A kliewer theme_meal

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Theme Meal: St. Patrick’s Day

Allison Kliewer

Baptist Health System Dietetic Internship

With

Texas Center for Infectious Disease

March 6, 2013

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Theme Meal Part One

The role as a director of dietary services is just one of the many roles that dietitians play.

According to the Academy of Nutrition and Dietetics a qualified dietitian must be utilized by

long term care facilities to plan, manage, and implement dietary service activities in order to

ensure that the residents receive adequate nutrition (2013). The dietitian must have training

and experience in budgeting and purchasing of food supplies, and in supervising institutional

food preparation, service and storage (2013). Long term care facilities must also have sufficient

dietary support personnel and sufficient staff preparation; there must be enough staff to

prepare and serve palatable, attractive, nutritionally adequate meals at proper temperatures

and times to support proper sanitary techniques being utilized (2013). To serve a theme meal, a

dietitian must be involved in all components of dietary service to ensure all guidelines and

policies are being followed, to evaluate the success of the meal, and to determine what can be

done to improve the quality and service.

The Texas Center for Infectious Disease (TCID) is a long term care facility with a unique

patient population. The patients suffer from tuberculosis (TB) and most have a drug resistant

form of TB. Many of the patients also suffer from psychiatric issues and substance abuse. Due

to their medical condition upon admittance, many patients stay at TCID for many months or

possibly years before they are healthy enough to be released. Therefore, to occupy time,

educate, and prepare the patients to be able to live on their own (without state support), the

patients have access to various activities while at TCID.


Most of the patients admitted are malnourished and very underweight due to the

physiological effect TB has on the body. Nutrition and diet is very important for the patients so

that they may gain weight and recover from their disease/diseases. Dietary service plays a large

role on the patient’s recovery, furthermore, the patient’s interest in the food adds to their

timely recovery. Dietary services should meet and aim to exceed patient expectations to better

the food environment and food relationship for the patient.

The theme meal lunch provided traditional Irish menu options with the following

nutrient profiles (Table 1). The corned beef is not the healthiest item, however, it was decided

with the registered dietitian that the beef would be an item the patients had never been served

while at this facility. Initially a lamb stew was chosen as the main entrée. However, lamb was

the entrée for the previous theme meal and was found to be costly. Therefore, corned beef was

chosen to offer variety at a lower cost to the facility.

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Table 1 Theme meal Nutrient Analysis

Serving Size

Total Calories

Total Fat

Saturated Fat

Cholesterol Carbohydrates Protein Sodium Fiber

Mustard Glazed Corned Beef

198 g 438 27 g 8.6 g 189 mg 13 g 23 g 846 mg 0 g

Red Potato Colcannon

1 cup 182 4 g 2 g 11 mg 31 g 6 g 653 mg 5 g

Fighting Green Irish Salad

2 cups 113 7 g 1 g 0 mg 10 g 3 g 152 mg 3 g

Brown Soda Bread

1 slice 169 1.9 g 0.9 g 6 mg 32.4 g 6.2 g 355 mg 3 g

Lucky Apple Crumble

½ cup 264 5 g 0 g 0 mg 56 g 3 g 75 mg 3 g

Silver Oaks Communications. (2009). Nutrition Calc Plus 3.2. The McGraw Hill Companies.

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To excite and involve the patients for the theme meal, flyers were posted around the

hospital in high traffic areas so that the patients and staff could read and plan for the meal. The

time, date, theme, and courses being served were included on the flyers. Furthermore, the

recreation director was contacted for participation in the theme meal. Ideas of crafts and

activities were provided for the recreation team so that the patients could participate in

activities specifically related to the theme meal. Marketing plays a role in any promotion. Bingo,

arts and crafts, and trivia were used for the theme meal marketing. The promotional material,

consumer survey, arts and crafts completed by the patients, and the meal can be viewed in

Appendix I.

The state facility receives budgeted funds every day for 72 people. The rate per person,

per day is $5.87 daily for all three meals. Breakfast cost $1.87 per meal, leaving $2.00 for lunch,

and $2.00 for dinner each day. Staff is allowed to purchase meals at $3.25 per meal, which is

recorded as profit. Although TCID is given money to provide for 72 patients, there are currently

only 44 patients at the hospital receiving meals from the cafeteria. Therefore, there is a cushion

for the cost of meals. The theme meal is given $144.00 (72 pt x $2.00) by the state and has

been made to serve 50 people; allowing $2.88 for each theme meal tray.

