Queensland Health Nutrition Standards for Meals and Menus · The health outcomes and experience of those in our care can be improved with quality meals and good nutrition. The Queensland

QUEENSLAND HEALTHNutrition Standards

for Meals and Menus2015

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Document title: Queensland Health Nutrition Standards for Meals and Menus

Publication date: May 2015

ISBN: TBC

Author: State-wide Foodservices Network

Audience: Foodservice personnel and dietitians within Queensland Health facilities

Review date: 2018

Endorsed by: State-wide Foodservices NetworkContact: [email protected]

URL: http://qheps.health.qld.gov.au/statewidefoodservice/home.htm

Disclaimer: These Standards have been prepared to assist menu planning in Queensland Health Facilities to meet patient and client needs. Menu planning shall be a collaborative process and include input from dietitians, foodservice managers and other key stakeholders.

This document does not replace or remove local assessment processes that should be considered during menu planning. Information within these standards is current at time of publication.

© State of Queensland (Department of Health) 2013

This work is licensed under a Creative Commons Attribution Non-Commercial Share Alike 2.5 Australia licence. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute Queensland Health State-wide Foodservices Network, you distribute any derivative work only under this licence and you abide by the licence terms. To view a copy of this licence, visit: http://creativecommons.org/licenses/by-nc-sa/2.5/au/

ForfurtherinformationcontactDietitian-Consultant,State-wideFoodservicesNetwork,DepartmentofNutritionandDietetics,RoyalBrisbaneandWomen’sHospital,ButterfieldStHerston, QLD4029,[email protected],orphone(07)36362288.Forpermissionsbeyondthescopeofthislicencecontact:IntellectualPropertyOfficer, QueenslandHealth,GPOBox48,BrisbaneQld4001,[email protected],phone(07)32341479.

OriginallywrittenbyQueenslandHealthNutritionStandardsWorkingParty,andfirstpublishedinTBC2011. This is version two of Queensland Health’s Nutrition Standards for Meals and Menu, and will remain current until reviewed.

HMMU Apr’13 0425_jk / CMM August '15 0527_ss

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CONTENTSForeword ......................................................................................... 4 Nutrition Standards Working Party ............................................... 5 Purpose ...................................................................................... 6

Section 1 – Nutrition Standards ...................................................... 7 Overarching principle ................................................................. 8 Adult acute ................................................................................. 9 Adult acute (short stay patients) ................................................. 10 Maternity .................................................................................... 11 Paediatrics ................................................................................. 12 Residential aged care ................................................................. 13 Mental health and acquired brain injury ..................................... 14 Vegetarian and vegan ................................................................. 16 Therapeutic and medical diets .................................................... 17

Section 2 – Meal Component Specifications .................................... 18 Overview .................................................................................... 19 Main (protein) dishes ................................................................. 20 Soups ......................................................................................... 21 Sandwiches ................................................................................ 21 Desserts / Hot Breakfast Protein .................................................. 22 Snacks/mid-meals ..................................................................... 23 Fortificationofmenuitems ......................................................... 23 Portion sizes for meal items ........................................................ 24

Section 3 – Minimum Menu Choice ................................................. 25 How to use the tables ................................................................. 26 Adult acute and Residential aged care ........................................ 27 Texturedmodified ....................................................................... 31 Paediatrics .................................................................................. 34 Mental health and acquired brain injury ..................................... 38

Section 4 – User guide and definitions ............................................ 42 User Guide ................................................................................. 43 DefinitionsandAbbreviations .................................................... 46 References ................................................................................. 48

.Apendix 1 – Length of Stay data ...................................................... 50

Apendix 2 – Reference persons used in Standards Development ...... 54

Apendix 3 – Examples menus .......................................................... 57

Apendix 4 – Minimum serve sizes ................................................... 64

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FOREWORD The health outcomes and experience of those in our care can be improved with quality meals and good nutrition. The Queensland Health Nutrition Standards for Meals and Menus suports this by providing a framework to enable health facilities to meet the nutritional requirements of the majority of patients, residents and clients.

Originally published in 2012, these standards have been implemented fully or partially around the State and have been used to provide a sound nutritional basis to inform the food contracts for Queensland Health facilities.

As a result, the majority of Queensland Health facilities are able to meet the nutritional requirements of patients, residents and clients without the addition of costly suplements and extensive dietetic input. In conjunction with the Foodservice Best Practice Guidelines, the standards continue to set out overarching principles that ensure a quality, patient-focused, food and nutrition service.

This revised edition of the Queensland Health Nutrition Standards for Meals and Menus incorporates feedback on useability and practicality and aligns to the new NationalHealthandMedicalResearchCouncilAustralianDietaryGuidelines,whicharebasedonthebestavailablescientificevidence.

The full implementation of the Standards across Queensland Health facilities will not only continue to improve patient, resident, and client satisfaction and outcomes but also will be a cost effective way of providing nutrition treatment for malnourished and nutritionally vulnerable people in our care.

Hon Cameron Dick MPMinister for Health and Minister for Ambulance Services

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Nutrition Standards Review 2015, conducted by the Nutrition Standards Work Group, Statewide Foodservices Network.Michelle Suter Team Leader(Chair) Dietetics & Foodservices Caboolture Hospital

MembersKylie Bruce, Senior Dietitian Nutritionist, Nutrition & Dietetic Services, West Moreton Hospital & Health Service

Trish Cowlishaw, Senior Dietitian, Allied Health, Biloela Hospital

Denise Cruickshank Dietitian Consultant, Food Services Network, Dept of Nutrition & Dietetics, Royal Brisbane & Women’s Hospital

Julianne Donnelly, Team Leader, Nutrition & Dietetics, Princess Alexandra Hospital

Jennifer Ellick, Senior Dietitian – Nutrition & Dietetics Department, Royal Brisbane & Women’s Hospital

Amy Hannigan, Acting Team Leader, Nutrition & Dietetics, Princess Alexandra Hospital

Marion Hogg, Director Nutrition & Dietetics, Ipswich Hospital, West Moreton Hospital & Health Service

Lindsey Johnson, Advanced Dietitian (Food Services), Cairns & Hinterland Hospital & Health Service

Philip Juffs, Dietitian Team Leader Food Service, Nutrition & Dietetics, and Patients Food Services, Royal Brisbane & Women’s Hospital

Troy Litzow, SeniorProjectOfficer–FoodSafetyAuditor(FSA/0282), Food Services Network, Dept of Nutrition & Dietetics, Royal Brisbane & Women’s Hospital

Gai Moritz, Acting Senior Clinical Dietitian (Foodservices / Surgical), Nambour General Hospital

Tara Stevenson, Manager Food Services, Corporate Services, QEII Jubilee Hospital

Acknowledgment of original Work Group, 2012 Julianne Donnelly Redland Hospital (Chair)

Denise Cruickshank State-wide Foodservices Policy and Planning

Dr. Merrilyn Banks Royal Brisbane and Women’s Hospital

Kylie Bruce The Park – Centre for Mental Health

Karly Burton Princess Alexandra Hospital

Laurel Evans Gold Coast Hospital

Dr. Maree Ferguson Princess Alexandra Hospital

Christine Gugole Eventide Aged Care

Mary Hannan-Jones Queensland University of Technology

Fiona Hjortshoj Baillie Henderson Mental Health Facility

Sally McCray Mater Health Services

Anneli Reeves Logan Hospital

Jennifer Shirtcliff Toowoomba Hospital

Aoife Smith Mater Health Services

Michelle Suter Caboolture Hospital

Zoe Walsh Mater Health Services

Dr. Melinda White Royal Children’s Hospital

Liz Wisely Gold Coast Hospital

Katie Vardy Gold Coast Hospital

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PURPOSEThe Nutrition Standards for Meals and Menus (NSMM) are designed to provide a framework to assist menu planning in hospitals, residential aged care, mental health facilities and acquired brain injury units managed by Queensland Health (QH). This framework aims to meet the nutritional requirements of the majority of patients, residents, consumers and clients taking into account length of stay, age, nutritional status and type of facility. These Standards are designed to be used in conjunction with the State-wide Food Service KPI6 which inform aspects of foodservice provision, menu delivery, type and quality of meal service.

The NSMM are intended to be used by dietitians and foodservice managers in the design and assessment of menus and recipes. These Standards provide baseline requirements for general patient and resident menus. However, they do not replace the need for individual assessment of patients’ nutritional status or needs.

These Standards are based on the premise that patients in QH hospitals and residential aged care facilities are predominantly unwell and have different nutritional requirements to the general public. The Australia Dietary Guidelines 20134 are not aplicable as these recommendations aim to meet the nutritional needs of healthy populations.

However, mental health and acquired brain injury consumers are generally younger, tend to have longer lengths of stay8, 9 and are known to experience increased rates of chronic disease.10, 11 A preventative health aproach is warranted in menu design and choices for these groups, and as such, the National Health and Medical Research Council’s Nutrient Reference Values12 recommendations for chronic disease prevention and The Australia Dietary Guidelines 20134 were considered in the development of this section.

This document is presented in four sections as follows:

Section 1 outlines:

• the overarching principles; • thespecificprinciplesfordifferentpatientgroupsanddiettypes;and• the rationale and evidence for these principles.

Section 2 outlines:

• mealcomponentnutritionspecifications. Section 3 indicates how these principles are put into practice in a menu including:

• minimum menu choices required across the day; and• minimum menu choices required across the cycle.

Section 4 outlines:

• a user guide to assist with menu review process; and• definitionsusedthroughoutthedocument.

The State-wide Food Service Best Practice Guidelines2 and the State-wide Food Service KPIs6 are available on QHEPS intranet.

Nutrition Standards for Meals and Menus

SECTION 1NUTRITION STANDARDS

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NUTRITION Standards

1.0 OVERARCHING PRINCIPLEAim: Food provision shall meet the nutritional requirements of the majority of patients, residents, consumers and clients, taking into account age, clinical need, nutritional status, psychosocial needs, cultural and religious diversity and length of stay.

BACKGROUND/RATIONALE STANDARDS

Patients in hospital are usually acutely ill or suffering from chronic diseases and thisincreasestheirnutritionalrisk.Thereissignificantevidencethatpoororalintake in addition to clinical treatment or medical disease is responsible for poor nutritional status of patients in hospital.13,14,15,16

The literature suports a link between poor nutrition status, recovery from illness, increased complications, length of hospital stay and increased costs.17,18,19 The literature also suports that cost savings through reduced length of stay and complications can be realised if nutritionally at risk patients orresidentscanbeidentifiedandnutritionalsuportimplemented.20

The State-wide Food Service Key Performance Indicators6 (SFSKPI) have been developed to ensure a client focus and underpins these Standards.

This overarching principal aplies to the patient groups included in Sections 2.0 – 9.0: Adults – Acute, Maternity, Paediatrics, Residential Aged Care, Mental Health and Acquired Brain Injury, Vegetarian and Vegan and those on Therapeutic and Medical Diets.

1.1 Menu planning will be undertaken as a collaborative process and will include dietitians, foodservice managers and other key stakeholders to ensurenutrition,financial,psychosocial,choiceandqualitygoalsaremet.

1.2 A dietitian will be available to assess the food and menu as meeting these NSMM and the requirements (cultural, religious, age, psychosocial, nutritional status) of the population in the facility2.

