Everyone ultimately agreed that they all needed to pay more attention to diet prescriptions and that by working together as a team it was possible to reduce the number of errors in tray line production. After going through my evaluation with my preceptor, I felt like I had done a good job conducting the in-service. We both agreed that additional education, as the menu changes will be helpful in the future. In the future, I would try and plan a more interactive in-service. The staff really liked giving their input and appreciated when I asked them how they felt. I asked a few questions, but I could have asked even more to keep the conversation going. Overall, it was a productive in-service and I felt like everyone left feeling encouraged and equipped with the correct information for success.

Pre/Post Staff Evaluation 1. How important is it to follow residents diet orders for all meals? (Circle your answer, 1- not important, 10- very important) 1 2 3 4 5 6 7 8 9 10

2. Can residents on a mechanical soft diet have the regular food items without modification? Circle your answer. YES NO SOMETIMES

3. Do mechanical soft, chopped, and ground mean the same thing? Circle your answer. YES NO SOMETIMES 4. Which is the correct definition of chopped meat? a. A slice of meat. b. A slice of meat with gravy. c. Soft meat that is easy to chew and diced into bite size pieces. d. Meat that has been ground in the food processor. 5. Which is the correct definition of ground meat? a. A slice of meat. b. A slice of meat with gravy. c. Soft meat that is easy to chew and diced into bite size pieces. d. Meat that has been ground in the food processor. 6. Can diabetic patients have the same dessert as patients on a regular diet? Circle your answer. YES NO SOMETIMES

7. Who is responsible for making sure that residents are given the appropriate food items at each meal? Fill in the blank. _______________________________________ 8. Is it okay to substitute a Health Shake for a Magic Cup? Circle your answer. YES NO SOMETIMES

9. Can a patient whose diet order lists nectar thick or honey thick have regular ginger ale, tea or lemonade? Circle your answer. YES NO SOMETIMES

10. Where is the diet prescription listed on a residents tray ticket? Circle your answer. a. At the bottom in all caps, bold letters. b. It is not on the ticket. c. At the top in all caps, bold letters. d. I am not sure.