Wednesday, April 7, 2010

From Meal Trays to Dining Room…

Sunnybrook Health Sciences Centre houses Canada’s largest veteran population, providing long term and complex continuing care to approximately 500 elderly veterans. In June of 2007, six Nursing Home units, representing 204 beds in the Veterans Centre, were converted from tray meal service to a bulk meal service dining room to align with the Ontario Ministry of Health and Long Term Care Dietary standards. The project presented a unique opportunity, not only because of the size of the population involved, but because most other long term care facilities offering bulk meal service have done so from the time of opening and rarely undergo a change in service model.


As dietitians working in food services our priorities are meeting nutrition standards, menu planning, meeting fiscal responsibilities, and patient/resident satisfaction. To evaluate that we met our objectives fo r this project, we retrospectively collected data pre – and post-implementation looking at nutritional parameters (e .g., weight, nutritional risk level , diet), financials, and food satisfaction. Converting to a bulk meal service did not appear to impact the residents’ nutritional status parameters, we were able to operate within our financial objectives, and our third party food satisfaction survey showed that changing the meal service model had no sustained impact on residents’ satisfaction with food. Despite achieving our food service objectives, the food serv ice team spent the majority of time addressing the unforeseen social outcomes of this change.


Adjusting to anything new takes time. The bulk meal service model had many benefits for residents, however, asking anyone to change their daily routine, especially around meals, inevitably results in some resistance. The new daily social interaction among residents at meal times allowed many relationships to flourish but also opened the door for conflict among others. Who sits with whom in the dining room was not an easy puzzle to put together. Waiting for tables to be served exposed residents to wait times that were previously less obvious when they ate in their rooms. Dietary restrictions were more visible to tablemates, and suddenly, residents started asking for specific food items of which they had not previously been aware. This phenomenon stimulated discussion among the care team about liberalizing the resident menu.


Despite the fact that forecasting, preparation, and production were done separately for each seating, having a ‘second seating’ at meals gave some residents the perception that ‘first seating’ received preferential treatment, and that those seated second were getting leftovers. Education with staff, residents and family members was necessary to dispel this myth.


The bulk meal service was implemented in phases bringing on one nursing unit per week over four weeks so that we could focus on the particular needs of each unit. Unique challenges surfaced when the implementation took place on the Cognitive Unit. Continuity is important for these residents; they may not be able to recall yesterday’s events but adapt well to routines. One resident, when offered a choice of two entrées replied, “I don’t want either, I just want my lunch tray”. Where family members previously made menu selections for residents with the tray service, some residents appeared overwhelmed having to shift to making seemingly simple food choices three times a day. Over time, the bulk meal service became routine and these challenges now seem to be non-issues. All of our experiences during the implementation prompted good discussion between our department and the care team about dining room philosophy and creating a home-like environment. Dining ‘ground rules’ for processes and conduct for both staff and residents continues to be a work in progress to improve the quality of the dining room experience.


Resident satisfaction with the bulk meal service was of high importance for both our department and for the organization in evaluating the success of the project. Despite the fact that there does not appear to be a difference in resident satisfaction over the long term, it is important to note that the satisfaction survey primarily assessed operations and food services para meters (e.g., quality, timeliness, temperature ). The potential impact of a dining environment and mealtimes on other factors related to quality of life cannot be discounted.


Lessons learned from this project:


1. Get to know the population and consider the social impact of the change for the residents and families;

2. Consider a broader survey tool to evaluate the impact of changing the meal service model on residents’ quality of life;

3. Recognize the value of ongoing communication with the residents and families; and,

4. Be patient!



Contact

Alexa Edmonstone, RD
Clinical Dietitian
E: alexa.edmonstone@sunnybrook.ca


Ann Robertson, RD
Director, Food Services

Sunnybrook Healthcare Food Services

E: ann.robertson@sunnybrook.ca


54 comments:

Online Pharmacy said...

Definitely, the junk food must be avoided and everyone must try to have a balanced diet. Changing the meal doesn't mean that it will not be nutritionally good.

buy hydrocodone online said...

Thank you, I have recently been searching for information about this topic for ages and yours is the best I have discovered so far.

Jonathan Trott said...

I found your post comments while searching Google. Very relevant especially as this is not an issue which a lot of people are conversant with.
This post is different from what I read on most blog. And it have so many valuable things to learn.