1.3 The menu is reviewed by a dietitian biennially.2

1.4 Patients/residents/clients are able to access at a minimum, three main meals and three mid-meals each day.2

1.5 Serve size variations* are offered on the menu.

1.6 The facility will endeavour to accommodate cultural and religious food preferences within the restrictions and constraints of food suply issues.

Note: *Refertop47fordefinitionsonservesizes

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2.0 ADULT: ACUTE (EXCLUDING SHORT STAY PATIENTS)Aim: The food offered provides choice, variety and meets the nutritional needs of the majority of patients, including those with higher protein and energy requirements.


Assessment of length of stay (LOS) at seven QH hospitals indicate that 60% – 75% of occupied bed days (OBD) are patients staying longer than seven days where these patients had an average LOS of 14.7 to 22.4 days (refer to Apendix 1 p 50). Reassessment of LOS at 2 sites in 2014 indicated that aproximately 70% of OBD are patients staying longer than seven days with an average LOS of 17 days.

The literature suports that cost savings, through reduced length of stay and complications, can be realised if nutritionally at risk patients or residents can beidentifiedandnutritionalsuportimplemented.20

Patients assessed with or at risk of malnutrition, or who are admitted for more than seven days in acute facilities, need access to extra food choices and higher energy/protein options at meals and mid-meals. This will increase the likelihood of meeting nutritional and psychosocial needs.

Studieswereidentifiedthatmeasuredtheeffectsofprovidingenergydensemeals and snacks to hospitalised patients21,22,23,24 and reported an increase in bothenergyandproteinintakewhenfortifiedfoodwasprovided.Onestudy23 lookedatfortificationoffoodandacookedbreakfastwhichresultedinthehighest increase in energy and protein intake.

2.1 Adult facilities shall have systems in place to identify patients who are at nutritional risk or are malnourished.

2.2 The standard menu shall provide a minimum choice across cycle length of 35 hot main meals with choices as outlined in Section 3 Minimum Menu (p 26 – 41).

2.3 The standard menu shall provide three main meals and three mid-meals each day. At least two mid meals are substantial i.e. group 1 or 2 (refer to Meal Component Table p 23).

2.4 Thestandardmenushallprovidefortifiedoptionsfor:

• hot cereal;• soup; and • one vegetable per day for all textures.

FortifiedfoodswillmeetthenutritiontargetsoutlinedinSection2 MealComponentSpecifications(p18–23).

2.5 The standard menu shall provide a hot protein breakfast choice for all texturelevels,includingregularunmodified(i.e.full)andTextureAsoft (refertoDefinition–BreakfastProteinp46andMealComponentTable p 22).

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3.0 ADULT: ACUTE (SHORT STAY PATIENTS)Aim: An additional menu may be provided for patients staying less than seven days. The menu offered shall meet average requirements for protein and energy for the patient group.


Patients who are in hospital less than seven days are considered short stay. These individuals if not assessed as being at nutritional risk do not require extensive choice on the menu or high energy/high protein options at all mid-meals.

Nutrition screening will be carried out to identify those patients at risk and needing the long stay menu. (Refer to EQuIP National Standard 12.6.2)

Assessment of LOS at seven QH hospitals indicate that between 77% and 95% of patients admitted to these hospitals stay less than seven days (refer to Apendix 1 p 50 - 53 for detailed LOS data and analysis). Reassessment of LOS at 2 sites in 2014 indicated that aproximately 70% of OBD are patients staying longer than seven days with an average LOS of 17 days.

Ashortstaymenu(refertop47fordefinition)providesanoportunityto offset increased costs associated with the standard menu against a lower cost menu. In this instance the long stay menu is intended to be targeted to patients/residents that have the highest nutritional needs.

3.1 An alternative menu for short stay patients (LOS less than seven days) shall have minimum choices across the menu cycle as outlined in Table 1.0 Adult Acute Minimum Choice (p 27 − 30) to meet the average requirement for non-nutritionally compromised adults.

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4.0 MATERNITYAim: The food provided shall meet the majority of nutritional requirements of pregnant and breastfeeding women.


During pregnancy there are increased nutritional requirements.12, 25, 26 Nutrients can generally be met with a normal healthy diet as provided by the standard menu. However elevated iron, iodine and folate requirements need consideration in menu planning. Dietary suplementation of iodine25, 26 and folate12 are required during pregnancy, and for iodine continued during breastfeeding.25, 26

Breastfeeding women have increased energy12andfluid12 requirements thus requireadditionalfoodchoicesandaccesstofluids.Sufficientchoiceshouldbeprovided to allow apropriate options for patients who are overweight, obese or have gestational diabetes.

Where dietary intake is compromised due to hyperemesis gravidarum or other complications, a therapeutic diet and/or nutritional suplement(s) may be required.

Pregnant women and their unborn child are considered at high risk of listeriosis. Current Food Standards Australia and New Zealand (FSANZ) recommendations outline pregnant women should take care with their food choices.27 Facility food safety programs should identify and mitigate listeria risks for maternity patients.

4.1 Pregnant and breastfeeding women shall be provided with the long stay menu (refer to Standard 2.0 Adult: Acute (excluding short stay patients p 9) in acute facilities to assist in meeting the increased energy, protein and micro-nutrient requirements.

4.2 Breastfeeding women shall be provided access to fresh water, additional snacksandotherfluids.

4.3 Breastfeeding women shall be provided with access to nutritional suplements (as assessed by a dietitian) if required.

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5.0 PAEDIATRICS Aim: The food provided shall offer a range of options that are age and developmentally apropriate.


Nutrition Standards are designed to provide a guideline for menus for children over 12 months. Children under 12 months will have their nutritional needs met by a combination of food and breastmilk or formula28 and will need to be individually assessed or guided by the carer.

LOS data (2011) suports that 60% of bed days (OBDs) are children who stay less than seven days. However the 40% of children who stay longer than seven days have an average LOS of 16.9 days (refer to detailed LOS data in Apendix 1 p 51).

Adolescents in paediatric facilities or units will sometimes require larger servings or the adult acute standard menu.

ADietitianshouldreviewanytexturemodifiedfooditemsfromtheadultStanding Offer Arrangement (SOA) for suitability with respect to sodium content and other additives before use with children under 24 months.

5.1 Paediatric patients in an acute facility shall have access to a menu with 35 hot meal choices across the menu cycle and choices equivalent to those outlined in Table 2 Paediatric Minimum Menu Choice (p 35 – 37).

5.2 Choices shall be available for children requiring therapeutic diets eg.cysticfibrosis,gluten-free.

5.3 All paediatric menus shall be free of whole nuts and nut pastes where possible.

5.4 Choices shall be available for children with food allergies and intolerances.

5.5 Choices for suitable weaning foods with apropriate textures shall be available for infants weaning onto a solid food diet.

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6.0 RESIDENTIAL AGED CAREAim: The food offered and dining environment provides choice, variety and meets the nutritional and psychosocial needs of the residents, including those withhigherproteinandenergyrequirementsandthoserequiringtexturemodifiedmeals.


Care and services in aged care homes: Information for aproved providers (2014)29, directs facilities to provide meals of adequate variety, quality and quantity in accordance with residents’ individual nutritional needs; 3 meals and 3 mid-meals a day; meals suitable for special dietary requirements having regard to either medical need or religious or cultural observance.

In ageing, energy (kilojoules) requirement is lowered but nutrient requirement is similar or higher than in the younger adult, necessitating the need for more nutrient dense foods.30, 31

Elderly persons are at risk of inadequate dietary intake therefore all residents should be assessed on admission and reviewed as necessary by a dietitian.29

Chewingandswallowingdifficultiesarecommoninthisgroup.Thereforemodificationtofoodtexturemayberequiredwhilestillprovidingnutritionallyadequate choices in apropriate serving sizes.

Residentswithdementiaandothersimilarconditionsbenefitfromfingerfoods.These options can facilitate increased oral intake, independence and self feeding (refertop46forfingerfooddefinition).32,33,34

Constipation and dehydration is a common issue in elderly persons for various reasons,thusencouragingapropriatefoodandfluidintakewillbebeneficial.

A study that measured the effects of providing energy dense meals and snacks to the institutionalised elderly31 reported an increase in both energy and proteinintakewhenfortifiedfoodwasprovided.Anotherstudy23 also looked atfortificationoffoodandacookedbreakfastwhichresultedinthehighestincrease in energy and protein intake.

6.1 Residents in aged care facilities shall receive a menu with a cycle of no less than 14 days and minimum choices across the menu cycle equivalent to those outlined in Table 3 Residential Aged Care Minimum Menu Choice (p 27 – 33).

6.2 Both hot and cold protein breakfast choices shall be offered to residents on full and soft textured diets each day.

6.3 A hot protein breakfast choice shall be offered to all residents on texture B minced and moist and texture C smooth pureed diets each day.

6.4 Finger food options shall be available when required for those residents whoareidentifiedasbenefitingfromthisoption.

6.5 Additionalfoodand/orfluidsuplementsshallbeavailableasrequired.

6.6 Thelongstaymenushallprovidefortifiedoptionsforhotcereal,soup andonevegetableperdayforfullandsofttextures.Fortifiedfoodswill meet the nutrition targets outlined in Section 2 Meal Component Specifications(p19–23).

6.7 Residents shall have the oportunity to have input into menu choices and menu reviews. If residents are unable to have input, family members can be consulted on preferred menu choices or for input into menu reviews.

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7.0 MENTAL HEALTH AND ACQUIRED BRAIN INJURY Aim: The food provided shall meet the psychosocial and physical health needs of consumers allowing nutritional requirements to be met and suporting healthy choices with a focus on chronic disease prevention and management.


Mental health and acquired brain injury consumers represent a diverse patient population, whose longer length of stay is one important factor in determining their nutritional requirements. Individuals with severe mental illness experience double the rates of obesity compared to the general population and are atsignificantlyhigherriskofchronicdisease,including:cardiovasculardisease, type 2 diabetes and associated risk factors such as dyslipidaemia and hypertension.10, 11 These diet-related disorders are the primary cause of morbidity and mortality in this population who experience a 13 − 25 year shortened life expectancy.10

The menu is an important tool to manage and minimise risk of chronic disease. The Nutrition Standards for this population group are informed by the National Health and Medical Research Council’s Nutrient Reference Values12 which provide advice for reduction of chronic disease risk in the form of Suggested Dietary Targets(SDTs)fordietaryfibre,selectedmicronutrientsandfattyacids,andAcceptable Macronutrient Distribution Ranges (AMDRs) for percentage of energy from protein, fats and carbohydrates in addition to the more recent Australian Dietary Guidelines 2013.4

Toimprovefattyacidprofiletheinclusionofpolyunsaturatedspreadsshould be encouraged.

Individuals with mental illness and acquired brain injuries tend to experience increased apetite and/or decreased satiety as a side-effect of some medications.35Hence,fortifiedmealsaregenerallynotindicatedforthispopulationgroup.However,swallowingdifficultiesareprevalentinindividualswith acquired brain injuries36;therefore,atexturemodifiedmenu(includingtexturesA,BandC),withfortifiedoptions,willberequiredbysomeindividuals.

7.1 In mental health and acquired brain injury settings the menu shall consist of a minimum cycle length of 14 days with choices equivalent to those outlined in Table 4 Mental Health and Acquired Brain Injury Minimum Menu Choice (p 38 – 41).

