menu project

Running head: MENU EVALUATION PROJECT 1

Menu Evaluation Project

Molly Chaffin

The University of Southern Mississippi

MENU EVALUATION PROJECT 2

Introduction

The Veterans Health Administration (VHA) of Biloxi offers a three-week cycle menu

prepared using the cook-chill method. The menus currently in use at the VHA have been

established for many years. These menus were originally created to offer regionally preferred

foods that meet the nutrient guidelines necessary for the patient population. Small changes have

been made to the original menu due to supplier availability and initiatives for healthier meal

service. Modifications such as omitting salt and high-sodium seasonings in food preparation and

decreasing the availability of fried menu items have occurred since the original menu was

created; however, the menu options have remained virtually static since their creation many

years ago.

Menu Planning

Menu items, particularly entres and alternatives, were initially established with the

therapeutic diets in mind. Alternative entre items were often chosen to accommodate

appropriate substitutions for preferences and dietary needs. For example, if a ham-based item is

selected as the default entre, the alternative may be a lower-sodium entre that does not contain

pork. By accommodating some of the therapeutic menu needs in the regular menu, the food

service staff is required to prepare fewer menu items, conserving both time and kitchen space.

As mentioned above, the VHA of Biloxi uses a three-week cycle menu. This menu may

be altered for special occasions or holidays in which a special meal is substituted for the

occasion. The general layout for the menu remains the same despite the cycle week or

therapeutic modification. For lunch and dinner, patients receive an entre, starch, vegetable,

bread, salad, beverage, and fruit or dessert. All meals come with condiments, and preferences

can be noted for desired dressings or seasonings. Breakfast meals follow a similar layout,


including an entre, cereal, bread, juice, milk, coffee, and condiments. While substitutions are

listed on the menu, patients are not necessarily given the opportunity to request the alternative on

a day-to-day basis; however, if the default item is not desired, preferences can be noted for

certain ingredients or items that the patient does not wish to receive. For example, in table 1 the

menu lists shrimp gumbo as the default and beef cubes as the alternative for the Thursday lunch

on the week-two menu. If the patient preferences list no seafood, no shrimp, or no shrimp

gumbo, the patient will automatically receive the alternative.

Therapeutic Diets

Therapeutic diets are prepared with similar components and alternatives. These menus

are typically modified forms of the regular menu to conserve food and labor costs. Eighteen

different therapeutic menus are offered by the VHA of Biloxi and may be combined to meet

individualized patient needs. The following therapeutic diets are offered at this facility:

mechanical, low sodium (2 gram), low sodium diabetic, low sodium/low cholesterol, vegetarian,

low cholesterol diabetic, low sodium/low cholesterol diabetic, 1800 calorie diabetic, mechanical

diabetic, diabetic maintenance, low cholesterol/low fat, low fat (50 gram), puree, soft

mechanical, clear liquid, dysphagia thin liquids, dysphagia semi-thick liquids, and dysphagia

thickened liquids. These various diets may be combined depending on patient needs; for

example, a low-sodium, mechanical soft diet is available although not specified as one of the

therapeutic diets.

This variety of modified diets was created to provide for each of the nutritional needs of

this patient population. Patients at this facility tend to be older males; therefore the recommended

dietary allowance (RDA) ranges used in the nutrient analyses are based on the male, 51+ plus


age range. When younger patients are admitted or individuals need a higher caloric intake,

standing orders can be entered that can provide between-meal snacks or supplements.

Patient Communication of Menu

This facility uses a daily default menu; while substitutions are available for each menu

item, patients receive the default item unless preferences or allergies are noted. This type of

system saves labor hours both in the kitchen and for dietary staff who would otherwise be

required to take orders in a selective menu. Menus are distributed to each unit as a whole but not

each patient. Weekly menus are usually placed in a central location for viewing. In the acute care

unit, the dietitian is responsible for acquiring information including food allergies and

preferences upon the patients admission and noting these in the system for food service staff.

The dietitian also keeps a copy of the weekly menu and is able to answer patient questions and

note dietary requests such as standing orders.

Once the dietitian collects the food preferences of the patient, they are then entered into

the patients information through VistA, the electronic dietary system. This system then adjusts

the patients meal ticket as needed. Using the previous example, if a patient has a preference or

allergy such as no shrimp, the system will recognize all menu items that contain shrimp and

automatically replace the menu item with the alternative to be printed on the meal ticket. The

diet communication office ensures that all preferences and needs are met with proper

alternatives; last minute additions or adjustments can be handwritten onto the meal ticket if

necessary. These tickets are then used to communicate with the tray line staff regarding which

items should be placed on each tray.

