Lauren Lindeman
3 Day Menu Assignment – Bayshore Medical Center
Market Analysis
Bayshore Medical Center houses a large obstetrician gynecology department, one day surgery
center, and one day outpatient procedures which drive the average Length of Stay to about 2.3 days.
However, Bayshore also cares for a large Hispanic Male, age 51-70 years old population, many of which
are ordered either an American Heart Association (AHA) diet or an American Diabetic Association (ADA)
diet. These are used for cardiac patients, and diabetic patients respectively. The average patient is
typically seen in the Psychiatric, Intermediate Care Unit, Intensive Care Unit, and the Cardiac Rehab Unit.
These patient’s experience a length of stay which is anywhere from 5 to 14 days, much longer than the
average 2.3 days. Quality Assessment/Performance Improvement Initiative scores determine
productivity of the food service department. QAPI scores for the last year were at 95%, however patient
satisfaction scores were around 30%. In order to bring the patient satisfaction scores up, my preceptor
and her management team has decided to target the Hispanic male, ages 51-70 years old group.
The food and nutrition department is contracted by Morrison’s food service. The corporate
wellness team through Morrison’s put together a Wellness menu to push for healthier selections in the
hospital. This was not received well by the Hispanic male population. It was also constructed as a 3 Day
repeating menu cycle, where lunches would be switched for dinners and vice versa during the second
cycle. This cycle rotation repeats weekly, and meals repeat more than once during one week. For
patients that are staying more than 3 days this can be repetitive. There are also many chicken and
turkey options, but not many beef and pork items to choose
from. The survey was conducted before the menu updates
Table 1: Menu Selection Survey
have come into place. However, I would also like to hand out
the following survey for one month prior to making menu
changes to determine further analysis of food choices that
would be preferable.
The following are the steps I would carry out, had the
information not already been recorded. The Menu Selection
Survey shown in Table 1 for market analysis would be given
by catering associates each morning with breakfast meal
service. These will be given out to all current patients
receiving a meal, and isolation patients will be given a survey
by their current nurse. When catering associates return to
pick up breakfast trays and read the menu for lunch and
dinner, surveys will be retrieved and turned into the food
service manager’s office. Data will be collected for one
month. At the end of the month the data will be put into a
spreadsheet that will calculate the likes and dislikes of main
entrees. In analyzing the likes and dislikes, main entrees with
75% or more dislike will be updated. Comments added on
menu items patients would like to see in the future will also
be considered. By obtaining a census report from the hospital,
we can determine the patient population.
Lauren Lindeman
3 Day Menu Analysis
The current diet given to patients with a physician ordered an 1800 calorie ADA Diabetic Diet is
intended to be consistent in carbohydrates. Using the carbohydrate exchange system which counts 15g
as one carbohydrate exchange, catering associates are told to serve 3 carbohydrate exchanges at
breakfast, 4 carbohydrates at lunch, and 4 carbohydrate exchanges at dinner for diabetic diets.
However, the current regular diet that doubles as the diabetic diet is not nutritionally equivalent to the
previously mentioned carbohydrate count. Many meals on the current 1800 Calorie Diabetic Diet menu
follow either less than or more than the prescribed carbohydrate goal.
Moreover, this current carbohydrate count does not follow the Acceptable Macronutrient
Distribution Range (AMDR) guidelines of 45-65% calories from carbohydrates1. By following the
carbohydrate grams desired, 3 exchanges at breakfast and 4 at lunch and dinner, this comes out to a
total of 165g or 660 calories. The current 1800 diet would provide 37% carbohydrate, and protein and
fat content would have to be much higher to meet the 1800 calorie goal. Evidence suggests that a low
carbohydrate diet is not favorable for individuals with type 2 diabetes2. The diabetic consistent
carbohydrate diet is also given to individuals prescribed an American Heart Association diet, which
needs to be lower than 30% of calories from fat3. This leaves 33% of the calories to be from protein,
which is on the higher end of the AMDR for protein. Below is the estimated Dietary Reference Intakes of
macronutrients, sodium, and saturated fat according to the Institute of Medicine1.
