Food service quality and nutrition intervention audits

Transcription

1 Learning Guide Food service quality and nutrition intervention audits Conduct food service quality audits and nutrition intervention audits in an aged care, health, or disability context Level 3 8 credits Name: Workplace: Issue 2.0

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3 Contents Introduction... 1 What is a food quality audit?... 2 Audit tools... 3 The importance of food service quality audits... 4 The Ministry of Health s Food and Nutrition Guidelines... 6 Preparing to conduct an audit... 9 Knowing the purpose of an audit... 9 Knowing the audit tool Organising the audit Explaining the purpose of the audit Conducting a food quality service audit Planned menus Suitability for meeting the person s needs Satisfaction Food service quality in kitchens Conducting a nutrition intervention audit Auditing therapeutic nutrition interventions Reporting back audit findings Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July 2015

4 Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July 2015

5 Introduction Many organisations provide meals to people who live in care. These meals have to meet certain standards. You will learn how to conduct audits for food to make sure they meet quality standards. How to use your learning guide This guide supports your learning and prepares you for the unit standard assessment. The activities and scenarios should be used as a general guide for learning. This guide relates to the following unit standard: Conduct food service quality audits and nutrition intervention audits in an aged care, health, or disability context (level 3, 5 credits) This guide is yours to keep. Make it your own by writing notes that help you remember things, or where you need to find more information. Follow the tips in the notes column. You may use highlight pens to show important information and ideas, and think about how this information applies to your work. You might find it helpful to talk to colleagues or your supervisor. Finish this learning guide before you start on the assessment. What you will learn This topic will help you to: understand food auditing for measuring quality and standards. conduct a food service quality audit. conduct a nutrition intervention audit. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

6 What is a food quality audit? An audit is a tool that is used to measure how well an organisation is meeting its requirements for quality, standards or outcomes. Many organisations are responsible for delivering meals to people who live in care. These organisations have an obligation to provide meals that meet certain standards. These standards come from two sources: 1 the organisation itself through its own policies and procedures. 2 external bodies such as the Ministry of Health. These standards exist around: food safety. nutritional requirements, including special diets and therapeutic interventions. appropriate modifications to allow the meal to be easily consumed by the person. the consumer s satisfaction with the food. Food service quality audits determine how well an organisation is meeting the required standards. These audits measure and provide information on how well: its own policies and procedures are being followed. individual persons nutritional needs are being met based on: the instructions from a dietitian. the information in each person s personal plan. the Ministry of Health s Food and Nutrition Guidelines. Nutrition is key to maintaining a person s function, energy levels, weight and health. Having appetising meals that meet the person s needs is essential to ensuring that they receive appropriate and adequate nutrition. Audits are important for ensuring that people living in aged care or other health contexts and people who require special diets and/or therapeutic nutrition interventions receive meals that: are safe. look and taste appetising. are physically able to be consumed (for example, appropriate texture modification, correct feeding procedure). meet their nutritional needs. meet their cultural and religious needs. cater to their personal preferences as appropriate. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

7 Audit tools An audit is conducted with an audit tool. An audit tool identifies the required standards to be met and allows you to record whether the organisation s practices meet those standards. Audit tools can come in a range of structures and sizes. They may be paper based or electronic. Audit tools usually consist of: a set of questions and/or a checklist of key considerations or factors that must be checked during the audit. ratings or check boxes that allow the findings to be recorded. For example: present/not present. compliant/not compliant. meets standard/does not meet standard. tick boxes to show an item is present or a process has been completed. a place for the auditor s comments or notes. With a paper based audit tool, the auditor carries the audit tool with them. They will check and mark off each item in a systematic way. The audit tool shows the areas that meet the required standards (are compliant) and the areas that do not meet the standard (are non-compliant). An example audit tool is shown in the following diagram. Source: New Zealand Dietetic Association: Menu Audit Tool for Aged Care Facilities. Available from Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