7.2 Facilities shall have systems in place to identify consumers who are at nutritional risk of or are malnourished.

7.3 Where practicable options shall be available for consumers with food allergies and intolerances.

7.4 Healthy meal options (eg low fat, reduced salt) shall be available at all main meals and mid-meals and these options shall be promoted.

7.5 Themenushallaimtoprovideatleastonefishmealperweek.7

7.6 Unsaturated spreads shall be provided for use to consumers.

7.7 The menu shall aim to provide at least 25 –30gramsoffibreperday.12

7.8 Fresh drinking water shall be available at all times. The suply of chilled water is encouraged where practical.

7.9 Consumers shall be informed of menu choices prior to meal service. Copies of written menus are accessible to consumers.

7.10 Facilitiesaretohaveasevenday‘fingerfood’menuavailable.Thismenu shall align with dietary targets to ensure that nutritional requirements are met.Ifaconsumerrequires‘fingerfoods’forgreaterthansevendays, or on a frequent basis, a dietitian shall review to ensure adequate variety.

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7.0 Mental Health and Acquired Brain Injury (Continued)


Constipation is prevalent within both patient groups37; therefore, the menu shouldpromoteadequateandconsistentfibreandfluidintake.

Variety and choice to prevent menu fatigue is important to increase satisfaction with the food provided and to prevent excessive food consumption from nutritionally poor sources outside the menu.

The style of meal service allows patients to choose meals and mid-meals, ideally at point of service.

7.11 Consumers shall have the oportunity to have input into menu choices and menu reviews.

7.12 For consumers who are unable to communicate menu preferences, ensure variety in meal choices, record likes/dislikes and/or consult with family and/or friends to ensure individual needs are met.

Note: Patients with an acute ABI to be offered options as per acute adults standard menu (p 9).

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8.0 VEGETARIAN AND VEGANAim: The food offered shall provide patients choosing to follow a vegetarian or vegan diet ability to meet the majority of their nutritional requirements.


Patients following a vegetarian or vegan diet may do so due to choice, cultural or religious reasons.

Vegetarian diets can be healthy when carefully planned and monitored. Adequate variety of suitable nutritious foods are required to meet individual patient or resident needs.

Protein quality of meals needs to be balanced to include all amino acids over the day which requires careful planning and inclusion of legumes, nuts, seeds and cereals across the three meals.

Studieshaveidentifiedthefollowingnutrientsatrisk:

Protein4,39, Iron 4,12,39,40,41, Zinc12,39,40,41, Iodine39,42, B124,12,39,40,41, Calcium12, 39,40,41, Vitamin D.39,40,41

Suplementation with at risk nutrients may be needed to meet nutritional requirements where patients are longer stay.

8.1 At least two vegetarian/ (including one vegan) options shall be available to choose each day (these can include hot meals, salads and sandwiches) but a minimum of at least one hot vegetarian/vegan choice shall be offered every other day. Depending on frequency of the requirement for vegetarian/vegan options in the facility, these options may or may not apear on the menu the patient receives but do need to be included on the master menu so that apropriate options will be available if required.

8.2 Acute adult and paediatric facilities shall where practical integrate vegetarian choices into the standard menu.

8.3 A variety of protein sources shall be available to vegetarian and vegan patients including cheese, egg, legumes, tofu, nuts, seeds and textured vegetable protein products (with the exception of nuts in paediatric wardsorfacilities).Milkalternatives(eg.soymilk)shallbefortifiedwith calcium and B12 and contain an equivalent level of protein to cows milk.

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9.0 THERAPEUTIC AND MEDICAL DIETSAim: Patientsidentifiedasrequiringtherapeuticdietsshallhavefoodprovidedthatmeetsthisneed,withtheaimofalsoachievingoverallnutritional requirements and psychosocial needs.


Patients with multiple diet requirements will exist within QH facilities. Every facility should have a process of identifying patients with therapeutic dietary needs.

Integratingtherapeuticdietscreatesefficienciesforfoodservicesthereforeamajority(~90%) of these diets should be integrated into the standard menu with minimum impactontheoverallnutritionalprofileofthemenu.However,notalltherapeuticdiets can be successfully integrated. Special foods may need to be obtained to meet this therapeutic requirement; however, it is expected that no more than 10% of diets require special foods (SFSKPI). Integration of therapeutic diets should not compromise the quality and taste/acceptability of the overall menu for the majority of patients (eg. low salt, reduced fat).

Examples of diets suitable to be integrated into a main menu include:

• TextureAsoft,highfibre,lowfibre,proteinrestricted,fatmodified (eg.suitableforpeopleoncardiovasculardiets),carbohydratemodified (for example, suitable for patients with diabetes) and low lactose.

• Somedietsthatmaybedifficulttointegrateinclude:verylowfat, glutenfree,electrolytemodified(eg.lowsodium,lowpotassium),allergy, milk free or metabolic (eg. ketogenic) diets.

• Texturemodifieddiets(TextureBmincedandmoistandTextureCsmooth puree) should follow the menu choice on the main menu as closely as possible.

Not all therapeutic diets can meet individual nutrition requirements, and a dietitian should determine the adequacy and make recommendations to meet individual patients/residents need.

Some therapeutic diets are short term and are not expected to meet nutritional requirements,examplesincludeclearfluiddiets,investigativediets.

Whilst every effort should be made to maximise choice for the patients requiring therapeutic diets, this may be difficult to achieve.

9.1 Every facility shall have a process of identifying patients with therapeutic dietary need before a meal is served to the patient.

9.2 Common therapeutic diets used in a facility shall be integrated into the standard menu without unnecessary restrictions.

9.3 There is a process to record and modify menus to accommodate patient likes and dislikes (where possible) when long stay patients are placed on a therapeutic and/or medical diet with reduced choice.

9.4 A dietitian shall determine the adequacy of any therapeutic diets for individual patients/residents that are not available on the main menu.

9.5 TexturemodifieddietsshallcomplywiththeAustralian Standardised DefinitionsandTerminologyforTextureModifiedFoodandFluids.43 Additional textures may be provided where dietitians and speech pathologists can provide evidence that textures in the Standards arenotsufficienttomeettheneedsofthepatients/residents/clients.

9.6 Fluid containing foods of the correct texture shall be available at all meals and mid meals to patients/clients/residents requiring thickened fluidstomaximisefluidintakes.

9.7 Allpatientsontexturemodifieddietsshallreceivefortifiedfoodoptions and substantial mid-meal options of suitable texture.

SECTION 2MEAL COMPONENT SPECIFICATIONSNutrition Standards for Meals and Menus

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NUTRITION STANDARDS MEAL COMPONENT SPECIFICATIONSThesespecificationswereadaptedfromtheVictorianNutritionStandardsforMenu Items.5Somenutrienttargetshavebeenmodified,removedorrelaxedtoensurepatient,resident,consumerandclientneedsaremetwithaspecificfocus on protein and energy requirements.

Each category of meal is divided into groups based on the nutritional value of the meal. These can be used for assessing pre-made products or for recipe analysis when preparing and cooking meals. The User Guide on pages 42–47, and the menu outlines on pages 57-63, explains how these can be used in menu design.

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MAIN (PROTEIN) DISHES (HOT)• Meat to be trimmed of excess fat, skin and unnecessary bone.

• Products should contain minimal amounts of added sodium but enough to achieve a tasty product. Note that a selection of dishes with less than 10mmol (230mg) sodium/serve will be required.

• Added fat to be poly or mono unsaturated. Note that a selection of dishes with less than 15g of total fat/serve will be required.

• The nutritional analysis for this category should not include potato, rice and pasta unless it is an ingredient in the dish itself eg. lasagne and is analysed asweightoffinalcookedproduct.

GROUP 1 GROUP 2 GROUP 3 GROUP 4^

Description Predominantly cuts of meat such asroasts,grillsandfish(i.e.100%meat content)

The meat component must not weigh less than 100g per serve*

High meat content dishes (i.e. 75% meat content).

The meat content must not weigh less than 100g per serve*

(ovenable crumbing and batter accepted in this category)

Product is even mix of meat/meat alternative and vegetables/ -rice/-pasta (i.e. 50% meat/meat alternative content)

Dishes have a varying protein and fat content

Example Dishes Roast Beef

Grilled Fish

Beef rissoles and gravy

Chicken Chasseur

Spaghetti Bolognaise

Chicken Stir-fry

Singapore noodles

Pumpkin Risotto

Serve Size# Dry, greater or equal to 100g 130g – 160g 150g – 180g Greater or equal to 150g

Energy Greater or equal to 550kJ per serve Greater or equal to 700kJ per serve Greater or equal to 700kJ per serve No target set

Protein Greater or equal to 20g per serve Greater or equal to 15g per serve Greater or equal to 10g per serve Greater or equal to 7g per serve

# The maximum serve size for Texture C Smooth Pureed is 120g (for pasta and potato based dishes 180g).* Texture C – Smooth Pureed dishes are permitted to contain less than 100g of meat per serve.^ = Group 4 is not intended to be a frequent menu item and is only included for variety.

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SOUPS

GROUP 1 GROUP 2

Description Provides significant protein and energyMay have vitamins and minerals added

Provides moderate protein and energy

Serve Size 120 – 200ml 160 – 200ml

Energy Greater or equal to 600kJ per serve Greater or equal to 400kJ per serve

Protein Greater or equal to 8g protein per serve Greater or equal to 5g protein per serve

Note: Fortification of Soups –addskim/fullcreammilkpowderorreplacewaterwithmilk,cream,cheese,pureedlentils/legumesoryoghurt.Group1andGroup2soupsareconsideredfortifiedsoups.

SANDWICHES

GROUP 1 GROUP 2

Description Provides significant protein and energy Provides moderate protein and energy

Example dishes Ham and cheese sandwich (1 x 30g slice ham and 1 x 20g slice cheese)Salmon and cream cheese sandwich (40g tinned salmon and 1 tbsp cream cheese)

Ham and tomato sandwich (1 x 30g slice ham)Egg and lettuce sandwich (1 x 50g egg)

Serve Size 2 slices bread (4 points) 2 slices bread (4 points)

Energy Greater or equal to 1,250kJ per serve Greater or equal to 1,000kJ per serve

Protein Greater or equal to 15g protein per serve Greater or equal to 8g protein per serve

Page 22

DESSERTS

GROUP 1 GROUP 2 GROUP 3 GROUP 4

Description Fortified Desserts. May have vitamins and minerals added

Desserts with a significant level of energy and moderate protein

Desserts with a moderate level of energy and protein

Desserts that have a varying nutrient value

Example Dishes • Protein enriched pudding

• Fortifiedcheesecake

• Cheesecake

• Chocolate or banana cake

• Baked egg custard

• Rice pudding

• Aple crumble

• Apricot strudel

Serve Size Not greater than 180g^ 90 – 120g* 90 – 120g* Not less than 50g

Energy Greater than 800kJ per serve Greater than 800kJ per serve Greater than 500kJ per serve Greater than 300kJ per serve

Protein Greater or equal to 8g per serve Greater or equal to 4g per serve Greater or equal to 4g per serve No target set

Fat No restriction No restriction Less than or equal to 7g per serve

No target set

*Excludes mousse and whips which should weigh greater than or equal to 60g.^Dessert components can be combined to achieve this group e.g. cheesecake and ice cream or banana cake and custard.