Diet Manual


The VHAs nutrition and food service department utilizes the Health Care System Diet

Handbook (Gulf Coast Veterans Health Care System, 2011). Guidelines in this handbook are

adapted from the Food and Nutrition Board of the National Research Council of the National

Academy of Sciences and the Dietary Guidelines for Americans (2010). This handbook defines

the required nutrient composition and a suggested meal pattern for each of the available

therapeutic diets offered at the VHA. The VHA also uses the Mississippi Academy of Nutrition

and Dietetics (AND) Diet Manual (2013) to ensure that therapeutic diets meet individual patient

needs.

Nutritional Analysis

Nutritional analyses are conducted on three menus twice per year through Vista. The

menus selected for the analysis may be the regular menu or any of the modified menus; this

selection rotates through each of the menus so that all of the diets are monitored regularly.

Because menus are not significantly altered over time, this schedule is sufficient to monitor

nutrient profiles of the menus. If a menu item or recipe is changed, a new nutritional analysis

will be conducted to ensure that the menu still complies with nutritional recommendations. These

recommendations are established from the Dietary Guidelines for Americans (2010) and the

VHA Healthy Diet Model (Veterans Health Administration, 2005). This VHA uses the RDAs for

males 51+ due to the patient population at this facility.

According to the most recent nutrient analyses conducted on the regular menu and the

above-mentioned modified menus, the three-day averages of nutrients are not always meeting the

recommendations. As observed in the three-day nutrient analysis (table 2 and 3), the average

daily fiber intake ranges from 10.5-19 grams per day while the guidelines recommend 25-30

grams per day (Veterans Health Administration, 2005). This may be due to the lack of available


fresh fruit and default starch items such as white bread or rolls. Other nutrients that are not

meeting recommended daily allowances on most therapeutic menus are folate, vitamin E,

magnesium, and potassium. These values might also increase with greater incorporation of fresh

fruits, vegetables, and whole grains.

As seen in tables 2 and 3, sodium levels in many of the daily menus are also consistently

out of the recommended range of 2000-3000 g/day (Veterans Health Administration, 2005).

Recent action to reduce sodium levels has included the omission of added salt during preparation

of foods. Many items, however, are purchased in a highly processed state to conserve labor hours

and decrease employee skill requirements. In the future, the VHA may attempt to procure less

processed items and prepare more raw materials to reduce sodium levels as well as food costs.

The use of fresh fruits and vegetables as opposed to canned or pre-packaged items may also

decrease sodium levels of the meals prepared.

Menu Strengths and Weaknesses

One of the greatest weaknesses of the VHAs current menu is the fact that the nutrient

analyses of the menus often do not meet all of the RDAs. For moderately long-term patients such

as those in the mental health unit or the community living center (CLC), these nutrients may not

be met for an extended period of time. Changes to the menu may be necessary to provide

adequate amounts of all of the necessary nutrients.

There are, however, benefits that come from the long-term use of the current menu.

Because the three-week menu has remained mainly unchanged over the years, the employees can

adapt to the menu production. Additional training is not necessary for food service workers to

learn new dishes or preparation methods. Employees are also able to improve their skills for the


set of menu items they prepare regularly. This could cut down on labor costs and food waste

with fewer mistakes being made.

Another strength of the current menu is the variety of options and appropriate alternatives

it provides for each menu item. Because the majority of patients do not stay more than three

weeks, menu items are rarely repeated. The choices provided successfully mirror the cultural

preferences of the area such as shrimp gumbo or red beans and rice. Patients are also provided

suitable alternatives if preferences are noted.

Another weakness of this menu, however, is that patients cannot freely select the

alternative. Patients that may receive meals in a community dining area, such as the CLC or

blind rehabilitation facility, may see other patients with an alternative entre and then prefer that

item instead. At that point, however, the patient may not change his or her meal immediately but

must keep the tray that was initially delivered. This could cause patients to become upset because

they desire the alternative option but cannot change his or her order. Patients in these units might

also see the menus posted and bombard the dietitian with menu requests on a daily basis. Due to

the frequency of restaurant dining or other food service systems today, individuals are not

accustomed to this lack of choice in menu items. This system is beneficial, however, for the

foodservice staff; it reduces difficulty in diet orders and tray preparation and saves labor hours

by eliminating the need for diet orders to be taken daily. A selective menu would also be very

difficult in an advance-preparation food service system because meals are plated at least one day

in advance.

Conclusion

This menu and food production system has proven successful throughout its use at the

VHA. Some recommendations, however, could be made to improve dietary quality, production


efficiency, and customer satisfaction. Incorporating more fresh, seasonal fruits into the menu at

least once daily could improve levels of the nutrients that are lacking (specifically potassium,

folate, and dietary fiber). Incorporating spinach into the daily side salads could also increase

nutrient levels of magnesium and folate. For breads or starches, whole grain items could be

changed to the default item with items containing white or enriched flour as the alternative. This

would also improve magnesium and dietary fiber levels. These items may, however, create

difficulty for certain therapeutic diets such as mechanical soft, renal diets, or those on vitamin K

restrictions.