8 The importance of food service quality audits A food service quality audit is an audit of the provision of food services. Food service includes all aspect of meal provision, such as: menu planning. food storage and preparation. serving of meals. safety and hygiene. space and equipment requirements. food presentation (where appropriate). the consumer s satisfaction with the food. Food service quality audits are important because they help an organisation to be confident that it is meeting its obligations to provide people with appetising meals that meet their nutritional and personal needs. Audits do this by giving an organisation assurance that it is: operating with sound food safety principles and practices. reducing risk associated with the transport, storage, preparation and consumption of food. improving and/or maintaining each person s nutrition. Audits are also important because they help an organisation to improve the way it delivers food services. An audit may identify areas where the organisation s policies and procedures: are working well. are not being followed. could be improved. This is valuable information. The organisation can take the appropriate corrective action to improve its performance. In this way, audits have an important part to play in improving food service quality. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

9 Write What food service audit tools does your workplace use? List the audit tools used in your workplace here. You may like to attach a copy to this learning guide to refer to. Describe the purpose of two of these audit tools. 1 2 What areas are they used in? 1 2 What people are they used with? Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

10 The Ministry of Health s Food and Nutrition Guidelines The Ministry of Health has produced guidelines that identify the nutritional requirements and support the health and wellbeing of healthy people in five population groups. infants and toddlers (0 2). children and young people (2 18). pregnant and breastfeeding women. adults. older people. Healthy members of each population group need food from the four major food groups each day. The four major food groups are: 1 vegetables and fruit. 2 breads and cereals. 3 milk and milk products. 4 lean meat, chicken, seafood, eggs, legumes (cooked dried beans, peas and lentils), nuts and seeds. The food and nutrition guidelines give information on the recommended daily intakes/requirements for: energy. carbohydrates, fat and protein. nutrients and minerals, such as iron, calcium, sodium, zinc, iodine, selenium, fluoride, vitamin C, folate, thiamine, vitamin B12. fluids. These guidelines have two parts: 1 a background paper that gives comprehensive and detailed information on the nutritional requirements of these groups. 2 health education resources that summarise this information and present it in an attractive and easy to understand way. The food and nutrition guidelines are available from: The health education resources are available from: Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

11 The Ministry of Health s guidelines provide a framework or baseline information that can be used to support the health and wellbeing of the people in these population groups. For healthy adults or older adults, menus and meals should be based on these guidelines. A person s health and disability status and/or medical condition may mean their nutritional needs are different to those of a healthy person. Their needs may include a special diet or a therapeutic nutrition intervention, for example, a lactose or gluten free diet, or one designed for weight gain or loss. Therapeutic nutrition interventions are planned and purposeful treatments, including dietary supplements that aim to improve a person s nutritional status and/or reduce the risk of malnutrition. For those people who need therapeutic nutrition interventions or special diets there will be instructions from a dietitian or other appropriate health professional. The audit will need to measure the person s nutritional intake against their specific instructions as these will have been developed to ensure that their particular needs are met. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

12 Write How many servings a day do healthy members of each population group need from the four major food groups? Check the Ministry of Health s Food and Nutrition Guidelines if you are unsure. Age group Infants and toddlers (0-2) Vegetables and fruit Breads and cereals Milk and milk products Lean meat, chicken, seafood, eggs, legumes, nuts and seeds Children and young people (2-18) Pregnant and breastfeeding women Adults Older people Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

13 Preparing to conduct an audit Preparing for an audit is an important step in ensuring the audit runs smoothly. Preparation involves: knowing the purpose of the audit. knowing the audit tool. organising the audit. explaining the purpose of the audit. Knowing the purpose of an audit Audits are more likely to be successful when they have a very clear purpose. A clear purpose means you have to know what it is trying to measure (the standards required or audit criteria) and how to measure if those standards have been met. Audit criteria are specific statements about the standard or outcome relating to nutrition care and food service quality that is to be measured. The standards or outcomes need to be specific and measureable so that evidence can be gathered to show whether the standard is being met or not. For the audit to fulfil its purpose there must be clear identification of: the information and/or evidence that is needed to show that the standard or outcome is being met. how this evidence will be gathered. It is only with relevant and accurate information and/or evidence that the audit will reveal how well the organisation is performing and meeting its goals. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