Table 2: Estimated Calorie requirements for males ages 51-70 years old
Nutrient
RDA/AI
Grams per day
130g
45-65%
Fat
N/A
20-35%
Protein
46g
10-35%
Sodium
<2,000mg
N/A
<10%
N/A
Carbohydrates
Saturated Fat
AMDR
In the past, food service received complaints of high blood sugars from nursing staff attributed
to high carbohydrate meals. In order to improve the patient care menu, I have proposed to change to
providing 4 carbohydrate exchanges at breakfast, and 5 carbohydrate exchanges at lunch and dinner to
better distribute the calories as per AMDR recommendations, and to provide consistent carbohydrates
throughout the day in order to lower blood sugar. This menu will also provide less than 30% of calories
from fat to be consistent with American Heart Association diet guidelines. It will also provide no more
than 2,000mg per day per my preceptor’s request and Morrison’s guidelines. No high sugar drinks or
juices will be available in this meal plan in order to reduce in patient blood sugar levels for diabetics. The
goals of caloric distribution percentage, grams per macronutrient, and calories per macronutrient per
menu updates are as follows in Table 3.
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Table 3: Caloric distribution breakdown goals per new menu updates of 1800 Calorie American Diabetes
Association, American Heart Association Diet.
Macronutrient
% of Total
Calories
Grams per
Macronutrient
Calories per
Macronutrient
Carbohydrate
47%
211g
846 calories
Fat
30%
60g
540 calories
Protein
23%
103.5g
414 calories
An 1800 calorie diet is the most often prescribed diet for Diabetics at Bayshore Medical Center.
However, there are few 1600 calorie diets, 1200 calorie diets, and even sometimes 2200 calorie diets. In
the even that these diets are prescribed, the caloric breakdown is shown in Tables 3, 4 and 5. This is
based off of carbohydrate exchanges, in which the catering associates will only change the carbohydrate
exchange choices given to the patient, and the fat and protein intake will remain the same. This
accounts for changes in side items while keeping the main hot plate the same in order to reduce
confusion.
Table 4. Caloric Changes of Carbohydrates based on a 2200 calorie diet.
Macronutrient
% of Total
Calories
Grams per Macronutrient
Calories per
Macronutrient
Carbohydrate
56%
270g
1246 calories
Fat
24.5%
60g
540 calories
Protein
18%
103.5g
414 calories
Table 4.1. Carbohydrate Exchange per Meal for a 2200 Calorie Diet
Meal
Breakfast
Lunch
Dinner
Carbohydrate Exchange
7
7
7
Carbohydrate Grams
105g
105g
105g
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Table 5. Caloric Changes of Carbohydrates based on a 1600 Calorie Diet.
Macronutrient
% of Total
Calories
Grams per Macronutrient
Calories per
Macronutrient
Carbohydrate
45%
180g
720 calories
Fat
30-33%
50-60g
480-540 calories
Protein
25-26%
100-103.5g
400-414 calories
Table 5.1 Carbohydrate Exchange per meal for a 1600 Calorie Diet.
Meal
Breakfast
Lunch
Dinner
Carbohydrate Exchange
4
4
4
Carbohydrate Grams
60g
60g
60g
Table 6. Caloric Changes of Carbohydrates based on a 1200 calorie diet
Macronutrient
% of Total
Calories
Grams per Macronutrient
Calories per
Macronutrient
Carbohydrate
45%
150g
600 calories
Fat
40-45%
50-60g
480-540 calories
Protein
33-35%
100-103.5g
400-414 calories
Table 6.1. Carbohydrate Exchanges per meal based on a 1200 Calorie Diet.
Meal
Breakfast
Lunch
Dinner
Carbohydrate Exchange
3
3
3
Carbohydrate Grams
45g
45g
45g
The modifications per calorie prescribed diet will aid catering associates in modifying the same
standard menu easily per patient by adding or subtracting carbohydrate exchanges. While the AMDR
ranges for fat and protein per calorie amount, the consistent carbohydrate amount will help stabilize
blood sugars while in the hospital. Although it deviates from the AMDR, dietary fat intake should mostly
be from polyunsaturated and unsaturated sources in order to be therapeutic on a 1200 calorie diet4.