Texas Center for Infectious Disease is unique in many ways, for example, the kitchen

often purchases food from venues that are not in their contract such as HEB. This is due to the

fact that many of the patients are from other countries and request food items that are not

standard ordered items. Many patients are underweight, and weight maintenance and gain are

important to the treatment of the patients: TCID works to provide the patients with their


individual requests. Based on the monthly food service report from February, 2013, the facility

spent $1655.86 on food items purchased from HEB. Therefore, over ten percent of total food

cost is not on contract, which in turn raises the transportation cost of food because of the

numerous trips to HEB. The facility also has a total cost of $334.59 in stored food items,

including frozen, USDA, and dry storage (February, 2013). There were items required in the

theme meal that were not on contract with the facility and had to be picked up from HEB.

The total cost of the meal is based on the amount of product used and can be seen in

Table 2 along with the ingredient list, standardized amount needed, and amount purchased.

The recipes were standardized to fit the facility using Food for Fifty with the help of the head

cook. Pricing for the theme meal was solely based on food cost. Pricing excluded labor,

transportation, and inventory. The meal was estimated to have a food cost percentage of 163%

based on 50 meals served, 20 were staff meals at $3.25 and 30 were patient meals at the state

budgeted $2.00.


Table 2

Theme Meal Cost Analysis

Ingredient Amount Needed

for Recipe Standardized

Amount Amount

Purchased Cost of

Purchased Items Total

Food Cost

All Purpose Flour 13 1/2 cup 7 lbs 50 lb bag 13.74 1.92

Whole Wheat Flour 10 cup 5 lbs 5 lb bag 2.98 2.98

Baking Soda 7 1/2 tsp 0.09 lbs 1 case (12 x 2 lb bags) 14.43 0.05

Salt 21 tsp 0.26 lbs 25 lb bag 3.77 0.04

Buttermilk 10 cup 0.6 gallon 2 half gallons 2.15 1.29

Small Red Potatoes 13 lbs 13 lbs 50 lb bag 22 5.72

Butter 2 sticks, 16 Tbls 0.5 lbs 30 lb case 74.85 1.25

Onions, Sliced 6 1/2 cup 3.4 lbs 50 lb bag 15 1.02

Cabbage 7 heads 7 heads 7 heads 1.5 1.50

low fat Milk 13 cups 6.5 pints 7x ½ pint 1.4 1.30

white Pepper 3 1/4 tsp 0.5 oz 1 BLT (4 oz) 2.58 0.32

Lemons 8 each 1 box 1 box 22.5 22.50

Lemon Juice 1 1/2 cup 0.37 quarts 1 quart 2.47 0.91

Canola Oil 15 1/2 cup .97 gallon 1 gallon 3.99 38.70

Sugar 6 tsp 0.08 lbs 50 lb bag 26.52 0.04

Pepper 1 1/2 tsp 0.02 lbs 4.25 lbs 24.31 0.11

Boston or Bibb Lettuce 12 heads 12 heads 1 case (24 ct) 26 13.00

Asparagus 12 cup (6 bunches) 6 bunches 6 bunches 2.98 2.98

Peas, Shelled 12 cups 6.25 lbs 20 lbs 13.9 4.34 Grape or Cherry Tomatoes 6 pints 6 pints 6 pints 1.88 1.88

Light Brown Sugar 10 1/2 cup 5.5 lbs 1 case (12 x 2 lb bags) 26.13 5.99

Brown Mustard 12 oz 12 oz 1 each (12 oz) 5.4 64.80

Corned Beef (Beef brisket, 32 lbs) 26.62 lbs 26.62 lbs 4.25 per lb 4.25 4.25

Oats (42 OZ) 7 cup 56 oz 1 case (12 x 42 oz bags) 29.49 3.28

Ground Cinnamon 10 1/2 tsp 0.13 lbs 1 lb 4.42 0.57

Apple Juice Concentrate, Frozen 12 oz 12 oz

1 can (12 fl oz) 0.97 0.97

Apples, peeled, cored, thickly sliced 42 cups 70 each

1 case (125 ct) 38.5 21.56

Total 388.11 203.29


Theme Meal Part Two

The theme meal was chosen for Thursday March 14, 2013 in celebration of St. Patrick’s

Day. The theme was to bring cultural awareness to the patients by celebrating a familiar

holiday. Traditional Irish food was the focus of the menu along with healthy cooking styles and

ingredients. The meal included red potato colcannon, fighting green Irish salad, brown soda

bread, lucky apple crumble, and mustard glazed corned beef. The beef chosen is not the

healthiest cut of meat, however, after communication with the facilities preceptor, corned beef

was chosen for the purpose of can cutting, and to offer the patients a meat that had not been

previously available.