14 To carry out a food services audit, you must have a good understanding of nutrition and the food service sector. You will need to have enough knowledge and experience in the following areas to be able to accurately judge whether a standard has been met. 1 Technical knowledge. For example, knowledge of: food hygiene and safety. nutritional requirements. the Ministry of Health s Food and Nutrition Guidelines. food and fluid modifications and when it is appropriate to use these. hazards during the preparation of food. 2 Understanding the instructions of a registered dietitian on a person s personal plan. 3 Knowing the policies, procedures and guidelines and being able to interpret these in relation to food services and how they meet the criteria set. 4 Professional conduct. Knowing how to behave in an ethical, impartial and professional way. Knowing the audit tool The audit tool defines the scope of the audit. It sets the boundaries of what will be checked and what the audit will and will not cover. Most workplaces will have audit tools that are already prepared. These will have been developed to cover the key areas that need to be checked. Your responsibilities will be to make sure you understand how the audit tool works. Understanding how the audit tool works involves knowing: the structure and length of the tool. the different sections of the tool. the standards that must be met. what evidence must be gathered to show that the standard has been met. how that evidence is to be gathered, for example, interviews with staff and/or consumers, physical checking of organisational documents, observation of kitchen practices and taking samples such as menu cycles. the criteria to determine if the standard has been met. For example, if five items need to be present to meet the standard and only four items are present, will the standard be met? If interview questions are to be used, it is important that the staff and/or the consumers of the food who need to be interviewed are identified and that the questions actually measure what they need to measure. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

15 Organising the audit Organising the audit involves making all the arrangements for the audit to occur. It includes contacting and communicating with the organisation to schedule dates that will be convenient for the audit to occur. It involves giving the organisation information about: the length of time the audit is expected to take (eg one or two days). who will need to be involved from the organisation, such as managers, kitchen staff, carers. who else will need to be involved, such as consumers or external contractors. what documentation the auditors will need access to. what resources the auditors will need to conduct the audit, for example, a room to work in. It is important that the audit is organised with enough time for the organisation to make the appropriate arrangements for the audit to run smoothly. It is often helpful to have an audit timetable. This schedules each stage of the audit so everyone knows what is happening at any one time. For example, the timetable can show where the audit will take place, meetings/interviews that have been scheduled and/or when observations will be occurring. Explaining the purpose of the audit Explaining the purpose of the audit involves making sure that the people in the organisation who will be involved or affected by the audit are aware that it is occurring and what its purpose is. This is to facilitate the co-operation and support of the people involved in the audit. Explaining the purpose of the audit includes: identifying who will be conducting the audit (membership of the audit team). explaining your role. explaining the benefits of the audit. explaining the process that will occur and what will happen at each stage/step. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

16 Conducting a food quality service audit Food service quality audits are based on: the Ministry of Health s Food and Nutrition Guidelines. suitability for meeting the person s needs as identified in their personal plan. the consumer s satisfaction with the food. food service quality in kitchens following the organisation s policies and procedures. Food service quality involves ensuring that people receive nutrition in accordance with the Ministry of Health s Food and Nutrition Guidelines. Auditing this involves analysing the menus, the number of servings and the nutritional requirements planned for people. It is important to remember that organisations base their menus on the Ministry s guidelines to feed all the people within their care. From this general menu, modifications are then made to meet the needs of individual person. For example, a low calorie dessert is offered to a diabetic person instead of the main dessert option. Planned menus The meals given to a person will be part of a planned menu. This menu will cover a period of time, for example four weeks. Menus are planned to allow the person to have meals that consistently provide for their nutritional needs but also give variety. An audit of a menu may check that: meals include food from the main food groups. These include the recommended daily servings from the four main food groups fruit and vegetables, breads and cereals, milk and milk products and lean meat, chicken, seafood, eggs, legumes (cooked dried beans, peas and lentils), nuts and seeds. a variety of foods is provided and a person s preferences are taken into account. seasonal fruit and vegetables are included. a variety of preparation methods, such as frying, roasting, steaming are used to prepare food. an assortment of flavours, textures, colours per meal, per day and per week is provided. sugar levels of foods on the menu are appropriate for the person. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