Another recommendation to improve the nutrient content of the menus is to increase

scratch cooking. Many menu items are purchased pre-cooked; while this conserves labor hours

and employee skill requirements, it increases food cost and sodium content. Some items could be

purchased in a less processed state, such as ground beef instead of pre-cooked beef patties. Other

items such as fruits and vegetables could be purchased frozen instead of canned. While

purchasing less processed materials may increase labor costs, this could be balanced out by food

cost savings and increased food quality.

Regarding the lack of patient input for menu choices, few changes can be made due to the

advanced food preparation methods. Patients who are admitted to the units for a longer stay,

however, could be offered the weeks menu prior to meeting with the dietitian. The dietitian

could then briefly explain how the menu works, allowing the patient to better inform the dietitian

of his or her preferences according to the menu options.

In conclusion, the current menu planning and food production method at the VHA has

proven effective for many years. While this system would be difficult to significantly alter, small

changes should be made to ensure that nutritional recommendations are met for all of the diets


offered. Incorporation of more fresh fruits, vegetables, and whole grains could increase

micronutrient levels and dietary fiber. Scratch cooking methods could be used on certain menu

items to decrease sodium levels. Patients who are admitted for a moderately long-term stays

could also have a greater opportunity to establish food preferences according to the upcoming

menu. The current menu does, however, provide a variety of options and meets almost all of the

recommended daily allowances for this specified age group. The current staff understands and

functions within this system well. While major changes are not feasible or necessary, these small

recommendations could improve the nutritional quality of the meals, the efficiency of meal

production, and patient satisfaction.


References Gulf Coast Veterans Health Care System. (2011). Diet Handbook. Retrieved from

http://vaww.biloxi.med.va.gov/New_Look/Policies.htm

Mississippi Academy of Nutrition and Dietetics. (2013). Diet manual of the Mississippi Academy

of Nutrition and Dietetics. Gulfport, MS: Mississippi Academy of Nutrition and

Dietetics.

Veterans Health Administration. (2005). VHA Healthy Diet Food Model.Washington, DC:

Department of Veterans Affairs.

United States Department of Agriculture and United States Department of Health and Human

Services. (2010). Appendix 5. Nutritional goals for age-gender groups, based on dietary

guidelines recommendations. Dietary Guidelines for Americans, 7e.


Appendix

Table 1: Sample of week-two regular menu.


Table 2: Three-day sample of therapeutic menus.


Table 3: Regular diet three-day nutrient analysis

Regular Diet AverageNUTRIENTS RDA* Day 1 Day 2 Day 3Kcal 2000-2400 2228.6 2372.2 2004.7 2201.833Protein (g) (10-35%) 60-120g 101.1 99.7 95.4 98.73333Carbohydrates (g) (45-65%) 270-390g 277 310 284 290.3333Fat (g) (25-35%) 55-95 79 81 54 71.33333Saturated Fat (g) (


Table 3: Therapeutic diets three-day nutrient analysis

2g Na Diet AverageNUTRIENTS RDA* Day 1 Day 2 Day 3Kcal 2000-2400 2082 2108 2238 2142.667Protein (g) (10-35%) 60-120g 100.2 85.5 107.7 97.8Carbohydrates (g) (45-65%) 270-390g 283 334 284 300.3333Fat (g) (25-35%) 55-95 67 53 79 66.33333Saturated Fat (g) (


Low Chol/Low Fat Diet AverageNUTRIENTS RDA* Day 1 Day 2 Day 3Kcal 2000-2400 2011 2270 2125 2135.333Protein (g) (10-35%) 60-120g 11.2 105.6 106.1 74.3Carbohydrates (g) (45-65%) 270-390g 311.5 337.7 328.5 325.9Fat (g) (25-35%) 55-95 38.3 55 48.4 47.23333Saturated Fat (g) (


Renal Diet (60 g pro, low Na, low K) AverageNUTRIENTS RDA* Thursday Friday SaturdayKcal 2000-2400 1476 1690 1557 1574.333Protein (g) (10-35%) 60-120g 60.7 61.6 56.1 59.46667Carbohydrates (g) (45-65%) 270-390g 212 241 222 225Fat (g) (25-35%) 55-95 43 53 50 48.66667Saturated Fat (g) (

menu project

Documents

menu planning menu items

regular menu

original menu

menu options

fewer menu items

threeweek cycle menu

menu lists shrimp gumbo

alternative entre items