DIETARY MANAGERS TRAINING PROGRAM REVIEW SESSION

1. DIETARY MANAGERS TRAINING PROGRAM REVIEW SESSION Becky Rude, MS, RD, CDM, CFPP University of North Dakota beckyrude@mail.und.edu

2. What the Exam Includes • Management of food services – 35% • Nutrition – 22% • Management of Personnel – 19% • Sanitation – 24%

3. Be Prepared • Know what to expect • Test outline • Refer to the exam application booklet • Know the percentages for each area • Resources needed • Calculator, pencils, test admission letter, ID, etc. • Review your textbooks • Practice the multiple choice questions at the end of each chapter

4. Test Taking Strategies • Relax • Be physically ready • Be mentally ready • Pace yourself • Don’t spend a large amount of time on one question. Circle it, and go back later • If in doubt – go with your first instinct • Take a deep breath every now and then

5. Medical Nutrition Therapy • Nutrients • CHO • Protein • Fat • Vitamins • Minerals • Water

6. Calculating Calories • Chicken Alfredo C P F • 4 oz. chicken breast 0 28 12 • 1 cup pasta 30 6 0 • ¼ c. alfredo sauce 0 0 10 • Calculate kilocalories • Calculate % Kcal from CHO, Pro, and Fat

7. Assessment • Clinical • Laboratory • Anthropometric • Diet • Medical / Social hx (history)

8. Assessment Timeline • New admission • Assessment – 5 day ; 14 day; 30 day • Care Plan –21 days • Quarterly • Annually • Changing conditions • Monthly weights

9. Triggers • Significant weight loss • Taste alterations • TPN / IV / TF • Mechanical altered diet • Therapeutic diet • > 25% food left • Pressure ulcers (decubitus ulcers)

10. Calculate Nutrient Needs • Kcal (Kilocalories) • Male 1 Kcal/kg body weight x 24 hours • Female 0.9 Kcal/kg body weight x 24 hours • Plus activity • Plus stress (injury factor) • Protein (0.8 g, x kg. body weight) • Fluids ( 30 ml c kg. body wt.) (1cc per Kcal)

11. Case Study • 77 y.o. female • CC: productive cough and weakness • Alert and oriented x 3 • Dx: pneumonia • Ht. 65”, wt. 135#. UBW = 145# (1 mo ago) • Nutrition related labs: • hgb – 10.9 • Hct – 32.1% • PMHx: HTN and colon CA • Diet Order; NAS

12. Healthy Body Weight • 65” client • 100# + (5# x 5”) = 100 + 25 = 125# • Large frame: + 10% → 125# + 13# = 138# • % healthy body weight: 135# / 138# = 0.98% • % weight change: 145# - 135# = 10# 10# / 145# = 0.07 or 7%

13. Estimated Needs • BMR 135# / 2.2 = 61.36 kg. 61.36 kg. X 0.9 kcal / kg x 24 hours = 1325 kcal Maintenance 1325 kcal x (activity factor) x (stress factor) Protein 61.36 kg. X 0.8 g. Pro / kg. = 49 g. Pro Fluids 61.36 kg. X 30 ml. / kg = 1841 ml./day

14. Diet • Diet Order: NAS • Diet Hx C P F 1 c. coffee 0 0 0 1 slice toast / 1 t. marg. 15 3 5 ½ Roast Beef Sandwich 15 14 10 ½ c. water packed pears 15 0 0 1 c. cornflakes 15 3 0 ½ c. skim milk 6 4 0

15. Diet Analysis • Totals C P F 66 24 15 Kcal: 264 + 96 + 135 = 495 Kcal Percentages: Food Guide Pyramid Deficiencies?

16. Applications • Appropriateness of diet / menu modifications • Religious preferences • Individualized care plan • Tray accuracy • Supplemental feedings • Food acceptability

17. Education • Assess needs / knowledge base-goal oriented • Identify resources • Adapt teaching materials • Home care

18. Documentation • Appropriate format • Section K • Other sources • Confidentiality

19. Review - • High Sodium Foods • High Potassium Foods • High Calcium Foods • High Protein Foods

20. Review • High Cholesterol Foods • Gluten containing foods • Lactose containing foods • Common allergens / foods

21. 1 t. = _____ ml 1 oz. = _______ ml 8 oz. = ________ ml 1# = ______ oz. 1 c. = _____T. 1 T. = _____t. 1 qt = _____ c. 1 gal = ____ qt. #8 scoop = _____ cup # 16 scoop = _____ cup 1 T. = _____ ml 1 qt.= _____ ml 1 qt. = _____ oz. 1 c. = ______ oz. Review