17 high sodium (salt) menu items (eg corned beef, bacon) are limited to once per day. people have available a variety of fluids, such as water, tea, coffee, juice, cordials, milk and high energy or protein beverages, throughout the day to enable the daily requirements to be met. portion sizes meet the required standards as determined by the Ministry of Health s Food and Nutrition Guidelines. An audit tool will contain specific standards to measure. Auditing planned menus may involve the following steps as outlined in the flowchart. Audit of menus Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

18 Write Choose a healthy adult on a normal diet. Obtain a copy of a full day s menu that applies to this person. Audit the menu to determine whether the person received the requirements as outlined in the Ministry of Health s Food and Nutrition Guidelines. An example of an audit tool is provided in the table below from the New Zealand Dietetic Association: Menu Audit Tool for Aged Care Facilities. You may use this or any other audit tool, for example, an audit tool your organisation uses. Menu planning audit Organisation Name of auditor: Standard Compliant Not yet compliant 1.1 At least three servings of vegetables each day. 1.2 At least two servings of fruit each day. 1.3 At least one serving of fruit or vegetable offered each day is fresh. 1.4 At least three servings of milk or milk products are offered each day, including incidental use in beverages. 1.5 At least 100 gm of cooked chicken, seafood, eggs, dried beans and lentils is available per day. 1.6 Fish (including canned) is offered at least three times per fortnight and includes some fatty fish. Did this meet the person s personal plan? Date: Comments Recommended corrective action Did this meet your organisation s policies and procedures? Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

19 Suitability for meeting the person s needs Food service quality audits aim to determine how well the meals and nutrition provided meet individual needs. Determining this involves auditing: how clearly the person s needs are identified in their personal plan. how appropriate the meals and snacks provided are. Clear identification of the person s needs The person s needs should be documented in their personal plan. A personal plan will have a nutrition component. This might be an additional supporting document. The meals a person receives must meet their nutritional needs as well as be served in a way that makes it possible for them to be consumed. A person s health and disability status may mean that the way they receive their food must change, such as texture modification or enteral feeding. Enteral feeding is tube feeding via the small intestine. It can be nasogastric (through the nose and into the stomach) for short term treatment or via a tube surgically inserted into the stomach or jejunum (second part of small intestine) for long term management. These people may have instructions from a dietitian and a speech language therapist to ensure they receive adequate nutrition in an appropriate way. Nutritional requirements Any modifications needed to areas such as food selection or consistency will be recorded in a personal plan. These instructions will also reflect any special additional requirements, such as low fat, high fibre, low sodium, lactose free, gluten free. The instructions for any therapeutic nutrition interventions will be recorded. An audit should check that the nutrition component of the person s personal plan is being implemented and monitored. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

20 The nutrition component of the person s personal plan may be audited to check: that the nutrition component of the plan is up-to-date and reflects the person s current needs. that all instructions for the person s nutrition, including special dietary requirements are documented and the information is readily available to appropriate staff, for example, portion size, texture modification, eating aids, assistance with feeding, behaviour support and any therapeutic nutrition interventions. that the nutrition component of the plan is reviewed as set out in the organisation s policies and procedures. For example, if the organisation s policy states a six-monthly review, then there is evidence of that review occurring every six months. that the nutrition plan is revised in response to the person s changing needs. For example, updated in response to instructions from a dietitian or doctor or reassessment of the person. the person s weight is taken and recorded as per the instructions of the dietitian or other health professional. that monitoring is occurring to ensure implementation of the plan, for example, observation at meal times, documentation or notes taken by staff. Information and relevant data that may be gathered as a part of this auditing process can include: consumer/patient notes. records of discussions from staff meetings/shift changeover. records that monitor daily intake of food and/or fluid to track and evaluate the implementation and monitoring of the plan. Safety and security Information relating to safety and security will include the level of support, supervision or assistance with eating and drinking needed to ensure a person s comfort, safety, independence and dignity. This information may also include any relevant details about: allergies or food intolerances. eating habits and behaviours. strengths and abilities. the need for assistive devices. the use of seating modifications and body position. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