The theme to be followed is Tex-Mex, in order to capture the interest of our average
population. Foods chosen will be closer to the more familiar Texan barbecue and Latin flair that you can
find around the Pasadena area while still following dietary guidelines. Whole grains will be used in place
of refined grains, and lean meats will be served in place of higher fat protein. Black beans, pico de gallo,
Lauren Lindeman
cucumbers, and tomatoes will be used as these are more familiar side dishes. Fruits that will be served
are strawberries, mangoes, and pineapple flavors. Familiar desserts that are already served, and new
desserts that will be close to those on the current menu will be included in the menu if it meets the
carbohydrate range for the 1800 calorie diet. In order to update per calorie requirements, a
carbohydrate choice can be added or taken off following the carbohydrate count guidelines listed above
in Tables 4-6.1.
The current menu offers many turkey and chicken dishes. In order to appeal to our target
population more lean beef and pork options will be offered. There will also be less repetition. Although
the current menu is on a 7 day rotation, there are 3 day options that rotate between lunch and dinner
options. This makes patients who stay longer than 3 days feel the menu is very repetitive. Patient’s often
lose their appetite and chose not to eat when the menu options become too repetitive. In order to
ensure our food will not only be appealing, but also healing, we must offer more varying options.
3 Day modified Diabetic Diet Menu based on the Regular Diet of 1800 Calories
Each patient meal tray currently receives a condiment container with appropriate condiments
per diet. Regular diets are allowed 2 salt packets, 2 pepper packets, and as many sugar packets as they
would like. Phase 1 American Heart Association diets receive 1 Mrs. Dash herb seasoning packet with
each meal in place of salt packets, and the rest is the same as the regular diet. Diabetic, American
Diabetes Association Diets, are given 2 salt packets, 2 pepper packets, and sweet n low in place of sugar
packets. In place of iced tea diabetics may also request crystal light fruit punch mix which is sweetened
with a similar artificial sweetener. I incorporated the similar condiments per diabetic diets which are
currently being served with each meal including sweet n low. However, due to the increased risk of
complications of heart disease which is associated with individuals diagnosed with type 2 diabetes, I
would like to not provide salt packets with any diabetic diets. In place of the salt packets, diabetics will
receive Mrs. Dash herb packets. This will ensure that each 1800 calorie diet provides under the
recommended 2,000mg of sodium per day5. These however are not included on the 3 day menu
analysis. The Mrs. Dash herb packets will be offered as complimentary condiments that do not have to
be eaten with the patient tray, however they do not provide any amount of calories or nutrients.
Lauren Lindeman
Day 1 Nutrition and Cost Analysis:
Menu items included in day 1 are familiar foods with a more desirable carbohydrate range. By
adding a skim milk to the breakfast I was able to achieve a carbohydrate range that is closer to 4
carbohydrate exchanges. Lunch for day 1 introduces a new menu item with Latin flavor. This will be
using the same pork tenderloin that is currently used on the menu, but adding a new sauce and pairing
it with Mexican Corn and Spicy Black Beans. It will also feature a new side item of cucumber salad. These
recipes can all be found by the production team in Webtrition.
The dinner meal is the popular meatloaf meal that my preceptor has decided to keep on the
menu. This meatloaf uses turkey and beef, as well as bread crumbs to hold it together. This provides
close to 1 carbohydrate exchange, and will require catering associate training to add to their
understanding of counting carbohydrate exchanges.
Every meal is currently served with a condiment container which includes sweet n low, salt and
pepper. However, as previously explained, diabetic meal choices will not receive added salt packets on
this menu due to its association with increased risk of cardiac complications. Instead, we will provide a
Mrs. Dash herb packet to with each meal to add flavor without all the added salt. The whole day
provides less than 2,000mg of salt which is the upper limit recommended to those with cardiac risk
factors and diabetes. According to the American Diabetes Association less than 2,300mg on a 2,000
calorie diet is optimal for reducing cardiac risk factors6. A comparable level for a 1,800 calorie diet would
be 2,000mg.
