Food in Hospitals - NHS National Services Scotland

1 FOOD IN HOSPITALSN ational Catering andNutrition Specificationfor Food and FluidProvision in Hospitalsin ScotlandRevised March 2016 Food in Hospitals1 of 194 Food in Hospitals2 of 194 FOOD IN HOSPITALSN ational Catering andNutrition Specificationfor Food and FluidProvision in Hospitalsin ScotlandThe Scottish Government, Edinburgh 2016 Food in Hospitals3 of 194 IIFOOD IN HOSPITALSFood in Hospitals4 of 194 FOOD IN HOSPITALSCONTENTSIIIC ontentsList of Tables VIIList of Appendices IXGlossary of Terms XFood in Hospitals Context in Scotland Introduction Purpose Policy Background Scotland s National Food and Drink Policy Good Food Nation The Scottish Dietary Goals Food, Fluid and Nutritional Care Standards Healthcare Improvement Scotland nutrition Support for Adults: Oral nutrition Support, Enteral Tube Feeding and Parenteral nutrition , Methods, Evidence and Guidance The Council of Europe Produced Resolution ResAP (2003) Food and Nutritional Care in Hospitals : How to Prevent Undernutrition The Procurement Reform ( Scotland ) Act Catering for Change.

2 Buying Food Sustainably in the Public Sector Non-patient Food-related Policies and Initiatives Food Standards Scotland (FSS) Business Continuity Needs of the Hospital Recognising Patient Needs13 Assessment, Screening and Care Planning 13 Nutritional Care Assessment Nutritionally Vulnerable Hospital Patients Nutritionally Well Hospital Patients Nutrient Specification Nutritional Requirements of Hospital Patients Rationale for Differences in Nutrient Criteria 17 Food in Hospitals5 of 194 IVFOOD IN HOSPITALSCONTENTS3. Menu Planning and Food-based Criteria Menu Planning Criteria Food-based Criteria 244. Menu Planning Guidance Introduction The Planning Process Assessment of Patient Population Dietary Needs Cost and Resource Implications Food-based Menu Planning Guidance Healthy Eating Advice Basic Principles Food Group Menu Planning Guidance Menu Structure Catering Specification A Choice of a Hot Meal at Midday and at the Evening Meal Between-meal Snacks Outwith Main Meal/Missed Meal Time Provision Ward Provisions Standard Recipes Safe Provision of Therapeutic Diets Required Information Recipe Development Recipe Analysis Analysing Menu Capacity Portion Sizes Essential Criteria Meal Presentation 595.

3 Therapeutic Diet Provision Introduction Criteria Dietary Coding Kitchen Space and Equipment Higher Energy and Nutrient-dense Diet Coding Criteria Catering Guidelines Healthier Eating Coding Criteria Catering Guidelines 70 Food in Hospitals6 of 194 FOOD IN Allergen-free Diets Food Allergy Food Intolerance Catering Guidelines Food Labelling Food Allergen and Food Intolerance Gluten-free Diet Oats Catering Guidelines Texture-modified Diets Criteria Coding Criteria Catering Guidelines Diets for Kidney Disease Coding Criteria Restriction Issues for Protein and Potassium Catering Guidelines Diet Suitable for People with Neutropenia Catering Guidelines Monoamine Oxidase Inhibitors (MAOI) Diet Catering Guidelines and Personal Introduction Religious and Ethnic Groups in the UK and Scotland Essential Criteria Vegetarianism and Veganism Common Dietary Variations Halal Diet Food Laws Festivals and Fasting Hindu Diet Food Restrictions Festivals and Fasting Kosher Diet Food Laws Festivals and Fasting Chinese People Food Rules of Religion 121 Food in Hospitals7 of 194 VIFOOD IN and Nutritional Guidance for Children and Young Menu Planning Planning Group Planning Process Food-based and Group Planning Guidance Menu Structure Portion Sizes Fibre and Children Nutrient Criteria for Children and Young People and Introduction 1 Dietary Needs of Significant Patient Groups138 Appendix 2 Estimated

4 Average Requirement (EAR) for Energy142 Appendix 3 Rationale and Considerations for the Provision ofNutrients to Hospital Patients 146 Appendix 4 Omega-3 (-3) Polyunsaturated Content (g/100g Edible Portion) of Selected Fish 155 Appendix 5 Template for Suggested Menu Structure 155 Appendix 6 Membership of Hospital Food Reference Group 2008 158 Appendix 7 Membership of Hospital Food Reference Group 2015 15910. References161 Food in Hospitals8 of 194 FOOD IN HOSPITALSLIST OF TABLESVIIList of TablesTableHeadingPage numberTable 1 Healthcare Improvement Scotland Food, Fluid and Nutritional Care Standards 4 Table 2 Essential criteria for the provision of nutrients for hospitalised adults 18 Table 3 Menu planning criteria21 Table 4 Food-based criteria24 Table 5 Potatoes, bread, rice, pasta and other starchy carbohydrate34 Table 6 Fruit and vegetables36 Table 7 Beans, pulses, fish, eggs, meat and other proteins38 Table 8 Dairy and alternatives40 Table 9 Oils and spreads.