21 Personal preferences These may include: diet choice such as vegan or vegetarian. likes and dislikes. cultural or religious needs, for example, halal meat or kosher foods. social and emotional needs that may involve adaptations to the meal time environment. When auditing whether the food service quality is suitable for a person, it is important to check that the person is not being served food items that they will be unable to eat. Appropriate meals and snacks Meals and snacks given to the person should be audited to ensure they are compliant with the instructions on the personal plan. If the person requires a special diet, then the audit must check that this is the meal the person receives. The audit should check the organisation s processes for delivering any nutritional supplements to people. Nutritional supplements are often used to supplement a person s normal eating and drinking and must be given in accordance with the instructions on the person s personal plan. Where nutritional supplements are being given as a complete food, the audit should check the organisation s processes to monitor the amount consumed or wasted. Procedures associated with the giving of nutritional supplements, such as documenting amounts and times given, regular monitoring of the person s body weight must be audited to ensure they are being followed. Meal is appropriate for the person to consume An audit should check that people are receiving meals that are appropriate for them to consume. For example, if a person requires a texture modified meal, did they actually receive that texture modified meal and was the texture modification correct? Every texture modified food or fluid will have a standard to be met. Modified fluids are: Level 150 (Mildly thick). Level 400 (Moderately thick). Level 900 (Extremely thick). Modified foods are: Texture A (Soft). Texture B (Minced and moist). Texture C (Smooth pureed). Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

22 Example procedures for auditing are described in the following flowcharts. The word client in diagram refers to the consumer, the person consuming the meal. Audit of appropriateness of texture modified food Audit of if food is appetising Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

23 Meal is appetising People will be encouraged to eat, and therefore obtain good nutrition, if the food is appetising and inviting to eat (well presented). It is very important that food is appealing, particularly for people who are unwell, experience a lack of motivation to eat (for example, through side effects of medications) or have difficulty chewing or swallowing. Determining if a meal is appetising can involve the auditor evaluating a meal given to the person against a set of characteristics, such as, aroma, temperature, appearance, taste, texture and presentation. Characteristic Aroma Description A food item with an acceptable aroma has a pleasant aroma. Food that has been modified should have an aroma similar to unmodified food. Temperature A food item with an acceptable temperature is served at an appropriate temperature (hot foods served hot and cold foods served cold). Appearance Taste A food item with an acceptable appearance will look appetising. Appetising includes shape, size, colour, surface condition, pleasing arrangement of the items on the plate. Texture modified foods resemble unmodified foods. A food with an acceptable taste has an appropriate taste. There is no unpleasant after-taste. Texture Presentation Texture is the structure and feel of the food item. A food item with an acceptable texture will have an appropriate consistency. For example, crunchy salad or smooth mashed potatoes. Unacceptable textures include watery soup, lumpy mashed potatoes, limp or soggy salad. The meal is attractively presented. The auditor can evaluate these characteristics by tasting or sampling the food the person would receive. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

24 Write Identify three people you work with. Make sure each person has a different medical diagnosis. You will need a copy of their personal plan. Complete the table below. What is their age group? For example: older adult What is the medical diagnosis of person? For example: dementia, diabetic. What are their nutritional needs as identified in their personal plan? Person 1 Person 2 Person 3 What special dietary considerations does the person have? What food modification is the person receiving (if any)? For example: modified fluids or texture, enteral feeding. What personal, cultural or religious preferences need to be taken into account? Is the person satisfied with their food? If not, what would improve this? What other considerations would need to be audited to ensure needs are being met? Eg frail, so fortified high-protein supplements. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