GROUP 1 GROUP 2

Description Breakfast dishes with a significant level of protein and moderate energy

Breakfast dishes with a moderate level of protein and energy

Example dishes • Savoury mince• Bacon & tomato omelette

• Savoury pancake• Baked beans + hash brown

Serve Size 10g or greater 6g or greater

Energy Greater or equal to 550 kJ Greater or equal to 550 kJ

HOT BREAKFAST PROTEIN

Page 23

SNACK/MID-MEALS

GROUP 1 GROUP 2 GROUP 3 GROUP 4

Description High protein, high energy snack Mod protein, high energy snack Low protein, high energy snack

Healthy snack (low fat, no added sugar, high fibre)

Examples • Cheese and crackers• Cheese scone• Sandwich one slice bread (two points) with a proteinfilling• Nuts (not paediatrics)• Yoghurt• Custards

• Cake• Breakfast bar• Muffin• Sandwich one slice bread (two points) with a non-proteinfilling• Dairy dessert (eg. fromage frais, crème brulee)• Mousse

• Chocolate• Potato crisps• Extruded snacks• Dried fruit• Sweet biscuits (2 – 3)• Savoury biscuits (2 – 4)

• Sandwich one slice high fibrebread(twopoints) with a low fat proteinfilling• Nuts (no added salt or fat)• Low fat yoghurt• Low fat cheese and crackers• Fresh fruit or no added sugar tinned fruit

Energy Greater than 500kJ Greater than 500kJ Greater than 500kJ Less than 800kJ

Protein 5g or greater 2g or greater No target set No target set

FORTIFICATION OF MENU ITEMS(Seep46fordefinition)

Toprovideadditionalnutrition,fortificationofcertainmealcomponentsincludinghotcerealsandvegetablesisrequired. Fortificationaimstoincreasetheproteinand/orenergydensityofthemealcomponent.

Description Hot cereal Starchy vegetables Other vegetables

Energy Greater than 550 kJ Greater than 400kJ Greater than 300kJ

Protein 10g or greater 3g or greater 3g or greater

Type of fortification Skim/full cream milk powder, cream, evaporated milk, protein/energy suplement.

Add cheese; a dairy based sauce (eg béchamel, hollandaise); butter, margarine or milk, yoghurtorcreamtosteamedvegetables.Includespotatobake,cauliflowerorbroccoliin cheese sauce, potato wedges with sour cream, potato mashed with butter and added skim milk powder

Page 24

PORTION SIZES FOR MEAL ITEMS

Thefollowingtableidentifiesportionsizesforindividualmealitemsthatarenotincludedinthemealcomponentgroupspecificationsonpages20–23. Variations to serve sizes may occur for therapeutic/medical diets or on a dietitian’s request.

MENU ITEM PORTION SIZE

Fruit juice (100% juice) 100 – 120ml

Hot cereal (porridge, semolina, high protein wheat germ cereal) 150 – 180g

Ready to eat cold cereal Not less than 20g

Milk for cereal Not less than 100ml

Bread/roll 1 slice or equivalent

Yoghurt 100g as snack or dessert component Note: not less than 150g if served as a sole dessert item

Cheese Not less than 15g

Butter or margarine Not less than 7g

Starchy vegetable/rice/pasta 90 – 120g

Non-starchy vegetable 60 – 80g

Fruit, canned and drained Not less than 80g

Fruit, fresh 1 piece or equivalent (100g)

Jelly Not less than 120g

Ice Cream Not less than 50g

Tea, coffee, cordial or milk based drinks 150 – 200ml

SECTION 3MINIMUM MENU CHOICENutrition Standards for Meals and Menus

Page 26

HOW TO USE THE MINIMUM MENU CHOICE TABLESThere are several patient categories covered in this section including

• Adult acute and Residential aged care– short stay and long stay apear in the same table but in separate columns.

• Paediatric

• TextureModified–acute,MentalHealthandAcquiredBrainInjury

• Mental Health and Acquired Brain Injury

For each of the patient categories in this section there are tables for

• Breakfast

• Lunch and Dinner combined

• Mid-meals

Tables within this section outline:

• The minimum number of choices available to be offered including

− Minimum menu choice required per day:

> eg. the standard acute menu requires a minimum of two hot main meals a day (could be served at lunch or dinner or both)

> eg. the short stay acute menu requires a minimum of one hot main meal a day (could be served at lunch or dinner)

− Minimum menu choice required across the menu cycle:

> eg. the standard acute menu requires a minimum of 35 hot meal choices per cycle, with at least 14 being full choices and 21 being soft choices

> eg. the short stay acute menu requires a minimum of 14 hot meal choices per cycle, with at least 7 being full choices and 5 being soft choices

− Minimum menu choices required across the meal groups:

> eg. the standard acute menu recommends that one of the two hot main meals should be a group 1 or 2 meal and a second choice can be a group 1, 2 or 3 meal refer to p 20.

> eg. the short stay acute menu recommends that the main hot protein can be from either group 1, 2 or 3 p 20.

Page 27

Table 1: Adult Acute and Residential Aged Care – Minimum Choice

BREAKFASTSHORT STAY MENU STANDARD MENU LONG STAY MENU EXAMPLES

Per day Per cycle Per day Per cycle Today’s choice Choices across the cycle

Cold cereal –lowfibre 1 2 1 2 Puffed Rice Puffed Rice , Corn flakes

Cold cereal –highfibre 1 2 2 3 MuesliWheat Biscuit

Muesli, Wheat Biscuit, Sultana &

Bran Flakes

Hot cereal 0 0 1 1 Porridge Porridge

Cold protein 1 1 1 2 Yoghurt Yoghurt, Banana Smoothie

Hot protein 0 0 1 At least 3 Grp 1Total 6 choices

Baked beans + hash brown

Baked beans + hash brown, scrambled

egg, cheese & bacon omelette, Chipolatas

+ baked beans, Poached eggs +

tomato, Pancakes + syrup

Bread/toast/rolllowfibre

1 1 1 1 White bread White bread

Bread/toast/rollhighfibre

1 1 2 2 Wholemeal bread Fruit bread

Wholemeal bread, fruit bread

Fresh fruit 1 3 1 3 Banana Banana, mandarin/pears, aple

Tinned fruit and/or juice 1 (juice or fruit) 2 1 juice1 fruit

2 juice4 fruit

Orange juice and/or peaches

Orange juice, aple juice and/or peaches,

prunes

Milk Full and low fat Cereal and drink Full and low fat On cereal and in drink

Full fat, 2% fat Full fat, 2% fat

KEY:Minced = Texture B minced and moist NAS = No Added SugarPureed = Texture C smooth pureed Veg = VegetableMod thick = Level 400 moderately thick Alt = Alternate

Page 28

Table 1: Adult Acute and Residential Aged Care– Minimum Choice (continued)

MAIN MEALlunch and dinner

SHORT STAY MENU STANDARD MENU SUGGESTED MENU EXAMPLES

Per day Per cycle Per day Per cycle Today’s choice Choice across the cycle

Soup (powder base)

1 7 0 0 0 0

Soup Groups 1 and 2

0 0 1 x group 1 or group 2

4 x group 1 7 x group 2

Pea & Ham soup Grp 1 – pea & ham, beef & vege, lentil,

minestroneGrp 2 – Chicken & corn, Creamy

pumpkin, Tomato & bacon, Potato & leek

Main hot protein* Groups 1, 2, 3 and 4

1 x group 1, 2 or 3 14 minimum* (at least 7 soft)

(at least 1 vegetarian choice

every 2nd day)

1 x group 1 or 2

2nd choice* 1 x group 1, 2 or 3

35 minimum 14 x full

21 x soft# 7 x full or soft

(at least 1 vegetarian choice

every 2nd day)

Roast Beef

Chickpea curry

P 57 - 61

Starchy vegetable**** or alternative (eg. rice/pasta/cous cous)

1 2 1 4 starchy veg** 2 alternatives

(as starchy choice)

Roast potato Mashed sweet potato, roast potato, Corn, Mashed potatoRice, noodles, pasta,

cous cous

Fortifiedvegetable**** 0 0 1 3 Caulifloweraugratin Caulifloweraugrain,Potato Bake, Mashed potato (butter & milk)

Orange vegetable**** 1 3 2 3 Mashed pumpkinCarrot

Mashed sweet potato, carrot,

mashed or roast pumpkin

Green/brassica vegetable**** 1 4 2 5 CaulifloweraugratinBeans

Caulifloweraugratin,beans, brussel sprouts, peas,

broccoli

Note: * group4hotproteinmainmealchoicesareonlyforvarietythereforenospecifiedusage.Needatleastonevegetarianhotoptioneverysecondday.SeeStd.8.1p16 # some of the soft choices available on the menu can also be minced choices and included in both choice lists ** including potato prepared different ways i.e. mashed potato, roast potato

**** onefortifiedvegetableoptionneedstobeavailableeachdaywhereavarietyoffortifiedoptionsshouldbeofferedseeStandard2.4(p9)andpage23forfortificationoptions

Page 29



SHORT STAY MENU STANDARD MENU SUGGESTED MENU EXAMPLES

Per day Per cycle Per day Per cycle Today’s choice Choice across the cycle

Side Salad Minimum 4 vegetables

1 1 1 1 Lunch: Lettuce, tomato, carrot sticks, cucumber

0

Main Salad 1 x 100g meat or meat alternative 1 x carbohydrate serve 2 x core vegetables* 2 x rotating vegetable**

1 7 x meat or meat alternative

4 x carbohydrate

4 x rotating vegetable

1 10 x meat or meat alternative

4 x carbohydrate 4 x rotating vegetable

Dinner: Corn beefRice salad

Lettuce & tomatoCucumber & beetroot

See menu P 57 - 61 for meat/alternative choicesRice Salad, Potato salad,

Pineaple, CornLettuce & tomato

Cucumber, beetroot, capsicum, carrot

Sandwich/Wrap/Roll Groups 1 and 2





Lunch: Ham & cheeseDinner: Chicken & cranberry

See menu P 57 – 61 for choices

Dessert Groups 1, 2, 3 and 4 Tinned fruit and dairy

1 x group 3 or 4

1 x tinned fruit

and dairy

7 x group 3 or 4

4 x tinned fruit

and dairy

1 x group 1 or 2 2nd choice

1 x group 1, 2, 3 or 4 or tinned fruit

and dairy

6 x group 1 6 x group 2 5 x group 3 5 x group 4

6 x tinned fruit and dairy

Lunch:Apricots & custard

Dinner:Lemon cheesecake

& ice cream


Fruit – fresh 2 (1 soft fruit)

3 2 (1 soft fruit)

3 Lunch: ApleDinner: Fruit in season

Aple, banana, fruit in season

Bread/roll –lowfibre 2 2 2 2 Lunch: White breadDinner: White roll

White Bread, white breadroll

Bread/roll –highfibre 2 2 2 2 Lunch: w/meal breadDinner: w/meal roll

Wholemeal bread, wholemeal breadroll

* core salad vegetables stay the same each day. Eg: lettuce and tomato see p 46

** rotating salad vegetables would change from day to day to add variety Note: There is a requirement for 2 vegetarian/vegan options each day which can be hot meals, salad and sandwiches See Std 8.1 p 16.