Lauren Lindeman
Day 1 Production Plan:
Day 1 Temperature Control, Production Forecast, and Waste Log:
Lauren Lindeman
Day 2 Nutrition and Cost Analysis:
The menu for day 2 features the familiar whole wheat cinnamon French toast and oatmeal. I
have added a skim milk in order to properly meet the carbohydrate requirements of 4 carbohydrate
exchanges at breakfast. I have also changed the portion size of the French toast to be one slice of toast,
instead of one and one half pieces of toast. This will help catering associates better count carbohydrate
exchanges for breakfast meal service, as this now counts for one whole carbohydrate exchange rather
than one and one half carbohydrate exchanges.
For lunch I have added a new main dish of chicken fajita and vegetables. This will include similar
sides to the day 1 lunch, including Mexican corn. It also features a whole grain tortilla, roasted tomato
salsa, guacamole, and sour cream. For dessert we will feature a familiar orange creamsicle gelatin. This
is all within the 5 carbohydrate exchange specifications. With lunch, the condiments will be the same for
the day before. It will include a Mrs. Dash herb packet, 2 packets of pepper, and sweet n low to sweeten
tea. Patients will also have the choice of having a crystal light fruit punch drink instead of iced tea.
For dinner I have added another new menu item. Due to the high amount of catholic influence
in the Pasadena area, it is customary for Friday’s dinner to feature fish as the main dish. The current fish
meal for the Friday dinner main dish is a Dijon herb crusted tilapia. I have changed this to include a
southwestern feel instead. The Veracruz tilapia has a nice southwestern flavor, and I have paired this
with black beans, Spanish rice made with whole grains, and southwestern coleslaw. Instead of dessert
this dish will provide grapes for a lighter sweet choice of carbohydrate.
Lauren Lindeman
Day 2 Production Plan:
Day 2 Temperature Control, Production Forecast, and Waste Log
Lauren Lindeman
Day 3 Nutrition and Cost Analysis:
For the menu on day 3 I added a breakfast that is different from the usual. I found two new
recipes on Webtrition for breakfast, the egg white scramble with spinach, potatoes, and a honey wheat
English muffin, as well as a peach and yogurt breakfast parfait that is specifically for patients. These
recipes provided 3 carbohydrate exchanges, and by adding a skim milk I was able to reach the
recommended 4 carbohydrate exchanges.
The current meal served for lunch on Saturdays is Salisbury steak. While this is still a popular
item, I did not feel that it fit the Tex-Mex theme. Instead, I added a new recipe that is closer to the
barbecue fair we see often in Texas. The braised beef is made with carrots and onions, and is topped
with a brown gravy. I chose the brown gravy instead of a barbecue sauce because many of the barbecue
sauce recipes offered through Morrison’s were full of sugar. The brown gravy still gives it a nice flavor
without exceeding the carbohydrate exchange. For sides, I thought a potato salad would be a nice
addition. I was very glad to have found a recipe for a quinoa potato salad, in order to introduce
something new with something familiar, as well as to add more whole grains to the diet. For dessert, I
thought the banana pudding mousse would give a nice picnic barbecue fell while still staying low on the
carbohydrate count.
A meal option to include on the new menu, per my preceptor’s request, was pork carnitas. I
added a whole wheat flour tortilla, which is only 55% whole wheat, in order to add some whole grains to
the menu while still considering taste preferences of the patient population. For this meal I wanted to
provide red and green bell peppers with caramelized onions which are much like the chicken fajitas for
Friday’s lunch. I also incorporated Mexican pinto beans and Spanish rice in order to create a complete
Tex-Mex meal.
Lauren Lindeman
Day 3 Production Plan
Day 3 Temperature Control, Production Forecast, and Waste Log
For each day I have added Temperature Control logs for the cooks. This will aid them in logging
time and temperature control, forecasting for the current patient census, and recording leftover food.
The leftover food log will aid the food service department in better waste control. In order to better
control for waste, the executive chef will be able to analyze these logs daily and retrain cooks on proper
forecasting if necessary.