25 Satisfaction Satisfaction is a key part in getting people to eat the meals that have been prepared for them. Auditing people s satisfaction comes from obtaining feedback from them. Determining people s satisfaction and enjoyment of the meals can also be obtained through interviews or discussions with them. Questions can be designed to elicit their feedback and comments can be recorded by the auditor on the tool. Either one, or a number of people can be interviewed to audit satisfaction. Example questions that may be asked include: How was your meal? Does the food taste good? Does the food look good? Are the hot foods hot enough? Are the cold foods cold enough? Do you usually get enough to eat? Do you eat most of the food you receive at each meal? If you do not like the meal served, are you offered another choice? People can be given a choice of answering yes or no or marking a scale. It is also important to meet the person s cultural, religious and personal preferences in food. Find out what audit tool your workplace uses to measure people s satisfaction. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

26 Food service quality in kitchens Organisations have policies and procedures to define acceptable standards of service, ensure consistency of practice and deliver quality services. Effective policies and procedures: define and communicate the standards and outcomes required. define and communicate the systems and processes to be followed to achieve those standards. define and communicate acceptable and best practice. ensure food safety and hygiene at all times. promote consistency in service delivery. Policies and procedures must be written and located in a way that makes them accessible to all staff so they can be understood and followed. The role of an audit is to measure how well an organisation s practice meets the standards set in their policies and procedures. People rely on an organisation to deliver food to meet certain standards, such as consistently appealing, health and safety standards and nutritional and personal requirements. Adherence to policies and procedures by all staff is critical to ensuring food safety and hygiene. The policies and procedures that are audited may vary depending on the type and scope of audit being performed. Examples of the types of policies and procedures that may be audited include: food purchasing guidelines and requirements. standards for special diets that specify amounts, types and modifications to foods. food production, including: food safety and hygiene. cleaning schedules. waste management. service of food and the provision of appropriate assistance to people. standardisation of recipes. communication and documentation to keep, maintain and convey information relating to food production and person s nutritional needs. The scope of the audit will determine the specific policies and procedures that are audited and the evidence that needs to be used. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

27 Conducting a nutrition intervention audit Some people will require additional nutrition support through nutrition interventions. These people may have been identified through nutrition screening tools. Alternatively, the particular health or disability status of a person may mean they cannot consume food in the conventional way. Thus, nutrition interventions such as special diets, nutritional supplements or enteral feeding are required. As these people must also receive adequate and appropriate nutrition, it may be necessary to conduct nutrition intervention audits. Any therapeutic nutrition interventions must be consistent with the Ministry of Health s Food and Nutrition Guidelines. The purpose of the nutrition intervention will be to provide, as closely as possible, nutrition that meets the recommended intakes as stated in the guidelines. A dietitian or a doctor will give instructions as to what appropriate nutrition interventions should be and how these interventions will be assisting a person s nutritional status. The instructions will be recorded on the individual s personal plan and these instructions will be a key part of the audit. Auditing therapeutic nutrition interventions The purpose of auditing therapeutic nutrition interventions is to ensure that the person is receiving nutrition that meets the instructions of the registered dietitian and conforms as much as possible to the Ministry of Health s Food and Nutrition Guidelines. Audits may be required to ensure that the dietitian s instructions are being followed for people: on special diets. receiving nutritional supplements. receiving enteral feeding. The person s personal plan must be followed, including any personal, cultural or religious preferences and any other needs. The person s data must be recorded and monitored. This includes: weight records. food and fluid intake records. level of ability to access food independently at meal times. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