Page 30


MID MEALSMorning Tea, Afternoon Tea and Super

SHORT STAY MENU LONG STAY MENU SUGGESTED MENU EXAMPLES

Per day Per cycle Per day Per cycle Today’s Choice Choice across the cycle

Snack

Groups 1, 2, 3 and 4

1 x group 1 or 2

2 x other (notspecified)

4 x group 12 x group 2

1 x group 1 or 22nd choice

1 x group 1, 2 or 3

4 x group 14 x group 22 x group 3

Cheese & biscuits

Fruit cake

Grp 1: Cheese & biscuits, fruit yoghurt, nuts, ½ cheese sandwichGrp 2: Fruit cake, muffin,Breakfastbar,½ vegemite sandwichGrp 3: Potato crisps, 2 x cream biscuits

High protein/energy suplement*

0 0 1 3 Chocolate milk Chocolate milk, Fortifiedfruit

juice suplement, high protein milk

suplement

Drinks Tea, coffee, water, cordial, milk drink Tea, coffee, water, cordial, milk drink tea, coffee, cordial, milk drink, water

Note: *Highprotein/highenergysuplementcanincludecommercialsuplementsorfortifiedmilkdrinks

Page 31

Table 2: Texture Modified Menus Acute, Residential Aged Care, Mental Health & Acquired Brain Injury - Minimum Choice

BREAKFAST Texture Modified menu Suggested Menu Examples

Per day Per cycle Today’s choice Choice across the cycle

Coldcereal–lowfibre 1 minced0 pureed

2 minced0 pureed

Puffed rice Puffedrice,cornflakes

Coldcereal–highfibre 1 minced0 pureed

2 minced0 pureed

Wheatflakebiscuits Wheatflakebiscuits,Puffed brown rice

Hot cereal 1 minced1 pureed

1 minced1 pureed

PorridgePuree Porridge

Cold protein 1 minced1 pureed

2 minced2 pureed

Smooth Yoghurt Smooth Yoghurt

Smooth Yoghurt, banana smoothieSmooth yoghurt, banana smoothie

Hot protein 1 minced1 pureed

3 minced3 pureed

Savoury mincePuree savoury mince

See menu P 62 – 63 for choices across cycle

Bread/toast/roll–lowfibre 0 0

Bread/toast/roll–highfibre 0 0

Fresh fruit 1 minced (offer once/week)0 pureed

1 minced0 pureed

Mashed banana Mashed banana, mashed paw paw

Tinned fruit/juice 1 juice1 fruit x minced*1fruitxpureed

3 juice6 minced*6 pureed

Orange juice Orange juice, aple juice, prune juiceMinced or puree diced peaches + pears, peaches, pears

Milk Full fat On cereal & in drinks Full fat milk Full fat milkNote: *if on minced diet, pureed options can be substituted

Key: minced = Texture B minced and moist NAS = No Added Sugar pureed = Texture C smooth pureed veg = vegetable mod thick = Level 400 moderately thick alt = alternate

Page 32

Table 2: Texture Modified Menus Acute, Residential Aged Care, Mental Health & Acquired Brain Injury – Minimum Choice (continued)

1 pureed *


Long stay menu Suggested Menu Examples

Per day Per cycle Todays Choice Choice across the cycle

Soup# Groups 1 and 2

1 x group 1 #1 x group 2 or powder

based#

5 x group 14 x group 2

Puree Pea & ham Grp 1: pea & ham, beef & vege, lentil, minestrone, chicken & vege

Grp 2: Chicken & corn, Creamy pumpkin, Tomato & bacon, Potato & leek

Main hot protein* Groups 1, 2, 3 and 4##

1 x group 1 or 2-minced1xgroup1or2-pureed

2nd choice* 1 x group 1, 2, 3 or 4

28 minced

28 pureed

Minced roast beef & gravyMinced chick pea curry

Puree roast beef & gravyPuree chick pea curry

See menus on P 62 - 63 to see choice across menus

Starchy vegetable*** or alternative**

1 minced*1 pureed

3 minced*3 pureed

Mashed potatoPuree potato

Mashed/puree sweet potato, mashed/puree potato Mashed/puree pasta

Fortifiedvegetable*** 1 minced*1 pureed

3 minced*3 pureed

Mashed or pureecauliflowerau gratin

Mashed/pureeCaulifloweraugrain,Potato Bake, Mashed potato

(butter & milk)

Orange vegetable*** 2 minced*2 pureed

3 minced*3 pureed

Mashed pumpkin, mashed carrot

Puree pumpkin, puree carrot

Mashed or puree sweet potato, carrots, pumpkin

Green/Brassica vegetable*** 2 minced*2 pureed

5 minced*5 pureed

Mashed or puree Caulifloweraugratin,

Mashed or puree beans

Mashed/pureeCaulifloweraugratin,peas, beans, broccoli, brussel sprouts

*if on minced diet, pureed options can be substituted**starchy vegetable alternative includes pasta, rice, noodles***onefortifiedvegetableoptionneedstobeavailableeachdaywhereavarietyoffortifiedoptionsshouldbeofferedseeStandard6.6andP23 forfortificationoptions# soup texture moderate thick puree##group4hotproteinmainmealchoicesareonlyforvarietythereforenospecifiedusage

NOTE:

Page 33

Per day Per cycle Todays Choice Choice across the cycle

Dessert Groups 1, 2, 3 and 4 Tinned fruit and dairy

1 x group 1 or 2 for both minced***and pureed

2nd choice1 x group 1,2, 3 or 4

minced***and pureedor pureed*** fruit & dairy

3 x group 1- 6 x group 2

6 x group 3&47 pureed tinned

fruit & dairy (2 minced*)

Lunch Mashed Apricots & custard Puree apricots & custard

Dinner Lemon Cheesecake & ice cream*

Lemon cheesecake (without base) & ice cream*

See menus on p 62 – 63to see choice across menus

Fresh fruit 1 minced (once per week)0 pureed

1 minced0 pureed

Mashed banana

*Icecreamnotallowedonthickenedfluiddiets.


MID MEALS Morning Tea, Afternoon Tea and Super

Long stay menu Texture Modified menu

Per day Per cycle Per day Per cycle

SnackGroups 1, 2, 3 and 4

2 x group 1 or 2 minced**

2xgroup1or2pureed

**4 x group 1 for both minced and pureed

**4 x group 2 for both minced and pureed

Smooth yoghurt, mashed fruit. Soft cake with custardSmooth yoghurt

& puree fruitChocolate mousse

Grp 1 - Smooth yoghurt + mashed fruit, Fruit smoothie, High protein custard + mashed fruit,

Cheese spread & vege rouladeGrp 2 Soft cake with custard, Chocolate mousse, soft

savourymuffinwithsmoothchutneyGrp 1- Smooth yoghurt & puree fruit, Fruit smoothie,

Cheese spread & vegie roulade, High protein chocolate custard

Grp 2 - Chocolate mousse, Puree cake & custard, pureesavourymuffin&chutney

High protein/energy suplement 1 3 (desirable to have multipleflavoursofthesuplements available)

HP milk suplement

HP Milk suplement, HP fruit suplement, HP pudding suplement

Drinks Tea, coffee, water, cordial, milk drink Tea, coffee, water, cordial, milk drink

Tea, coffee, water, cordial, milk drink


Note: ** Please note that some of the snack choices for the minced & moist texture can be the same as those provided for smooth pureed texture.

***Hydrationisimportantinthisgroupensuretooffervarietyofapropriatetexturedfluidsareofferedie.thickenedtea,coffee,cordial,milk, water and includes dairy desserts not just liquids.

Page 34

Table 3: Paediatric Minimum Choice

BREAKFASTSTANDARD MENU SUGGESTED MENU EXAMPLES


Coldcereal–lowfibre 2 2 Puffed rice PuffedRice,Cornflakes,

Coldcereal–highfibre 2 4 Wheat-flakebiscuit Muesli,WheatflakeBiscuit,Mini Wheat biscuit, sultana

&branflakes

Hot cereal 1 (on request of Dietitian) 1 Porridge

Cold protein 1 3 Vanilla Yoghurt Vanilla Yoghurt, Chocolate milk, Banana Smoothie

Hot protein 1 (on request of Dietitian) 3Baked beans & hash browns Scrambled egg,

Cheese omelette,Baked beans & Hash brown

Bread/toast/roll–lowfibre 1 2 Crumpet Crumpet, White Toast

Bread/toast/roll–highfibre 1 2 Fruit toast Fruit toast, Wholemeal Toast

Fresh fruit 1 3 Banana Banana, Aple, Mandarin ^

Tinned fruit/juice 1 2 fruit, 2 juice

Peaches/Orange juice Peaches, Diced 2 fruits, Orange juice, aple juice

Note: ^ Fruits with tough skin eg: oranges should only be provided if they are cut up

Page 35

Table 3 Paediatric Minimum Choice (continued) MAIN MEALlunch and dinner

STANDARD MENU SUGGESTED MENU EXAMPLES


Main hot protein*# Groups 1, 2, 3 and 4

1x group 1 or 2 2nd choice*

1 x group 1, 2, 3 or 4

35 minimum 14 x full

21 x soft#

Roast BeefChickpea curry

See menus on p 57 – 61 to see choice across menus

Starchy vegetable or alternative 1

4 starchy veg**2 alternate (as starchy choice)

Potato Chips

Roast potato Mashed sweet potato, roast potato, Corn, Mashed potato,

Chips, Rice, noodles

Orange vegetable 2 3 Mashed pumpkin Mashed sweet potato, carrot, mashed or roast pumpkin

Green/Brassica vegetable 2 5 Caulifloweraugratin Caulifloweraugratin,beans,peas, broccoli, steamed

cauliflower

Main Salad100g meat/meat alternative1 x CHO serve2 core vegetables 2 rotating vegetable

As requested 7 x meat or meat alternatives4 x CHO


Chicken tendersRice salad

Lettuce, tomatoBeetroot, Celery

See menu P 57 – 61 for meat/alternative choices

Rice Salad, Potato salad, Pineaple, Corn, Lettuce & tomato, Celery, beetroot,

capsicum, carrot

Salad – small50g meat/meat alternative & minimum 4 vegetables

As requested 7 meat or meat alternatives ChickenfingersCarrot sticks, celery sticks,

tomato pieces,Capsicum sticks

See menu P 57 – 61 for Carrot sticks, Celery sticks, Capsicum

sticks, tomato pieces

Note: #provided/available in half serves *group4hotproteinmainmealchoicesareonlyforvarietythereforenospecifiedusage. ^ fruits with tough skins eg. Oranges, should only be provided if they are cut up. Need at least one vegetarian/vegan hot option every second day. See Std. 8.2 p 16

Page 36

Table 3: Paediatric Minimum Choice (continued)




Sandwich/Wrap/Roll Groups 1 and 2



Ham & cheese wrapEgg & lettuce swich

See menus on p 57- 61 to see choice across menus

Hotfingerfoods 1 (on request of dietitian) 5 Vege Spring Rolls Vege spring rolls, Chicken nuggets, Mini meatpies,FalafelBalls,Fishfingers

Dessert # Groups 1, 2, 3 and 4 Fruit and dairy dessert

1 x group 1 or 21 x group 3, 4 or dairy & fruit dessert

3 x group 1 or 27 x group 3, 4 or dairy &

fruit dessert

LunchApricots & custard

DinnerLemon cheesecake &

ice cream

See menus on p 57 - 61 to see choice across menus

Fruit − fresh 2 3 Banana, fruit in season Banana, aple, fruit in season (not orange unless cut up) ^

Bread/roll −lowfibre 2 2 White bread/roll

Bread/roll −highfibre 2 2 Wmeal bread/roll

Note: #provided/available in half serves *group4hotproteinmainmealchoicesareonlyforvarietythereforenospecifiedusage. ^ fruits with tough skins eg. Oranges, should only be provided if they are cut up. Need at least one vegetarian/vegan hot option every second day. See Std. 8.2 p 16

Page 37

Table 3: Paediatric Minimum Choice (cont)

MID MEALSMorning Tea, Afternoon Tea and Super

SUGGESTED MENU EXAMPLES


Snack Groups 1, 2, 3 and 4

3 x group 1 2 x group 2 2 x group 3

(on request of dietitian)

6 x group 14 x group 24 x group 3

Grp 1- Cheese & biscuits, Yoghurt, 2x ¼ s ham swichGrp 2 – Sponge cake, chocolate mousseGrp 3 – Potato crisps, Sweet biscuits

Grp 1 - Cheese & biscuits, Yoghurt, ½ ham swich, Chocolate custard, Cheese scone, ½ chicken swichGrp 2 - Sponge cake, chocolate

mousse, ½ vegemite swich, Cheese spread & crackers

Grp 3 – Potato crisps, Sweet biscuits, Chocolate animal, Savoury biscuit shapes

Drinks Plain milk, milk drink (with malt powder mix).

