Successful utilization of obra standards and CQI indicators to implement changes in a liberalized geriatric diet program

Abstract

The Methodist Home, Inc. houses 700 residents, 289 of whom are served in the skilled nursing facility, Wesley Nursing Center. Wesley complies with Omnibus Budget Reconciliation Act regulations which give nursing facility residents the right to choose or refuse services, including diets based on their food choices. Until 1990, 20% of the diets were regular, while the remaining 80%, including puree diets, were therapeutically modified to varying degrees of restriction. Some diet Rxs read 2 Gm Na with bacon, sausage, any cereal of resident's choice, and pie. This kind of prescription practice led to the two-step process of liberalizing diets. This received strong support from the Resident Council, the Medical Director, the Administration, the staff, and the families. The first steps in the process included the revision of menus, the standardization of recipes, and the extension of the main frame regular diets all the way to puree diets, so that the foods served resembled those on regular diets as much as possible. Extensive inservices to all involved departments and staffs and notification to 67 attending physicians of our intent and the rationale for liberalizing the diets followed. When these steps were completed, the menu spread sheet exhibited diets that were 50% Regular/Soft, 5% Regular/Soft with No Added Salt, 30% Regular Puree, 5% No Concentrated Sweets, 3% calorie control for unstable diabetics, and 7% Enteral Feedings. The second part of the process was the implementation of the menu spread sheets. Strict recipe compliance with the use of Continuous Quality Improvement indicators were major factors in the success of the program. The success of the project resulted in uniformity in food production and cost control; no use of commercial baby foods or thickeners and the decreased use of nutritional supplements; fewer requests for food substitutions as substantiated by entries in the substitution log book; fewer missing items on trays as indicated on the telephone log book; documentation on Flow Sheets of greater than 75% meal consumption; and weight losses of no more than 5% in one month or 10% in six months as shown on monthly weight charts. Liberalization of the geriatric diet to provide palatable, well-seasoned foods greatly improved resident satisfaction.