Production was planned to serve 50 trays. The soda bread was made in four loaves and

cut into 12 diagonal slices, producing only 48 slices. The other menu items produced enough for

50 trays. The fighting green Irish salad ran out at 12:50 pm, ten minutes before lunch was over.

The servings, leftovers, and what was done with the food after the meal can be seen in Table 3.

Table 3 Production Analysis

Servings Made Servings Left

Over Action

Mustard Glazed Corned Beef 50 12 Save and offer at dinner Red Potato Colcannon 50 3-4 Throw out Fighting Green Irish Salad 50 0 Ran out at 12:50 pm Brown Soda Bread 48 6 Save and offer at dinner Lucky Apple Crumble 50 20 Save and offer at dinner


The amount of meals served was 46, showing that a meal for 50 is adequate. The

amount of food leftover was predicted as the amount is common for this facility. The salad

proved to be liked by the consumers due to the fact that the salad ran out. The apple crumble

had the most leftover, but this can be due to the fact that the consumers had three different

dessert options to choose from. It is important to note that the administration staff was sent

home early, before lunch, due to a maintenance issue. Therefore, there could have easily been

over 50 trays served had they been there. The average trays served in the TCID facility is 50 for

lunch, however, due to the popularity and success of the previous Navajo theme meal, the staff

and patients might have been looking forward to another theme meal so that the turnout was

still good at 46 trays.

The planned budget was less than $400 total for the theme meal. This is over twice as

much as what is given for a lunch meal by the state ($144). The budget is not strictly controlled

due to the fact that the cafeteria is receiving more money from the state than what they are

using on the patients. As discussed earlier, the facility receives money to provide for 72

patients, while there are only 44 patients in the hospital at this time. Therefore, the theme

meal was allowed to exceed the $144 budget. The actual food cost was $203.29 going over the

state allotment by $59.29, but under the facilities budget by $196.71. The forecasted food cost

percentage was 163 percent and the actual food cost percentage was 177 percent. This is

because there were only 46 trays served during the meal instead of 50 that was estimated.

There were 18 staff trays, out of the 46 trays, served at $3.25 providing a $58.50 profit.

However, the profit difference did not make up for the total cost of food, and the meal cost the

facility $88.79.


A questionnaire was developed to target the consumer population. The purpose of the

survey was to assess how the consumers perceived the meal and meal service. The survey was

based on an agreement scale (A= agree, D= disagree, NE= neither agree nor disagree, N/A= not

applicable). The rating scales included neither agree/disagree and not applicable so that the

consumer did not feel pressured into an answer. Compared to other scale surveys, the

agreement scale is more difficult and requires the surveyor to completely understand the

statement being rated. The survey developed had seven statements for the consumer to rate

and an open-ended option so that comments about the meal experience could be left. As

discussed with the facility’s preceptor, the survey might be a little difficult for the patients, but

it was agreed that a challenge would be beneficial to the patient population. In other TCID

activities, the patients are encouraged to practice their English and written communication

skills, so the survey was concluded to be appropriate. The survey was personally handed to

each consumer after the consumer sat down. The consumer was encouraged to take the survey

on their own time and told that there are no right or wrong answers. The surveys were picked

up when finished as indicated by the consumer.

The results from the consumer survey can be seen in Table 4. There were a total of 37

(80%) surveys completed. There were approximately six people (loose estimate, based solely on

observations) who took the meal tray to-go and did not receive a survey. Two surveys left a

question blank; therefore, those questions were adjusted for 36 total surveys.