Water available at all times (after meals and between meals).

Access to low fat and skim milk, soft drinks and cordial on request.

NotspecifiedPlain milk, milk drink (with

malt powder mix).

Water available at all times (after meals and between

meals). Access to low fat and skim

milk, soft drinks and cordial on request.

Plain milk, milk drink (with malt powder mix).

Water available at all times (after meals and between

meals). Access to low fat and skim

milk, soft drinks and cordial on request.

Page 38

Table 4: Mental Health and Acquired Brain Injury – Minimum choice

BREAKFASTSTANDARD MENU SUGGESTED MENU EXAMPLES


Coldcereal–lowfibre 1 2 Puffed Rice PuffedRice,Cornflakes

Coldcereal–highfibre 2 4 MuesliWheat-flakeBiscuit

Muesli,WheatflakeBiscuit,Sultana&Bran Flakes, Mini-wheat biscuits

Hot cereal 1 2 Porridge Porridge

Protein – cold On Dietitian request Yoghurt Yoghurt, Banana Smoothie

Protein – hot On Dietitian request Baked beans + hash brown Baked beans + hash brown, scrambled egg, cheese omelette, Chipolatas,

Poached egg

Bread/roll/toast −lowfibre 1 2 White bread White bread, white bread roll

Bread/roll/toast −highfibre 2 4 Wholemeal bread, Fruit bread Wholemeal bread, fruit bread, wholemeal roll, wholemeal breakfast

muffin

Fresh fruit1 3

Banana Banana, aple, fruit in season

Tinned fruit** or Portion Controlled juice** 1 8

Orange juice and/or peaches Orange juice, aple juice, prune juice, peaches, prunes, diced 2 fruits, pears,

fruit compote

Milk Low fat On cereal and in drink

2% fat 2% fat

Note: *TheDietitianistoassessanddetermineconsumerneedsasperStandards1.2.Thoseatriskofmalnutritionrequirefortifiedfoodsi.e.fortifiedvegetable, soupsetcwheretheseoptionsneedtobeavailable.Fortheseconsumers,thesamemenuchoicesshouldbeofferedastexturemodifiedmenuforadultacute facilities.However,notallpatientsonatexturemodifieddietinthissettingwillrequirefortifiedoptionsandthiswillbedeterminedbytheDietitian. Healthier meal options will be offered i.e. low fat dairy to such individuals. **no added sugar ***only for long-stay/residential facilities

Page 39

Table 4: Mental Health and Acquired Brain Injury – Minimum choice (continued)




Soup (powder base)* No minimum set and include for seasonal variety 0 0

Soup* Groups 1 and 2 No minimum set

Pea & Ham soup Grp 1 – pea & ham, beef & vege, lentil, minestrone

Grp 2 – Chicken & corn, Creamy pumpkin, Tomato & bacon, Potato & leek

Main hot protein Groups 1, 2, 3 and 4

1 x group 1 or 2

2nd choice 1 x group 1, 2, 3 or 4

35 choices 14 x full 21 x soft

Roast Beef

Chickpea curry


Starchy vegetable or alternative

1 3 Roast potato Mashed sweet potato, mashed/roast potato, Rice/pasta

Orange vegetable 2 3 Mashed pumpkinCarrot

Mashed sweet potato, carrot, mashed or roast pumpkin

Green/brassica vegetable 2 5 CauliflowerBeans

Cauliflower,beans,brusselsprouts,peas,broccoli

Side Salad Minimum 4 vegetables

1 1 Lunch: Lettuce, tomato, carrot sticks, cucumber

Main Salad 100g meat or meat alternative 1 x CHO serve 4 x base vegetables 1 interchangeable vegetable

10 x meat or meat alternative

4 x carbohydrate choices


Dinner : Corn beefRice salad

Lettuce & tomatoCucumber & beetroot


Rice Salad, Potato salad, Pineaple, CornLettuce & tomato

Cucumber, beetroot, capsicum, carrot

Page 40



LONG STAY MENU SUGGESTED MENU EXAMPLES*


SandwichGroups 1 and 2

1 x group 1 (offer one high fibrebreadchoice)

or 1 x group 2


Lunch: Ham & cheeseDinner: Chicken & cranberry


Dessert Groups 1, 2, 3 and 4

No minimum set menu options should consider variety

1

No minimum set menu options should consider variety

7 tinned fruit** and dairy

Lunch: Apricots & custard

Dinner: Lowfattrifle

Fruit – fresh 2 (includes mid-meals) 5 Lunch: ApleDinner: Fruit in season

Aple, banana, fruit in season

Bread/roll/toast −lowfibre 2 Lunch: White breadDinner: White roll

White Bread, white breadroll

Bread/roll/toast −highfibre 2 Lunch: with meal breadDinner: with meal roll

Wholemeal bread, wholemeal breadroll

Note: **no added sugar ***if on minced diet, pureed options can be substituted ****only for long-stay/residential facilities

Page 41


MAIN MEALMorning Tea, Afternoon Tea and Super

LONG STAY MENU


SnackGroups 4 only

Three group 4 per day.Offer a variety of healthy, lowfathighfibrechoices

9 Raw nuts, ½ vegemite sandwich (wholegrain/

multigrain), Low fat yoghurt

Grp 4: Low fat yoghurt, Low fat cheese & wholemeal crackers, fresh

fruit, fruit yoghurt, raw nuts, Fruit cake,lowfatmuffin,½vegemitewholegrain sandwich, ½ banana

wholegrain sandwich

High protein/energy suplement and group 3 snacks As requested by Dietitian As requested by Dietitian

Drinks Tea, coffee, water, cordial (no added sugar), milk drink (low fat options)

Tea, coffee, water, cordial (no added sugar), milk

drink (full & low fat options)

Tea, coffee, water, cordial (no added sugar), milk drink (low

fat options)

SECTION 4USER GUIDE

Nutrition Standards for Meals and Menus

SECTION 4USER GUIDENutrition Standards for Meals and Menus

Page 43

USER GUIDE: PUTTING IT ALL TOGETHER

Section 1: Nutrition Standards

Section 1 outlines each Nutrition Standard including the aim, background and rationale.

The Nutrition Standards are measurable and should be used to assess if a sites menu, as well as suporting processes and systems are able to meet these Standards.

• You should be able to answer ‘yes’ or ‘no’ to each Nutrition Standard statements:

> If you answer yes, can you provide the evidence if required?

> If you answer no, then this may be an area for improvement unlessthereisreasonablejustificationastowhyithasnot been met.

Section 2: Meal Component Specifications

Section 2 provides nutritional information on meal components setting minimumlimitsforspecificnutrientstoensurenutritionaladequacy of the menu. The tables outlined in Section 3 Minimum Menu Choice arebasedonthesespecifications.

Section 2 outlines:

• The meal categories i.e. main protein, soup, sandwiches, desserts, hotbreakfastprotein,fortifiedcereals,fortifiedvegetablesand mid-meal snacks.

• The meal component specifications which are displayed as groups undereachcategory.Thespecificationsprovidethedefinition,some examples, recommended serve sizes as well as the energy and protein requirements for each group.

• Portion sizes for non-grouped items are listed separately.

Section 3: Minimum Menu Choice

Section 3 provides the framework for structuring meals across the day as well as across the menu cycle. In order to maximise patient intake, the menu Standards aim to provide a number of choices (as a minimum) that are available to patients per day and per cycle. To ensure maximum choice for main meal hot protein, menus needs to offer a total of 35 choices per cycle. Refer to p 45 to calculate the number of main meal hot protein serves to offer each day based on menu length.

Tables within this section outline:

• The minimum number of choices available to be offered including:

− Minimum menu choice required per day:

> eg. the standard acute menu requires a minimum of 35 hot main meals a day (could be served at lunch or dinner or both)

> eg. the short stay acute menu requires a minimum of one hot main meal a day (could be served at lunch or dinner)

− Minimum menu choice required across the menu cycle:

> eg. the standard acute menu requires a minimum of 35 hot meal choices per cycle, with at least 14 being full choices and 21 being soft choices

> eg. the short stay acute menu requires a minimum of 14 hot meal choices per cycle, with at least 7 being full choices and 5 being soft choices

− Minimum menu choices required across the meal groups:

> eg. the standard acute menu recommends that one of the two hot main meals should be a group 1 or 2 meal and a second choice can be a group 1, 2 or 3 meal (p 20.).

> eg. the short stay acute menu recommends that the main hot protein can be from either group 1, 2 or 3 (p 20).

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USING THE STANDARDS TO DEVELOP YOUR MENU

1. Determine the length of your menu cycle.

2. List all the items you have available that you plan to use on your menu.

3. Foreachitemthathasamealcomponentspecification(mainhotprotein, soup,sandwiches,dessertandsnacks)placethemintothe‘bestfit’ group. See Apendix 3 for menu examples.

4. Note recommended serve size ranges for other non-grouped meal items.

5. Ensure you have adequate quantity of meal items for your menu. You can check by looking at the recommended minimum number of items per cycle under Section 3.

6. Consider vegetarian and vegan choices in menu planning – see Section 1 for the Standards.

7. Consider what diets can be provided from the main menu and what diets need a separate menu.

8. With the above information you can begin to develop your master menu. (the menu that sits in the kitchen to inform all possible choices for different diet requirements).

a. Menu planning should ensure that the overarching principles in Section 1 of these Standards are met.

b. Menu planning principles such as ensuring variety, colour, texture, taste, apearance and budget should be used to guide your menu development.

Example of the number of daily main hot protein choices across different menu cycle lengths

You will need to know the length of your menu cycle to work out how many choices you should offer per day.

Below is an example of different menu cycle lengths and the number of protein choices you need to provide daily to meet the Standards eg. 35 choices per cycle for standard acute menus.

Repeats are the number of meals that can apear more than once within a cycle once the minimum requirements for variety have been met. Repeats are worked out by multiplying the number of choices per day by number of days in the cycle, then deduct the number of recommended choices (eg. 35 or 28) from the total to see how many repeats would be acceptable.

Page 45

Sample calculations for main hot protein across different menu cycle lengthsYou will need to know the length of your menu cycle to work out how many choices you should offer per day. Below is an example of different menu cycle lengths and the number of choices you need to provide daily to meet the Standards eg. 35 choices per cycle for standard acute menus.