28 Auditing special diets The audit process for people on special diets is essentially the same as for healthy people. Your workplace will have audit tools to use or you will follow a process similar to that of auditing the meals given to healthy adults. Considerations for auditing people on special diets may include: special dietary needs are documented in the person s personal plan and the information is readily available to the appropriate staff. staff responsible for the provision of meals have adequate training in providing meals to people on special diets. a nutritional and varied diet is provided. acceptable and appropriate snacks are provided between meals. suitable drinks are available. people s preferences are included in the meals where possible. Auditing the provision of nutritional supplements Nutritional supplements can include: nutritionally complete pre-packed drinks. Examples of oral nutritional supplements are Fortisip, Ensure, Sustagen, Fibresource. vitamin/mineral tablets. extra calcium in powdered milk. Nutritional supplements aim to improve the person s overall food and fluid intake to improve their nutritional status. It is important that the total intake from normal food plus the nutritional supplements provides a balanced mix of energy, protein and micronutrients. As vitamins and minerals can be harmful if given in excessive doses, it is important that the amount of vitamins and minerals received does not exceed the upper limits. The Ministry of Health s Food and Nutrition Guidelines give information on amounts of micronutrients suitable for healthy older adults. A dietitian will give instructions as to what supplements are to be given and how often they are to be given to ensure that the person receives an appropriate level of support. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

29 Considerations for auditing people receiving nutritional supplements may include: the correct nutritional supplement is given to the right person at the right time and that there is a system in place to ensure this is done and recorded. the person is not receiving an excessive dose of vitamins or minerals from the total food and nutritional supplements consumed. the person receives pre-packaged drinks that are to their liking, for example, a flavour they enjoy or a mixture of flavours for variety. adequate monitoring of the effectiveness of the nutritional supplements is occurring. This may include: regular monitoring of the person s BMI, weight and nutritional status. regular reassessment by a dietitian. there are no adverse effects of the supplement, for example, nausea or diarrhoea. the supplement is not interfering with prescription medications. any wastage of the supplement. Fortisip is a nutritional supplement. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

30 Auditing people receiving enteral feeding People receiving enteral feeding should have all relevant information relating to the feeding on their personal plan, for example: the name of the product/formula they are being fed and the correct rate of flow. feeding volume. method of administration, for example, rate of feeding, temperature of feeding. times of feeding. precautions to maintain hygiene and prevent bacterial contamination. flushing instructions and medication administration. disposal or washing of feeding bags. positioning instructions. monitoring criteria, such as weight records and weight goals. instructions for any leftover product. instructions for any oral feeding, such as ice chips. When conducting the audit, you should observe the feeding procedure and complete the audit. Each individual audit criteria is observed or checked and then marked as compliant or as not meeting the required standard. Any issues are noted for reporting back to the organisation. It is important to be aware of how the audit should be conducted so that the dignity of the person is maintained. Auditing the provision of enteral feeding can include the following areas: the person s personal plan contains all information relating to the enteral feeding. the formula is prepared in a clean and safe manner. the correct product is used. the correct amount of product is given. the person is positioned correctly during the enteral feeding. the person is positioned correctly for the required length of time after the enteral feeding. the correct rate of flow for the product/formula is given. the procedure to flush the tube is done correctly. the bag is washed and stored according to the organisation s policies and procedures. all records of the feeding are accurate and complete. appropriate monitoring of the person s nutrition status occurs. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

31 Reporting back audit findings The purpose of audits is to give the organisation information about their performance. At the end of the audit, a report should be prepared that communicates the audit findings to the organisation. The audit report must be signed by the auditor and should identify areas where the organisation: meets the required standards. needs to improve its performance. Reporting back the audit findings is an essential part of the auditing process. Each audit allows the organisation to further improve its performance so that quality standards are maintained or enhanced. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July

32 Write What audit tool do you use to audit the provision of nutritional supplements? You may like to attach a copy to this learning guide to refer to. What audit tool do you use to audit enteral feeding? You may like to attach a copy to this learning guide to refer to. How do the criteria in the audit tool you use differ from what is in this learning guide? List the procedure you follow in reporting the findings of your audits. Include who you report to, how you report, what feedback you give when standards are not met and what happens as a result of your findings. Food service quality and nutrition intervention audits (US 27456) Learning Guide Careerforce Issue 2.0 July