Final Reflections on WVU Dining Services Rotation

After spending 5 weeks rotating with WVU dining services, working with the dietitian and food service staff, I have a much more complete view of the role of a food service dietitian and a greater appreciation for the work they do.  Over the past five weeks I have been able to: work with food service administration to design staff in-services, wellness programs, and plan employee schedules; work with production staff in multiple dining facilities to learn about cash operations, assist with food preparation, design production schedules, and assist with catering events; conduct temperature, quality, and waste studies; assist with the farmer’s market and hold a student forum to promote local foods; design new meals and put together week-long menus, conduct recipe and cost analysis; and design and conduct a process improvement project on portion control.  In addition to food service activities, I have managed to attend and conduct nutrition counseling sessions, assess body composition, create meal plans, lead and assist with grocery store and dining hall tours, speak with athletic teams, and observe the interactions between the strength and condition staff, athletic coaches and the sports dietitian.  These past five weeks have been busy with a wide variety of activities to ensure that I walk away from this experience fully prepared to tackle the food service industry as a registered dietitian.

My favorite part of the rotation was the week I spent with the sports dietitian.  I had never imagined that I would end up liking sports nutrition as much as I did.  I found it fascinating and very enjoyable to work closely with student athletes.  This was also my first experience with outpatient nutrition counseling and I enjoyed that very much and was surprised how naturally it flowed.  I learned a great deal from the dietitian and listening to her converse with athletes and from her feedback on my counseling skills. (See my previous blog post about this section here!)

I learned so much from each of these activities and how the entire process works together to seamlessly serve thousands of students each day.  I learned the importance of knowing job descriptions in order to be able to contact the correct individual with concerns or consultations. In such a large institution it can seem overwhelming to determine who does what but after my time spent here I realize that that aspect just takes time.  I feel confident in my abilities and my understanding of the role of a dietitian in a food service organization and I can see the need to refill the open position with WVU Dining Services as soon as possible.

I find it very interesting when you think about how many different allergies and diets the staff must accommodate here at Café Evansdale.  This is definitely a skill I need to refine prior to working in a food service establishment.  It is difficult to know exactly which items contain some of the not-so-common allergens.  Part of learning this would come with time and dealing with this on a regular basis and becoming familiar with the food that is served.  I am thankful for having this opportunity to complete this rotation and have learned a tremendous amount of information that has helped me understand food service on a larger scale.

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Patient Services Rotation

My time for rotations is finally here! This past week I completed my very first rotation as a WVU Graduate Dietetic Intern at Monongalia General Hospital. Over the past week I have been busy conducting meal rounds, tray assessments, sanitation and quality audits, developing and conducting an employee in-service, developing menus, and conducting a plate waste study.

Meal Rounds

It is important to assess the patient’s view on the meals because consuming adequate nutrition is the only way for them to heal efficiently. At Monongalia General Hospital this is assessed and tracked by meal rounds. Meal rounds are conducted by the clinical dietitian, clinical nutrition manager, diet clerks, and of course – the interns. Meal rounds involve asking the patient’s the following questions:

Food Quality: “How would you rate the overall quality of the food at the hospital?”

Food Temperature: “How is the temperature of the food? Are the hot foods hot and the cold foods cold most of the time?”

Special Diet Understanding: “I see you are on a __________ diet. Do you have any questions about that? Would you like to speak with a dietitian to answer further questions”

Menu Needs: “Do you need any changes made to your menu?”

Additional Needs: “Is there anything else I can do today?”

This information is collected using a form (that can be seen by clicking here – Meal Rounding Form) and is compiled to assess trends and averages across the weeks.

Tray Assessments

Each day I would order a test through the diet clerks and have it sent a specific floor of my choosing. I chose a different diet for each meal to be able to taste and compare each diet. The trays were assessed on the following criteria: time in cart, temperature, portion size, appearance, quality, taste, aroma, and the completeness of the tray. The forms used can be seen by clicking this link – Tray Assessment Form. If any tray received below a 90% for an overall score then corrective action must take place immediately.

Sanitation and Quality Audit

In order to ensure that the Monongalia General’s Food Service Department was being compliant with guidelines, I conducted a quality checklist and a sanitation audit. The quality checklist (view here – Quality Checklist) was designed to assess employee hygiene, dry storage, refrigerator/freezer storage areas, and the serving areas. The sanitation audit (view here – Sanitation Checklist) was designed to look at the kitchen area, dish room, and the food transportation carts. Monongalia General had very minor issues that were noted on the quality checklist but performed quite well overall.

 

Employee In-Service

In order to education the hostesses on diet compliance, in-services are used as short educational lessons. It is important for the hostess to understand the basics on the diets that the patients are prescribed because they are delivering the meals and taking the orders from the patients directly. I chose to education the staff on neutropenic (low-microbial diets). The handout for the in-service can and the employee quiz be seen by following this link (Neutropenic Diet Inservice). I presented this in-service to all the hostesses on duty.

Neutropenic Precautions Sign

 

Menu Development

I was responsible for creating a three-day menu for every meal for the following diets:

  • Regular
  • Cardiac
  • 2g Potassium
  • 2g Sodium
  • Gluten Free
  • Consistent Carbohydrate
  • Clear Liquid
  • Full Liquid

In order to first design a menu, it is important to assess the needs and desires of the target population. I chose to specifically assess the patients on a cardiac diet. During meal rounding I conducted a brief patient survey regarding the flavor of the meals, what menu items they would like to see more of, and what items they would like to see less of. I took into account the comments made when I began to plan meals for the cardiac patients. When creating the meals I had to keep in mind diet needs, patient preferences, cost, and feasibility of production.

 

Plate Waste Study

As a special project, I chose to conduct a plate waste study on the returned trays from the lunch period. Plate waste studies are a quick method to assess intake from a large sample size in an efficient and effective manner. Typically, plate waste studies are used for school meals or large food service organizations. The importance of assessing plate waste for hospital patients is that these studies provide knowledge about food preferences, what foods are being consumed, and what is being thrown away. It is expected, that regardless of how good the food taste, that there will still be a significant amount of plate waste because the target population includes ill individuals who are likely to be on medications that may alter their appetite or ability to taste normally. For this study, plate waste data was collected on four consecutive days at Monongalia General Hospital. The cart from which the trays were selected from was chosen at random according to what was available at the time of the observation. Trays were excluded from the analysis if they did not have the original ticket to identify the diet and meal order or if they were on a liquid diet. Each day of the study 10 trays were analyzed and the percentages of each major item were recorded. The data collected and the forms used can all be seen here (Plate Waste Observation Sheet). The findings of this study can be found by following this link (Plate Waste Report).

Plate Waste Study