22. Quiz 1 – Sample Exam • Nutrition

23. Foodservice Operation • Centralized • Decentralized • Menu Planning / Recipe conversion

24. Recipes • Adjustment – new yield / old yield • Standardized recipe components • Proper cooking techniques • Calculate nutrition content / cost • Design new recipe • Criteria • Client acceptance

25. Example: Meatloaf Ingredients: 3# ground beef 1 egg ¼ c. chopped onion 1 c. bread crumbs 1 t. ground mustard 1 c. tomato sauce 1 T. worcestershire sauce Yield: 12 – 3 oz. portions Bake: 350 ° F. for one hour

26. Scaling Original yield: 12 – 3 oz. portions New yield: 57 – 3 oz. portions 57 / 12 = 4.75 (factor) AP = 16 oz. EP = 12 oz. 12 / 16 = 0.75 or 75%

27. Recipe Costing Ground Beef $2.29 / lb. Egg 1.79 / doz Onion .35 / cup Ground Mustard .05 / t. Worcestershire Sc .05 / T. Bread crumbs .45 / c. Tomato sauce .79 / c.

28. Workflow • Configuration • U- shaped • Galley • Workflow • Placement of equipment • Work simplification • Ergonomics

29. Production • Production Sheet • Forecast • Menu Items / substitutions • Portion control / food waste • Tray line systems • Productivity

30. Purchasing • Specifications • Menu • Space and utilities • Material (NSF / UL) • Cleaning • Maintenance • Repair vs. replacement

31. Specifications • Evaluate existing equipment • Evaluate replacement equipment • Budget justification • Vendor / product comparison • Can cutting • Vendor / product selection

32. Budget Cafeteria – gross receipt Raw food cost • beginning inventory $ 5000.00 + purchases 8000.00 • Ending inventory 3000.00 Raw food cost 10,000.00 Meals served 8250 Cost per meal (10,000 / 8250) = $1.21

33. Cost per unit • Cost a catered event • Cost menu • Calculate daily cost per client

34. Calculate Variance Actual money spent $66,250 - budget - 64,751 ___________ 1499 Divide by budget 1499 ÷ 64,751 = 0.023 x 100 = 2.3% over-budget

35. Quiz 2 – Sample Exam • Foodservice Management

36. Human Resources / Personnel • Implement change • Identify personnel needs • Job analysis / specifications / description • Orient / motivate • Present work procedures / plans • Teach / coach employees • Set goals

37. Management Styles • Authoritative • Participative • Proactive

38. Employees • Communicate • Schedules • Calculate FTE’s • Work assignments • Define needs • Performance evaluation • US Department of Labor

39. Professional Interactions • Organizational Chart • Patient Care Conferences • Meet community needs • Audits

40. Quiz 3 – Sample Exam • Personnel Management

41. Sanitation • Contaminants / Hazards • Biological • Chemical • Physical • Symptoms of foodborne illness

42. Personal Hygiene • Hand washing • Diseases transmitted by people • Universal precautions • Training

43. HACCP • Purchasing / receiving • Purchase order • Grade / inspection • Rejection process • Verify order • Signs of contamination • Storage temps • FIFO

44. Ground Beef • Purchasing • Inventory • Security • Perpetual • Physical • Cost control

45. Preparation • Cross contamination • Safe thawing

46. Cooking • Critical control points • End point cooking temps (critical limits) • Temperatures • Service • Cooling • Re-heating

47. Continued • Corrective action • Record keeping • Verify • 7 steps of HACCP

48. Materials • Easy to clean • Equipment maintenance schedule • Preventative maintenance • Proper cleaning technique • Training • Right to know • MDS

49. IPM • Clean vs. Sanitary • Temperatures in dishwashing • Safety inspection checklist • OSHA

50. Crisis Management • Emergency contact • Call list • Secure inventory • Alternate menu • Potable water