Adult Acute, Residential Aged Care, Mental Health & Acquired Brain Injury : Long stay menu

MAIN MEAL Hot Protein

MENU CYCLE

7 day 14 day 21 day

Lunch 2 choices 1 choice 2 choices 1 choice 1 choice

Dinner 3 choices 2 choices 2 choices 1 choice 2 choices

Possible Repeats# No repeats 7 repeats 21 repeats 7 repeats 28 repeats

Fortexturemodifiedmealswithatotalof28mincedandmoistand28smoothpureedchoices,thedailychoiceswouldbeasfollows:

Adult Acute: Texture Modified Menu

MAIN MEALHot Protein

MENU CYCLE

7 day 14 day 21 day

Lunch 2 Minced and Moist 2 Smooth Puree

1 Minced and Moist 1 Smooth Pureed



Dinner 2 Minced and Moist 2 Smooth Puree

1 Minced and Moist 1 Smooth Puree



Possible Repeats# No repeats No repeat 14 repeats each texture 14 repeats each texture

Note: *can use the same meat with different sauces/gravies to increase variety. #repetitions are only necessary if the 35 meals are the minimum – it is possible to reduce repetition by having additional choices available (see menu meal choices at the end of this document).

Page 46

DEFINITIONS AND ABBREVIATIONSBreakfast Protein

Referstoitemsavailablethatcontributesignificantly to protein intake.

Hot – Examples include eggs, sausages, savoury mince, bacon or baked beans. Note: spaghetti is not high in protein but can be offered in addition to one of the higher protein choices.

Cold – Includes yoghurt, cheese or milk drinks, cold boiled eggs, cold meats.

CHO

Carbohydrate

Choice

The number of available options, either over a day or within the cycle.

Finger Foods

Finger foods may be useful to assist intake and independence. These items do not require utensils thus enable patients to eat these foods on their own without feeding assistance. Examples include sandwiches, meat balls, sausage rolls, mini pies or quiches.

Fortification of Menu Items

Toprovideadditionalnutrition,fortificationofcertain meal components including hot cereals, soups, vegetables anddessertisrequired.Fortificationaimstoincrease the protein and/or energy density of the meal component. See p 21 – 23 for further details.

Fruit

Citrus and tropical fruits are a good source of Vitamin C and should be included each day. The intent is to have a small range of fresh fruit in season that is available for all texture levels so including at least one soft fresh fruit each day that can be mashed or minced. Note: all melons should be adequately sanitised and peeled before serving.

‘Healthy’ meal options

These meal options are lower in saturated fat, fat, energy and/or salt than other items offered at the facility. The Dietitian will assess what options are suitable for patient groups.

High fibre cereals

Theseshouldprovideatleast3gfibreperserve.

Integrated Menu

Refers to a menu structure that enables the most common diets to be ordered from the main menu without compromising taste and nutritional adequacy. Commonly integrateddietsarefibremodified,carbohydratemodified,fatmodified,lowlactoseandsofttexturediets.Somedietsaremoredifficulttointegrateintothemainmenuandmayrequire a separate menu eg gluten free and electrolyte modifieddiets.Howeveritisrecommendedthatsuitableitems from the main menu be used where able.

LOS

Length of stay.

Main menu

All foods available through the standard meal service, not requiring to be made up ‘specially’ as in an individual therapeutic diet.

Meats and Meat Alternatives:

Thefoodsinthisgroup(i.e.redmeats,poultry,fish,egg,nuts and legumes) are very valuable sources of protein as well as being a major source of a number of minerals and vitamins, such as iron, zinc, vitamin B12 and, in the case offish,omega-3fats.4

Red meats are particularly good sources of iron, zinc and B12, and include beef, veal, and lamb. A range of red meats should be offered across the menu cycle so that there is at least one red meat choice each day on the menu.

Arangeofpoultry,pork,eggs,fishandmeatalternatives(i.e. legumes, nuts or seeds) should be considered in menu planning to provide variety and additional nutrients i.e. omega-3fatsinfish.

Menu Assessment

It is a requirement that menus are reviewed biennially against Nutrition Standards for Meals and Menus (refer to Statewide Foodservice Best Practice Guideline2). This assessment would include a major review of menu structure including length of cycle and number of choices. Continual menu reviews should occur on an ongoing basis as required to address changes in contracts and/or SOAs, assess meal quality aspects, products or recipes.

OBD

Overnight bed days.

Salads

The Standards recommend a minimum of four salad vegetables for the side salad as well as the main salad. This includes lettuce (ideally mixed leaf), tomato and two rotating salad vegetables (eg. onion, capsicum, cucumber, grated carrot, celery, mushroom, beetroot or asparagus).

A carbohydrate (CHO) source for salad could include either a starchy vegetable salad item (eg. potato salad, sweet potato salad, corn, or bean mix) or a cereal salad item (eg. pasta salad, rice salad or cous cous salad). A CHO serve should be 90 – 120g. The main salad also requires a source of protein daily.

Page 47

Definitions and Abbreviationscontinued

Serve size variation

The Standards (refer to p 8) recommend that serve size variations be available on the menu including as a minimum small, medium (standard serve) and large options where practical.

For some items (i.e. portion controlled) offering serve size variations may not be practical and visual apearance of such items should be considered.

Main Meal Protein

• A small serve would be considered 75% of a standard serve due to the nutritional value of this meal component.

• A large serve would be up to 150% of a standard serve.

Vegetables

• A small serve would be considered between 50-75% of a standard serve.

• A large serve would be up to 150% of a standard serve.

Desserts

• A small serve would be considered between 50-75% of a standard serve.

• For a large dessert serve, it is suggested that additional components are offered where practical eg. custard, instead of a large portion size, if tray space is an issue.

Short stay menu

An alternative menu may be provided to patients who are not at nutritional risk and are admitted for less than 7 days toanacutefacility.Thismenudoesnotincludefortifiedoptions and has been modelled to provide a reduced choice version of the standard menu.

SOA

Standing offer arrangement. Products that are on the Qld Health State-wide Food Service SOA have gone through the tender process and have been accepted as meeting certain criteria. Current categories for SOA's are: SOA 066 –TextureModifiedfoodsincluding smooth puree and minced and moist textures.

SOA 067 – Full and soft meal components and plated meals. SOA 068 –Thickenedfluidsandthickener

Long stay menu

Long stay patients and those assessed as malnourished or at risk of malnutrition in acute facilities, need to have access to higher energy/protein food choices to increase the likelihood of meeting their elevated nutritional requirements. The standard hospital menu will provide nutrientdensemenuoptionsincludingfortifieditemsincluding a cold and hot protein choice at breakfast, fortifiedcereal,vegetable,soupandmid-mealstomeetnutritional targets and maximize patient/resident/client or consumer choice. This menu is intended to be offered as the standard or general menu in acute adult facilities with the exception of short stay patients i.e. patients staying less than 7 days who would be offered a short stay menu.

Texture modified diets

Terminology used is based on Australian Standardised TerminologyandDefinitionsforTextureModifiedFood and Fluids43.

Vegetables

Starchy vegetables – these vegetables are higher in kilojoules per unit weight than other vegetables but are a major staple in the Australian diet and a useful sourceofsolublefibresoaminimumofoneperday has been recommended. They include potato, corn, and sweet potato.

Green/brassica vegetables – have a good range of nutrients andarelowinkilojoulesandagoodsourceoffibre. Green/brassica vegetables include – green beans, peas, broccoli,cauliflower,brusselsprouts,cabbage,zucchini,spinach and silverbeet.

Orange vegetables – are also a good source of vitamins, mineralsandfibre.Theyincludecarrots,pumpkin and sweet potato. Note: sweet potato is counted as a starchy vegetable as well as orange and are higher in kilojoules.

Page 48

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3. Queensland Health. 1998. Queensland Health Foodservices Policy, Corporate Guidelines and Standards. Queensland Government, Brisbane.

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13. Almdal, T., L. Viggers, A. Beck, K. Jensen, 2003. Food production and wastage in relation to nutritional intake in a general district hospital – wastage is not reduced by training the staff. Clinical Nutrition, 22 (1): 47-51.

14. Kondrup, J., N. Hohansen, L. Plun, L. Bak, I. Hojlund Laresen, A. Martinsen, J. Andersen, H. Baernthsen, E. Bunch, N. Lauesen, 2002, Incidence of nutrition risk and causes of inadequate nutritional care in hospitals. Clinical Nutrition, 21 (6): 461-468

15. Barton, A., C. Beigg, I. Macdonald, S. Allison, 2000-2. High food wastage and low nutrition intakes in hospital patients. Clinical Nutrition, 19 (6): 445-449.

16. Dupertuis, Y., M. Kossovsky, U. Kyle, C. Raguso, L. Genton, C. Pichard, 2003. Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey. Clinical Nutrition, 22 (2): 115-123.

17. Gallagher-Allred, C., A. Cobble Voss, K. Koop, 1999. The effect of medical nutrition therapy on malnutrition and clinical outcomes. Nutrition, 15 (6): 512-514.

18. Alison, S. 2003. Hospital food as treatment. Ed. Clinical Nutrition, 22 (2): 113.

19. Isabel, M., M. Correia, D. Waitzberg. 2003. The impact of malnutrition on morbidity, mortality, length of hospital stand and costs evaluated through a multivariate model analysis. Clinical Nutrition, 22 (3): 235-239.

20. Elia, M. 2006. Nutrition and health economics. Nutrition, 22: 576-578.

21. Odlund Olin, A., OP. Osterberg, K. Hadell, I Armyr, S. Jerstrom, O. Ljungqvist. 1996. Energy-enriched hospital food to improve energy intake in elderly patients. American Society for Parenteral and Enteral Nutrition 20 (2): 93-97.

22. Gall, M., G. Grimble, N. Reeve, S. Thomas, 1998, Effectofprovidingfortifiedmealsandbetween-meal snacks on energy and protein intake of hospital patients, Clinical Nutrition, 17(6): 259-264

23. Barton, A., C. Beigg, I. Macdonald, S. Allison, 2000-1. A recipe for improving food intakes in elderly hospitalised patients. Clinical Nutrition, 19 (6): 451-454.

24. Lorefalt, B., U. Wissing, M. Unosson. 2005. Smaller but energy and protein-enriched meals improve energy and nutrient intakes in elderly patients. The Journal of Nutrition, Health and Aging, 9 (4): 243-247.

25. National Health and Medical Research Council. 2010. Public Statement: Iodine suplementation for Pregnant and Breastfeeding Women. Retrieved 16 May 2011 from http://www.nhmrc.gov.au/publications/synopses/ new45_syn.htm

26. National Health and Medical Research Council. 2010. Iodine Suplementation During Pregnant and Lactation - Literature Review. Retrieved 16 May 2011 from http:// www.nhmrc.gov.au/publications/synopses/ new45_syn.htm

27. Food Standards Australia New Zealand. Listeria and food – advice for people at risk. Retrieved 15 May 2011 fromhttp://www.foodStandards.gov.au/_srcfiles/ Listeria.pdf

28. Queensland Health. 2007. A Healthy Start in Life – a nutrition manual for health professionals. Queensland Government, Brisbane.

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30. Alix, E., G. Berrut, M. Bore, F. Bouthier-Quintard, J. Buia,A. Chlala, Y. Cledat, G. d’Orsay, C. Lavigne, R. Levasseur, J. Mouzet, M. Ombredanne, A. Salle, C. Gaillard, P. Ritz. 2007. Energy requirements in hospitalized elderly people. Journal American Geriatrics Society, 55: 1085-1089.

