Preparing food on the nursing unit

rn4ever? · Jan 9, 2012

Is that part of your cost-cutting measures? I see a couple of issues with that. First, the person doing the shake must be trained & educated in what to make. They should know something about the appropriate nutrition a certain patient with health issues should have. What are also the contraindications. Also, it should be done in a clean and hygienic way. What if it gets contaminated? What if the fruits also get contaminated? Maybe your Registered Dietitians could be a big help on this?

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.

CapeCodMermaid, RN · Jan 9, 2012

No, it's part of trying to make what we feed the residents taste like real food and not chemicals from a can.

We have a printed recipe which the dietician has reviewed and the protein and calories are comparable to the purchased supplements.I'm trying to keep this as simple as I can. I don't really think the DPH is going to site me for giving residents yummy shakes instead of Boost.

merlee · Jan 10, 2012

Why don't these shakes/smoothies come from your actual kitchen??? Why are the CNAs expected to add this to their duties?

I'm having a problem with this situation. Before you know it, all of your AAO pts will be requesting these at all hours.....

CapeCodMermaid, RN · Jan 10, 2012

My staffing ratio is 5 or 6 residents to one CNA. They have more than enough time to make someone a shake. We bake cookies together, go apple picking, decorate the units together. It's their HOME. If I want a snack at home I go to my kitchen and get one...whenever I want. Certainly it's not too much to ask that our residents can do the same, or if they are not capable of making their own, ask a staff member to do it. We have kitchens on each unit.

Nascar nurse, ASN, RN · Jan 10, 2012

My staffing ratio is 5 or 6 residents to one CNA. They have more than enough time to make someone a shake. We bake cookies together, go apple picking, decorate the units together. It's their HOME. If I want a snack at home I go to my kitchen and get one...whenever I want. Certainly it's not too much to ask that our residents can do the same, or if they are not capable of making their own, ask a staff member to do it. We have kitchens on each unit.

See, this is exactly why I think you are one of the best. I just love your attitude (not meant as a negative attitude at all). Sorry, can't offer any help. I'm stuck with a CNA ratio of 12:1 so making milkshakes is out of the question - but this is the way it should be!

Lynx25, LPN · Jan 10, 2012

Oh my Lord I want to work there...

I love this idea. I've tasted a couple of the supplements we serve... pretty gnarly- especially the canned ones... you can smell the chemicals as soon as you pop the top. It's a wonderful idea, but with a 15-20 to 1 ratio, it's not going to happen here. :

SCSTxRN · Jan 10, 2012

....now we are told we need policies and education. Thanks.

It would seem appropriate that they be made in the kitchen, since there is one on every unit - at our LTAC, they were made in the med room - and that was a PITA and a mess besides.

Anyway - so far as policies,

You likely need a 'disinfection procedure' for the blender (hot soap and water, followed by rinsing with hot water)

A storage and dating procedure for the berries (the JC seems to like 3 days) so the berries will be stored in labeled containers (to prevent cross contamination / allergies / etc) and labeled with the date of purchase and expiration date (three days later). Log on the front of the storage refrigerator to document temperature checks daily and clean up / storage.

And maybe a food handler's permit for your CNAs, if it's required to work fast food where you're at.

That seems like it would be sufficient, but ymmv.

runnergirl86, BSN, MSN · Jan 10, 2012

I worked at a resident directed facility such as you are explaining. We had a 8:1 ratio during the day and 12:1 in the evening for the CNAs with one RN. The CNAs and myself, the nurse, would make scrambled eggs, sandwiches, banana splits, and on and on for residents per request because as you said- it is their HOME!

We were required to have a food handlers permit and be trained on how to use the dishwasher (there were industrial tray sized ones in each kitchen).

Regarding keeping the food stored and everything, we would label and date anything in the fridge and the food host was educated on what things needed to be tossed after X amount of days.

Good luck, I know that the residents appreciated it, and multiple times during the week the food host would bake cookies, make milkshakes, or even offer cake for residents to eat. Add a little milk to a soft cake and even people on a pureed diet can tolerate it.

DixieRedHead, ASN, RN · Jan 10, 2012

Nascar, I have always felt that losing the ability to graze in one's own kitchen would be the worst part of going into long term care. How many times are we hungry, don't know what we want, and just go to the fridge, or cabinet and look around? Usually that it is lost in long term care.

Congratulations on a great job, and good luck.

Esme12, ASN, BSN, RN · Jan 10, 2012

It would seem appropriate that they be made in the kitchen, since there is one on every unit - at our LTAC, they were made in the med room - and that was a PITA and a mess besides.
Anyway - so far as policies,
You likely need a 'disinfection procedure' for the blender (hot soap and water, followed by rinsing with hot water)
A storage and dating procedure for the berries (the JC seems to like 3 days) so the berries will be stored in labeled containers (to prevent cross contamination / allergies / etc) and labeled with the date of purchase and expiration date (three days later). Log on the front of the storage refrigerator to document temperature checks daily and clean up / storage.
And maybe a food handler's permit for your CNAs, if it's required to work fast food where you're at.
That seems like it would be sufficient, but ymmv.

I agree. I would look up safe food handling laws for you state, MA, if your name is location, and I would check with the Board of Health for any required certifications for food prepared outside of the kitchen as a nutritional supplement. Your dietician may be able to help you.

What a wonderful idea!!!

SHGR, MSN, RN, CNS · Jan 10, 2012

Wow, I envy you! When I worked in LTC...it was the exact opposite of the place you are describing.

And kudos to you for getting away from the canned chemical supplements!