Substitutions for foods served are also included on the cook’s log in order to track any
deviations from the prescribed diet order, or the current menu. This will help the chef in determining
inventory discrepancies between the cooks, the inventory associate, and the order invoices.
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Kitchen Workflow Diagram:
Lauren Lindeman
Cost Average Analysis
There is no direct budget for the food service department here at Bayshore Medical Center.
However, good budget control can result in better credit for the food service department. This in turn
can be used to buy new supplies and equipment for the department, as well as to increase pay and
incentives for food service employees. By tracking total daily cost, the food service director can better
account for budget control and determine whether the department is making the best use of the
budget.
Day 1
Day 2
Day 3
Breakfast Cost
$1.53
$1.48
$2.29
Overall Average
Cost
$1.77
Lunch Cost
$2.51
$1.79
$2.57
$2.29
Dinner Cost
$1.72
$2.59
$1.25
$1.85
Total Daily Cost
$5.76
$5.86
$6.11
$5.91
Nutrition Analysis Average
Per Morrison’s guidelines, each patient menu needs to reach 90% of each recommendation per
patient population on average for the whole menu. In order to ensure that I have reached these
recommendations I have included information on the average of the macronutrients, sodium, and
saturated fat intake for the 3 day menu.
Total Kcals
Total CHO (g)
Total Fat (g)
Total Saturated Fat (g)
Total Protein (g)
Total Sodium (g)
Breakfast CHO (g)
Lunch CHO (g)
Dinner CHO (g)
Day 1
Day 2
Day 3
1843.12
221.03g
63.02g
17.16g
103.41g
1929.37g
64.08g
81.76g
75.19g
1825.84
221.23g
62.85g
12.40g
94.45g
2065.01g
62.94g
79.03g
79.25g
1818.60
222.88g
51.58g
15.36g
104.80g
1986.75g
67.14g
78.71g
77.02g
Overall
Average
1829.19
221.71g
59.15g
14.97g
100.89g
1993.71g
64.72g
79.83g
77.15g
% of
Requirements
101.6%
49.3%
29.6%
7.4%
22.4%
96.7%
107.8%
106.4%
102.9%
The 3 day menu presented is slightly over the calorie and carbohydrate amount allotted.
However, the macronutrients are within the Acceptable Macronutrient Distribution Range. Additionally,
the saturated fat and sodium levels are optimal for prevention of cardiovascular disease. This menu will
serve as the standard regular diet, serving a double purpose for patients on an American Heart
Association Diet. The aim of this menu is to continually provide patient care past medicinal and nursing
properties. The food service department purpose is to heal patients with food, by letting their food be
their medicine. By providing quality nutrition we can do just that.
Lauren Lindeman
References:
1. Trumbo P, Schlicker S, Yates AA, Poos M. Dietary Reference Intakes for Energy, Carbohydrate, Fiber,
Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. J Am Diet Assoc. 2003; 103(5):563.
2. Czyewska-Majchrzak L, Grzelak T, Kramkowska M, Cyzewska K, Witmanowski H. The use of lowcarbohydrate diet in type 2 diabetes – benefits and risks. Annals of Agricultural and Environmental
Medicine. 2014;21(2):320-326.
3. RH, Jakicic JM, Ard, JD, Hubbard VS, de Jesus JM, Lee IM, Lichtenstein AH, Loria CM, Millen BE,
Houston Miller N, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TW, Yanovski SZ. 2013 AHA/ACC
guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of
Cardiology American/Heart Association Task Force on Practice Guidelines. Circulation. 2013;00:000–000.
4. Huiyan W, Hongyi J, Yang L, Zhang M. Impacts of dietary fat changes on pregnant women with
gestational diabetes mellitus: a randomized controlled study. Asia Pacific Journal of Clinical Nutrition.
2015;24(1):58-64.
5. Merino J, et al. Is complying with the recommendations of sodium intake beneficial for health in
individuals at high cardiovascular risk? Findings from the PREDIMED study. American Journal of Clinical
Nutrition. 2015;101(3):440-448.
6. Nutrition Recommendations and Interventions for Diabetes. A position statement of the American
Diabetes Association. Diabetes Care. 2007;30(1):548-565.