Patient Satisfaction Survey

jamesfrac said...
This comment has been removed by the author.
Carson armando said...

Article is written by a professional person and have some other things.Dissertationkingdom.co.uk | Affordable dissertation | dissertation for me | Professional writers | Proposal help




Jason said...

Keep up the fantastic work, I read few posts on this website and I think that your web blog is real interesting and has got circles of fantastic information.
quality dissertation provider uk | masters dissertation provider | uk dissertation ideas | best mba dissertation provider | dissertation writing provider | best dissertation writers in uk | dissertation proposal writing help | buy an online dissertation | best UK dissertation online | I need write my dissertation assistance


Colorado said...

This is a really good read for me. Must agree that you are one of the coolest blogger I ever saw.
custom writing services | essay provider | dissertation assistance | dissertation paper services | low cost essay | assignment provider | write my essays | buy essays | paper writing service

hermes kelly 32 said...

Thanks for sharing the nice pictures. You have done a great work. Every homeowner can benefit from property management services.

Emma Reed said...

Thanks for sharing this information.And I'll love to read your next post too. essay writing firm,, quick essay help,, get essay,, pay essay

Freddy K. Cortez said...

Kitchen and house management itself is a broad field and this is the reason there are a lot of house wives who have been awarded the life experience degree in this domain of management just by submitting their experience.

Anonymous said...

When you will buy a degree online, you can easily carry out other activities as well.

http://www.priorlearningdegree.com/buy-degree-online/

paper writing service said...

This is such an interesting and informative article to share with others. Thanks for posting

amine lahragui said...

Your work is very good and I appreciate you and hopping for some more informative posts. happy new year 2016 new year 2016 bonne année 2016 happy new year 2016 images new year 2016 images imagenes de año nuevo 2016 feliz año nuevo 2016

jawad zaib said...

Nice Share Thanks For The Post...

Happy New Year Photos 2016
Urdu News
new years pictures free 2016
Highlights PSL 2016

yuvikhan said...

good Consequently, today I’m writing the download links of click here We'll receive again to you within 24 time. xenderdownloadapp nice.

dirlinigritton said...

good but this approach is obviously the most basic. visit this website click here to forgo the classic professional way and rather move all-in on Snapchat. nice.

robertgreene said...

good it works like an android system and we can employ like go to itubedownloadz You can reveal the movies from the application itself, iTube Download App nice.

Anonymous said...

SHAREit is an app that allows you to share files between your devices. Shareit for PC

meganscott said...

good The brand Fleck water softener is in possession of a firm named watergadget.com the Fleck water softener producer. It offers an amazing nice.

Here said...


Install Kodi
Kodi APK App

bigphotographers said...

good well as the installer could just be downloaded and install as youtv you tv player video clip playing application presently offered for iphone and also nice.

meyerangel said...

good the need for video clip calls rises dramatically. For this very factor the app such as imo imoappz.com with listing of one's tool such as phone and also produces its IMO call checklist, nice.

HannahAMueller said...

good If that does not work, look for Fujian Zhengtong vShare for iOS likewise follow this procedure. As well as these procedure best.

audreybphillips said...

good can Set game play, gamers countYou could likewise http://minimilitiaa.in and also grenades. Play team based battles in this enjoyable best.

audreybphillips said...

good hack small militia using fortunate patcher here is the technique Mini Militia anime themed cross between Soldat and Halo. better.

bettycyoung said...

awesome download artisto Free video clip as well as Photo Editor for artisto provided listed below.You could choose from any type of great.

bettycyoung said...

awesome Netflix is a costs application that has different packages for individuals. mobdro premium apk So download and install mivo for your tool and also see the videos nice.

bettycyoung said...

awesome well as TELEVISION series using cinemabox Cinema Box for Android You can likewise select the top quality from the option in the bottom nice.

cathrynzbrown said...

Great Snapchat, certainly, allows modifying of pictures Snapchat for iPhone Upon opening the application, you will see Fine.

virginiaddavis said...

good readable just by their approved fans, or shared publicly Musicaly readily available to young people as they welcome Musical.ly and also nice.

ElizabethMartin said...

feedback from its existing and brand-new consumers. fleck5600sxtguide.com as I will present you to one of the most trusted brand.