5 Including sugar and salt41 Table 10 Water and beverages43 Table 11 Suggested menu structure45 Table 12A suggested range of snack items including energy and protein contents50 Table 13 List of minimum ward provisions 53 Table 14 Essential information to be included in a standardised recipe 54 Table 15 Methodology for analysing menu capacity57 Table 16 Criteria for higher energy code (per portion) 65 Table 17 Higher energy diet menu planning guidance 66 Table 18 Criteria for healthier eating code (per portion)70 Table 19 Healthier eating menu planning guidance71 Table 20 Scope of allergenic ingredients required on food labelling 77 Table 21 Allergen-free food guidance 79 Food in Hospitals9 of 194 VIIIFOOD IN HOSPITALSLIST OF TABLEST ableHeadingPage numberTable 22 Gluten-free food guidance81 Table 23 Foods containing Gluten83 Table 24aNational descriptors for texture-modified food 86 Table 24bModified texture food guidance 94 Table 25 Criteria for diets for Renal diseases 97 Table 26 Potassium and protein allowances98 Table 27 Diet guidance for foods and fluids in kidney disease99 Table 28 Clean diet food guidance 104 Table 29 High risk foods to avoid and alternatives 106 Table 30 High risk foods that should be avoided and suitable alternatives107 Table 31 Dietary recommendations

6 For individuals taking MAOI drugs (adapted)109 Table 32 Criteria for vegetarian and vegan diets 115 Table 33 Characteristics of Chinese diets119 Table 34 Children up to 16 years old127 Table 35 Paediatric fluid requirements129 Table 36 Energy requirements for males and females 0 18 years130 Table 37 Estimated Average Requirement (EAR) for Energy131 Table 38 Reference nutrient intakes for protein 143 Table 39 Reference nutrient intakes for vitamins 144 Table 40 Reference nutrient intakes for minerals145 Table 41 Rationale and considerations for the provision of nutrients146 Food in Hospitals10 of 194 FOOD IN HOSPITALSLIST OF APPENDICES IXList of Appendices Appendix 1 Dietary Needs of Significant Patient Groups138 Appendix 2 Estimated Average Requirement (EAR) for Energy142 Appendix 3 Rationale and Considerations for Provision of Nutrients to Hospital Patients146 Appendix 4 Omega-3 (-3) Polyunsaturated Content (g/100g Edible Portion) of Selected Fish155 Appendix 5 Template for Suggested Menu Structure155 Appendix 6 Membership of Hospital Food Reference Group 2008158 Appendix 7 Membership of Hospital Food Reference Group 2015159 Food in Hospitals11 of 194 XFOOD IN HOSPITALSGLOSSARY OF TERMSG lossary of TermsAcute sectorHospital-based health Services which are provided on an in-patient or out-patient to eatingDishes, cups and cutlery that have been specifically adapted to allow individuals who have difficulty eating.

7 La carte menusDishes prepared individually out with the normal set severe, potentially life-threatening allergic reaction. Artificial nutrition SupportProvided to patients who cannot consume sufficient foods to meet their nutritional requirements. This is maybe in the form of a liquid oral supplement or a specially formulated liquid feed that is provided via a feeding tube either into the stomach or via a vein and is prescribed by a dietitian or process of measuring patients' needs and/or the quality of an activity, service or review of the procedures used for diagnosis, care, treatment, and rehabilitation, examining how associated resources are used and investigating the effect care has on the outcome and quality of life for the ScotlandHelps the Auditor General and Accounts Commission ensure that public bodies, including the NHS, spend money properly, effectively and efficiently.

8 By carrying out financial and performance Association for Parenteral and Enteral nutrition is a charitable association that raises awareness of malnutrition and works to advance the nutritional care of patients and those at risk from malnutrition in the wider drink which exceeds 85% water light meal of the day, usually comprising cereals and toast/rolls Dietetic Association ( BDA)The professional association for dietitians in the in Hospitals12 of 194 FOOD IN HOSPITALSGLOSSARY OF TERMSXIC hoiceMore than one option that meets an individual's dietary and nutrient needs. With careful menu planning, one option may meet the differing needs of more than one patient diseaseCoeliac disease is a common digestive condition where a person has an adverse reaction to Advisory PanelCommodity Advisory Panels (CAPs) are advisory groups who have clinical, technical or commercial expertise in the goods or Services under consideration.

9 CAPs are formed for each major area of expenditure, including food and fluids, to help to ensure that the goods or Services meet the needs of those who use them and offer best value for money. They advise National Procurement on the clinical, technical or commercial aspects of the goods and Services to be dishA composite dish should consist of a protein containing food, vegetables and a carbohydrate/starchy Nutritional PathwayIncorporates the Malnutrition Universal Screening Tool (MUST) and is intended to clarify what patients should expect in terms of effective nutritional care. It defines six critical points in the patient s journey from Admission to can refer to the transfer of either bacteria or allergen traces from one product to another via surface contact or the use of the same codingDietary coding provides information to patients, carers and staff to enable them to make an informed food choice whilst in hospital.

10 Hospital menus should be coded for healthier eating and higher-energy nutrient-dense meal options. Vegetarian options should also be coded. Foods that are not coded may still be suitable for patients to choose, but are perhaps not the preferred needsIndividuals' dietary needs include their eating and drinking likes and dislikes; food allergies/intolerances and need for therapeutic diet; cultural/ethnic/religious requirements; social/environmental mealtime requirements; physical difficulties with eating and drinking; and also whether there is a need for equipment to help with eating and in Hospitals13 of 194 XIIFOOD IN HOSPITALSGLOSSARY OF TERMSD ietary needs assessmentThe process of assessing the specific dietary needs of individual patients (see dietary needs ). The findings of the dietary needs assessment should be considered in the patient's nutrition care plan (see nutrition care plan ).