Preparing food on the nursing unit

[CapeCodMermaid]

We are trying to get away from purchased supplements such as Boost, Ensure, Resource...ick...and will be making our own milk shakes and fruit smoothies. Does anyone have any policies or procedures for making things on the unit? Our CNAs have been making milk shakes for residents who refuse to eat for years but now we are told we need policies and education. Thanks.

[CrunchRN, ADN, RN]

What a wonderful idea. I would think training on hygeine in preparing them would be adequate, but perhaps your state has a department of whatever that could give you the final word on this?

I wish more places would do this.

[netglow, ASN, RN]

When in hospice, one site actually had a small ice cream parlor that opened daily mid afternoon. Set up with the freezer glass case for the ice cream and room for wheel chairs to come in. It really was stocked well and managed quite nicely. Was a big hit with the residents. Some LTC have this but it's a fake and never operating unless there is an open house or something.

[CapeCodMermaid, RN]

Thanks for the ideas. We have dish washers on the units and the cycle takes 3 minutes so keeping things clean isn't a problem. I think hair nets might be in order but I'll take the advice and check with the local board of health. Make mine chocolate!

[debRN0417]

If they are "physician ordered" suppliments they could come under scrutiny by the DHP regarding calories, additives--yada yada..but if they are something that you are doing for "snack" or "pleasure foods" then all you need to do is make sure that whatever ingredients are used are appropriately stored, dated and labeled when opened and that they are discarded after whatever your use by date is. Your dietary department should have guidelines as to what their storage regulations are. Staff should wear hairnets when preparing and of course use other good hygenic practices, handwashing and cleaning of blenders and whatever is used.

We should not get all twisted up and bent out of shape over offering our residents a snack or pleasure food. Like it was said in other posts, when you are home you graze whenever you want and mix up all sorts of concoctions to eat or drink. Home-make smoothies and milkshakes are so much more tasty and more readily accepted. You just have to make sure you are monitoring the fridge temps, and storing, dating and labeling all your stuf that you keep and use.

I have seen ice cream parlors and snack bars in some facilities that are used daily but I think the kitchen staff directed those. We never "inspected" those during the survey but the local health department might have. I don't know and frankly I wasn't really concerned about it because the residents loved them and were having such a good time and very excited about it...so if it's not broken, why mess with it?

[CapeCodMermaid, RN]

deb, you are not like any other surveyor I've ever met in my 20+ years in long term care. And I mean that as a compliment of the highest kind.

[debRN0417]

Thank you CCM. I appreciate that. I just try to live in the real world....

[achot chavi]

CCM, you will have to prove that your shakes are effective by monitoring protein levels, weight, iron levels etc. I am sure you do it anyway. As you already have a recipe from your dietitian I would advise you to make sure they stick to it, then it will be up to the dietitian to defend her recipe if needed. We had a situation where our kitchen made the supplementary shakes and the state was able to prove that the shake was lacking protein- the cook was skimping on the protein ingredients!

I would also have special shakes per patients individual needs (for example you can add prunes for patients who suffer from constipation, soy milk for dairy intolerant patients, sugar free for diabetics, extra bananas for those who need potassium rich diets etc). I dont think the state can complain as long as you can prove that the shakes are as effective as the nutritional supplements you mentioned. I would also monitor compliance of taking the canned supplements and compliance with the shake so you can prove increase compliance (if that is the case).

This is a great project, I wish you luck with it, but like with all else- document, document document!

[CapeCodMermaid, RN]

The recipes came from the dietitian. She calculated the protein and calories. We are starting on one unit and will check weights regularly. I'm not that worried about the protein..

Thanks for the suggestions.

[sharpeimom]

if the powers that be would come with a more precise recipe, a smoothie i am able to drink despite being lactose intolerant, is simple, filling, and infinitely variable (depending what's on hand) uses this base. for a single serving:

1 carton plain or flavored yogurt (i use fat free or low fat)

1 small banana or some of a big one

unsweetened juice -- to thin the yogurt

about a cup of crushed ice (or use frozen cut-up fruit)

blend and drink.

my husband is a type-1 diabetic and he loves these! some of our favorite

combos are:

banana plus fat-free peanut butter powder

banana plus about 4-6 cut-up strawberries

pineapple chunks plus 4-6 cut-up strawberries or raspberries

mixture of cut-up strawberries, raspberries, blueberries

chocolate and coconut extracts

pineapple, strawberries, coconut extract

orange sections, coconut or chocolate extract

we also add espresso, vanilla, or mocha protein powder

to our morning and mid-day ones.

[achot chavi]

CCM, I know that the recipe is from the dietitian, I probably wasnt clear, the cook who prepared our shakes was not following the recipe and skimped on the protein ingredients (which are more expensive) assuming no one would find out. State found out. They simply cross matched her invoices for ingredients that she bought and calculated how much she would need for the amount of shakes she was preparing and came up short....