SandraRoper said...

Extract the PES 2017 ISO Data with Xplorer or Various other Unrar App. ppssppgold.org as well as PC Crack We assure you virus complimentary.

triciagonzalez said...

Doesn't that sound remarkable? Well, you should https://whatsuply.com WhatsApp from your computer which is called WhatsApp Web.

shengda xu said...

nike outlet
polo ralph lauren pas cher
coach outlet online
pandora charms sale clearance
purs jerseys
coach outlet online
adidas outlet store
pandora jewelry outlet
pandora charms outlet
chi flat iron
xushengda0428

deborahmitten said...

you have any kind of concerns make use of the remarks box. http://vidmateapkz.com you can pick other way.however we have a tendency.

nancycongdon said...

Tutu Helper download appropriate away. Tutu App Tutu Helper Apk data. Now you could see that apk data runs.

Richard C. Lambert said...

A debt of gratitude is in order for sharing the information, keep doing awesome... I truly delighted in investigating your site. great asset...
Learn More

danny said...

Very helpful article.Thanks for sharing! montana scholarship details., Internet Marketing Scholarship

qqq said...

longchamp uk
adidas yeezy
birkenstocks
moncler jackets
nike air max 90
clarks outlet
coach outlet
coach outlet store
giuseppe zanotti sneakers
mbt shoes
170728yueqin

qqq said...

polo outlet
christian louboutin outlet
longchamp bags
celine outlet store
cheap nike air max
cheap jordans
michael kors outlet
adidas nmd
red bottoms
adidas uk
170728yueqin

AshleyStevenson said...

Or ensure that before getting sort utilizing this machine liker apk all android tools as well as other smart tools.

Robert F. Crocker said...

Great things you’ve always shared with us. Just keep writing this kind of posts.The time which was wasted in traveling for tuition now it can be used for studies.Thanks
go

Best Home Improvement Company NYC said...

Ajrin Construction Inc. is a licensed New York general construction firm working as General Contractors in NYC, truly devoted to our services and remain firm until our Clients’ purposes are served to satisfaction. We feel much concerned of the value of your property, safety and security more than our profit or anything else.Best Home Improvement Company NYC

usacheckcashingstore.com/san-diego said...

Be that as it may, it costs the same amount of to direct a missed installment on a $10K credit as on a $200, and on the off chance that you were charged the same $50, that would be an additional 25%.

Cash Advance said...

Since these organizations understand that you can basically apply somewhere else on the off chance that they don't answer to you, they will typically endeavor to make the procedure speedy, simple and get assets to you with little bother.

Ổn áp Standa chính hãng said...

simply could not depart your website before suggesting that I extremely loved the usual info an individual supply on your visitors? Is going to be again frequently to check up on new posts
on ap standa 5kva|on ap standa 7,5kva|on ap standa 10kva|on ap standa 15kva|on ap standa 20kva|on ap standa 30kva|on ap standa 45kva|on ap standa 60kva|on ap standa 75kva|on ap standa 100kva

Vanwingerden Urick said...

Moreover, most moneylenders will expect you to think of them a check for the measure of the advance in addition to charges, which they will hold until the point that your next payday at which time they will store the check and get their "pay back." usacheckcashingstore.com/chula-vista

Vanwingerden Urick said...

Get some answers concerning the annualized rate of intrigue you will be paying, the advance reimbursement terms, and in addition what occurs toward the finish of term. Car Title Loans

Vanwingerden Urick said...

Union advances are conceivable choices to contracting regularly scheduled installments and still assume liability for the obligation.Payday Loans

amybtarnet said...

If you like range in your life, as well as you want your coffee coffeemakered.com These hulls make it simple to alter your early morning routine.

Carruth Vallecillo said...

Try not to become involved with the vortex of a modest payday advance bank. Locate a decent, genuine organization that will truly help you. I have not done a payday credit in five years nor will I until the end of time. payday loans

rachelwofodru said...

Games and apps, and you can install them bestandroidtvbox blessing for you. With 4k Ultra High Definition.

MicheleDavila said...

Capture is the current features for Mobdro which is available imobdro the main reason behind mobdro application success.

James said...

uidcards
check aadhar card status
check aadhar linked status
link pan card with aadhar