Table 4

Survey Results

A D NE N/A

The foodservice staff appeared professional 35 (94%) 0 2 (5%) 0

The food was at the proper temperature (whether hot or cold) when served

34 (92%) 0 3 (8%) 0

The foodservice staff were polite and responded to any questions I had

37 (100%) 0 0 0

Foods on the serving line appeared attractive 32 (89%) 1 (3%) 3 (8%) 0

The quality of ingredients meets my expectations 31 (86%) 0 4 (11%) 1 (3%)

The flavor of the food meets my expectations 33 (89%) 0 3 (8%) 1 (3%)

I would like to have this meal again 31 (84%) 2 (5%) 3 (8%) 1 (3%)

Results displayed as n(%); number of consumers with percent of total in parenthesis.

Of the 37 completed surveys, 27 agreed to every statement on the survey, while eight

answered differently, and two left a question blank. There were eight comments left for those

who agreed to all seven questionnaire statements. The statements are listed below:

Improve tea; too much water

Tea too watery

Soup is great

String beans need more flavor

Fun menu today, thank you. Soda bread, pea salad and beef were all very good

I’d like to come again

I appreciated the effort that goes into having meals and different foods. Thanks

Good survey. Good food, real good job with temperatures, and always good flavor

The consumers were not limited to the theme meal menu options and other options


were available. The first four statements listed do not apply to the theme meal, rather to the

facility as they are about regular food items and the beverage. The last four statements do

apply and reveal an appreciation of the meal. There were four comments left from those whom

did not agree to all seven of the questionnaire statements or who left a statement blank. The

statements are listed below:

Maybe a little more spices, but that’s my opinion

Liked the salad with asparagus, meat was great/tender

Uniforms would make professional

Cook the asparagus longer, and then chill. It was tough.

There were three comments left from the ten that did not agree to every statement. The

first statement listed was from a survey that agreed to all, but left one question blank and

therefore, was not included with the other agree surveys.

Seventy-three percent of those who took the survey agreed to all questionnaire statements

and therefore, agreed that the foodservice staff appeared professional, the food was at the

proper temperature, staff was polite, foods were attractive, ingredients met expectations,

flavor met expectations, and they would like to have the St. Patrick’s Day meal again. The

question that had the lowest amount of agree ratings was the statement that the consumers

would want the meal again (n= 31). This shows that Irish food might not be accepted as well as

other food items. This could be due to the lack of exposure, or simply that this population does

not enjoy typical Irish food.

The theme meal went as planned with no surprises or mishaps. The staff working at the

TCID facility was very helpful and greatly contributed to the success of the meal. I personally did


not enjoy much of the meal with the exception of the salad. However, the asparagus was not

cut as thin as the recipe suggested, and therefore was a bit tough to eat. Also, the salad bar was

not large enough to hold the theme salad and was placed on a table rather than ice. I would

have liked to have the asparagus thinly cut and the salad served on ice to maintain proper cold

temperatures.


References

Academy of Nutrition and Dietetics Quality Management Committee. (2013). Academy of

Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and

Standards of Professional Performance for Registered Dietitians. Journal of the Academy

of Nutrition and Dietetics. In press.

Silver Oaks Communications. (2009). Nutrition Calc Plus 3.2. The McGraw Hill Companies.

West, B., Shugart, G., & Wilson, M. (1979). Food for Fifty. 6th ed. John Wiley & Sons. NY


Appendix I


oin us for lunch Thursday the 14th of March from 11:30 am to 1:00 pm to celebrate a St. Patrick's Day meal in the TCID dining room. We will be serving traditional St. Patrick's Day foods that we hope for you to enjoy!

(Same standard price for staff!)

On the Menu:

ighting Irish Green Salad

ed Potato Colcannon

oda Bread

rown Sugar and Mustard Glazed Corned Beef

ucky Apple Crumble

J

F

R

S

B

L

For each petal on the shamrock This brings a wish your way-

Good health, good luck, and happiness For today and everyday


Rate the following statements according to the scale by marking: A= Agree D= Disagree NE= Neither Agree nor Disagree N/A= Not Applicable

Please list anything that would have made this meal and experience more favorable.

Thank you for your time and participation. “May your blessings outnumber the shamrocks that grow,

and may trouble avoid you wherever you go.” -Irish Blessing

A D NE N/A

The foodservice staff appeared professional

The food was at the proper temperature (whether hot or cold)

when served

The foodservice staff were polite and responded to any

questions I had

Foods on the serving line appeared attractive

The quality of ingredients meets my expectations

The flavor of the food meets my expectations

I would like to have this meal again

A kliewer theme_meal

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