Portion Control

1. Portion Control Kathy Halpin Manager Clinical Nutrition and Patient Services

2. Portion Control • Objectives • What is Portion Control ? • Why is it Important ? • How does it impact the patients, our staff and the budget ?

3. What is portion control? • To establish the correct amount of food designated as a serving size based on nutrient analysis , regulatory standards, and cost. • Use of proper serving utensils (measuring device) must be used to meet the above standard

4. Impact of Portion Control • Patients • Staff • Visitors • Budgets

5. Budget How does portion control impact our budget? A simple example If we charge an employee $1.95 for ¾ of a cup (serving size) of Macaroni and Cheese and the portion served is 1 cup Nutrition services would lose $7574.00 annually. If this occurs and I think we can assume it does “ What this means to our budget??????”

6. Staff • Staff are the key to correct portion control. From creating the recipe to placing the correct portion on the tray.

7. Patients • Nutrition services has more than 50 different diet orders and more than 100 allergy orders • The patients diet order is generated from the physician • The order is directly connected to the patients health conditions i.e fat controlled, renal, dysphagia, diabetes

8. Diet Orders-What does this have to do with portion control? • No matter what the diet order, the tray food items can be like medication orders. • What does that Mean? • CBORD/Nutrient Analysis

9. Diseases • Cardiac Diabetes • Renal Bariatric surgery • Stroke Diets are ordered based on these Diagnosis and others. The serving sizes of the food items served on these various diets can have a direct impact on the patients recovery and length of stay at MMC

10. Hospitalized patients with Diabetes Large % of out patients have Type 1 or 2 diabetes or stressed related diabetes- meaning their glucose levels out of the normal range 70-105 mg/dl MMC has a CSSP project in place with the goal to improve the glycemic control for our patients with elevated glucose levels- What does that mean for us?

11. What is Diabetes? • The food we eat breaks down into sugar called glucose. The body uses this sugar for energy. Insulin is a hormone that carries the sugar to the cells. People with Diabetes do not produce any or enough insulin to carry the sugar to the cells. • There are different categories of Diabetes usually defined as Type 1 or 2 Diabetes • Type 1 are those individuals needing to take daily insulin and type 2 are those that control the Diabetes with food, oral medication and or insulin.

12. Diabetes • One out of 3 patients are on a DB diet or related diet • What is happening at MMC to improve the patient care of these patients? • What is Nutrition Services doing to help with this effort?

13. CBORD Pattern Fixing • “What is this?” and “What does this have to do with portion size?” • Carbohydrate (CHO) Counting is key and “What is this? “

14. Carbohydrate (CHO) counting is a measurement method to count the number of gms of CHO eaten in a meal or as a snack, and helps to determine how much insulin to give. • If this is done correctly the result will be improved Blood Sugar control. • If the serving size is different than what the recipe indicates the patient will receive too much or too little food and medications administered will be inaccurate. • This becomes a patient safety issue

15. 3 Macronutrient groups • Carbohydrate (100%) • Starches: breads, pasta, cereal, lentils • Natural sugars: fruits, milk, vegetables • Added sugars: Desserts, candy, jams, syrups • Protein (58%)--Count if >6 ounces • Meats, poultry, fish, eggs, cheese • Small amounts in starches and vegetables • Fat (10%) • Margarines, oils, nuts So it is not just about the amount of CHO

16. Determining Insulin-carb Ratio • Carbohydrate (CHO) consumption is one factor when deciding how much insulin to administer. • Average is 1 unit of insulin for every 15 gm’s of CHO consumed • This varies by individual and insulin doses will be changed as knowledge of Blood sugar results are known.

17. Example • If the diet order calls for the patient to receive 60 grams of carbohydrates this instructs the nurse based on hospital protocols to give 4 units of insulin • (Ratio=one unit of insulin for every 15 grams of carbohydrates) • If a person does not get the prescribed amount of CHO the person’s medication will not be correct possibly creating the patient to have low or high blood sugar levels. This is a major safety issue.

18. Hospital Diabetic Menu Dinner Entrees Spaghetti/Meatballs w/ garlic bread (45) Wax Beans Broccoli Desserts D’Vanilla Pudding (15) Beverages Coffee Breakfast Cereals (all 15g) Special K Breads 1/2English muff (15) Entrees Hard boiled egg Beverages Orange Juice 1/2 cup (15) Milk 2% 1cup (12)

19. It’s all about the size Portion sizes matter Carbohydrate gms. differ for each food item Factors include: ingredients, nutrient content of the ingredients and the portion size Examples: Casseroles Pasta Muffins Potato Eggs Cookies Vegetables Milk

20. MMC Examples Entrees Chicken ala king 39 g Chop Suey 28g Mac and Cheese 30g Meatloaf 8 g Pizza 30g Chef Salad 10g Plain bagel 61 g Ginger snaps(2) 15 g Thumb cookie 30 g Diet custard 9 g Toast 15g Pt Muffins 30 g

21. PortionControl impacts our total service • Portion control is a safety issues for our patients and staff • Touches all of our customers; staff, patients and visitors QUESTIONS ????????