31. Odlund Olin, A., I. Armyr, M. Soop, S. Jerstrom, I. Classon, T. Cederholm, G. Ljunggren, O. Ljungqvist. 2003. Energy-dense meals improve energy intake in elderly residents in a nursing home, Clinical Nutrition, 22 (2): 125-131

32. NSW Health. 2010. Eating Well - A Food and Nutrition Resource for Frail Older People and their Carers. Retrieved 14 April 2011 from http://www.mncrcsd. com.au/uploads/uploads/Eating%20Well-final- NSCCAHS-2010.pdf

33. Jean LA. 1997. Finger food menu restores independence in dining. Health Care Food and Nutrition Focus. 14 (1): 4-6.

34. Ford G. 1996. Putting feeding back into the hands of patients. Journal of Psychosocial Nursing and Mental Health Services. 34 (5): 35-39. 35. Holt, I.G. Peveler, R.C. 2009. Obesity, serious mental illness and antipsychotic drugs. Diabetes, Obesity and Metabolism, 11: 665-679.

36. Ward, E. C. and Morgan, A. T. 2001. Dysphagia following traumatic brain injury in adults and children: assessment and characteristics. In B.E.Murdoch and D. G. Theodoros (Eds.), Traumatic brain injury: ssociated speech, language, and swallowing disorders p. 331-367. San Diego: Singular Publishing Group.

37. De Hert M, Dockx L, Bernagie C, Peuskens B, Sweers K, Leucht S, Tack J, Van de Straete S, Wampers M, Peuskens J.2011. Prevalence and severity of antipsychotic related constipation in patient with schizophrenia: a retrospective descriptive study. BMC Gastroenterology 11:17.

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41. Craig WJ. 2009. Health effects of vegan diets. American Journal of Clinical Nutrition. 89(5): 1627S – 1633S.

42. Lightowler HJ, Davies GJ. 2002. Assessment of iodine intake in vegans: weighed dietary record vs duplicate portion technique. European Journal of Clinical Nutrition. 56(8): 765-770.

43. Dietitians Association of Australia and The Speech Pathology Association of Australia Limited, 2007. AustralianStandardisedTerminologyandDefinitions forTextureModifiedFoodsandFluids.Nutrition and Dietetics, 64: (Supl. 2): S53-S76

44. Cruickshank D. 2009. Development of nutrition Standards for general menus for Queensland Health hospitals and residential aged care facilities. Masters research paper. Unpublished. 45. Gaillard, C., E. Alix, Y. Boirie, G. Berrut, P. Ritz. 2007. Energy requirements in frail elderly people: A review of the literature. Clinical Nutrition 26: 16-24.

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Page 50

APENDIX 1Length of stay Summary Data Acute – overall (2011)

HOSPITAL DAYS ADMITTED

NO. ANNUAL SEPARATIONS

PROPORTION HOSPITAL SEPARATIONS

MEAN LOS % OVERNIGHT OBDS

AVG AGE MAL - NUTRITION

INDIGENOUS PATIENTS

TOTAL OVERNIGHT

Rural/remote medium

1 or > 4 or > 7 or >

14 or > 21 or > 60 or >

4,735 2,403 1,461 729 476 61

74.3% 37.7% 23.0% 11.5% 7.5% 1.0%

100% 50.7% 30.9% 15.4% 10.1% 1.3%

8.2 14.3 20.5 31.6 35.2 77.4

100 96.4 66.5 40.6 20.5 4.1

36.1 36.3 36.3 33.3 31.1 20.6

NA41%

Regional − medium

1 or > 4 or > 7 or >

14 or > 21 or > 60 or >

15,608 5,728 3,129 1,323 766 84

50.3% 18.5% 10.1% 4.3% 2.5% 0.3%

63.3% 36.7% 20.0% 8.5% 4.9% 0.5%

5.5 11.8 17.7 29.5 38.7 88.9

100 80.0 65.1 45.5 34.8 8.8

41.0 52.6 58.4 59.2 58.2 53.2

25% 6.00%

Tertiary Metro Large

1 or > 4 or > 7 or >

14 or > 21 or > 60 or >

32,859 16,174 9,949 4,341 2,492 368

42.1% 20.7% 12.7% 5.6% 3.2% 0.5%

100% 49.20% 30.0% 13.2% 7.6% 1.1%

7.5 13.7 19.0 31.7 42.9

102.9

100 88.0 76.5 55.7 43.3 15.3

56.4 58.8 59.4 58.9 57.9 53.7

NA 2.60%

Page 51

HOSPITAL DAYS ADMITTED

NO. ANNUAL SEPARATIONS

PROPORTION HOSPITAL SEPARATIONS

MEAN LOS % OVERNIGHT OBDS

AVG AGE MAL - NUTRITION

INDIGENOUS PATIENTS

TOTAL OVERNIGHT

Regional medium

1 or > 4 or > 7 or >

14 or > 21 or > 60 or >

17,973 6,132 3,111 1,334 613 40

54.2% 18.5% 9.4% 4.0% 1.8% 0.1%

100% 34.1% 17.3% 7.4% 3.4% 0.2%

4.6 10.3 15.7 24.5 34.0 80.9

100 76.5 59.3 39.5 25.2 3.9

47.8 60.8 67.6 69.4 68.7 65.3

33% 1.00%

Regional large

1 or > 4 or > 7 or >

14 or > 21 or > 60 or >

29,254 11,190 6,289 2,909 1,821 339

47.6% 18.2% 10.2% 4.7% 3.0% 0.6%

100% 38.3% 21.5% 10.0% 6.2% 1.2%

6.7 14.7 22.4 37.6 50.2

122.9

100 84.0 71.9 55.8 46.7 21.3

49.5 56.8 59.8 60.7 60.5 54.0

36% Not provided

Paediatric metro 1

1 or > 4 or > 7 or >

14 or > 21 or > 60 or >

8,300 2,469 1,390 533 276 54

41.1% 12.2% 6.9% 2.6% 1.4% 0.3%

100% 29.7% 16.7% 6.4% 3.3% 0.7%

4.6 12.1 17.7 31.3 45.3

101.3

100 77.1 64.0 43.3 32.5 14.2

6.1 6.9 7.2 7.1 6.3 4.4

NA13%

21.5% 9.0% 9.3%

11.3% 18.5%

Paediatric metro 2

1 or > 4 or > 7 or >

14 or > 21 or > 60 or >

8,058 2,098 1,070 408 183 28

50.9% 13.3% 6.8% 2.6% 1.2% 0.2%

100% 26.0% 13.3% 5.1% 2.3% 0.3%

3.8 10.6 16.2 27.9 42.4

107.4

100 77.4 56.1 36.8 25.1 9.7

5.8 6.0 6.2 6.4 5.8 5.0

NA8%

11% 13% 19% 21% 21%

Page 52

HOSPITAL LOS (DAYS) SEPARATIONS % HOSPITAL SEPARATIONS MEAN LOS % OVERNIGHT OBDS

AVG AGE

TOTAL OVERNIGHT

Tertiary Metro

< 11 or > 4 or > 7 or >

14 or >20 or >60 or >

48467399481716897442320537327

10045.219.411.02.60.60.4

10043.024.45.81.30.8

3.46.3

12.518.354.7

184.0107.3

1008472

59.242.132.413.9

55.656.759.559.959.559.153.1

Regional - Large

< 11 or > 4 or > 7 or >

14 or >20 or >60 or >

237482986190194509167883879

10055.716.88.43.11.60.1

10030.215.15.62.80.3

4.410.816.829.843.3

156.2

10073.857.638.127.69.4

NA

Length of stay Summary Data Acute (2014)

Page 53

Length of Stay data for Acquired Brain Injury (ABI) QH facilities (2011)

LOS DAYS (AVERAGE)

GENDER % M/F

AGE(YRS)

WEIGHT(KG)

BMI AVERAGE(KG/M2)

2,991 M 100 50 76 25

1,910 M 60 F 40 50 73 25

700 M 83 F 17 46 85 27

1,778 M 44 F 56 47 71 26

Average 1,845 (5.1 years) M 72 F 28 48 76 25.8

Length of Stay Data for Mental Health Units QH facilities (2011)

MH UNIT DAYS ADMITTED NO. ANNUAL SEPARATIONS

% OVERNIGHT SEPARATIONS

MEAN LOS AVG AGE

Tertiary Metro Large

1 or >

4 or >7 or >

14 or >

21 or >

60 or >

1,356

998820

569

383

73

100%

77.6%

63.8%44.3%

29.8%

5.7%

21.7

27.3

31.941.3

52.7

129.7

40.4

41.7

43.044.2

46.2

54.3

Tertiary Regional Large

1 or >

4 or >

7 or >14 or >

21 or >

60 or >

3,328

3,027

2,238

1,4741,127

417

100%

90.9%67.2%

44.3%

33.9%

12.5%

69.7

75.498.5

145.5

168.3

455

39.4

38.4

39.347.4

39.8

33.8

Page 54

APENDIX 2REFERENCE PERSONS USED IN STANDARDS DEVELOPMENT Adult Reference Persons and Nutrient Targets

Length of stay (LOS)

Analysis of LOS across Queensland Health facilities revealed two distinct patient populations. Those admitted for less than seven days and those that remained longer than fourteen days (refer to Apendix 1 for LOS details). This result informed the recommendation that a basic seven to fourteen day menu be provided for short stay patients. For those patients admitted for more that seven days, or assessed as being malnourished or at risk of malnutrition, a minimum fourteen day menu with additional items is required. Dataanalysisfor2siteswasrepeatedin2014andshowednosignificantchange in the percentage of patients that stay longer than 7 days but did show an increase in the average LOS of those patients.

Age

All adult acute hospitals analysed showed similar age and Occupied Bed Days (OBD)datawiththeexceptionofMountIsawhichhadasignificantlyyoungerpopulation and the highest number of indigenous patients. The average age of patients admitted for less than seven days is 41 – 67 years with exception of Mount Isa where the average age is 33 years. Analysis of patients with LOS greater than seven days revealed 50% OBD are occupied by people with average age 58 – 69 years except at Mount Isa hospital where the average age 36 years and decreases to 21 years for those staying more than 60 days.44

Nutritional Requirements

To determine the energy and protein requirements for the average age of patients admitted to Queensland Health facilities, a reference male of 76kg* was adapted from NHMRC Nutrient Reference Values for Australia and New Zealand including Recommended Dietary Intakes (NRVs).12

*Note: excludes mental health and acquired brain injury refer to section for details on reference weight use.

Standard acute adult patient

Energy and protein requirements* were calculated utilising equations derived from studies30, 45, 46, 47 in acute hospitals and residential aged care to determine the values below;

Energy 105 – 125 kJ/kg/day: 76kg male 8,000 – 9,500kJ

Protein 1.2g/kg/day: 76kg male 95g protein

*Note: Mount Isa Hospital average patient age for LOS greater than seven days was 36 years. Estimated energy and protein requirements for males aged 31 – 50 (Mount Isa) with average weight 76kg.

Energy 125kJ/kg/day 9,500kJ

Protein 1.2g/kg/day 95g

Standard acute menu

For patients with LOS greater than 7 days, Recommended Dietary Intake (RDI) reference values for males aged 51 – 70 years were utilised to assess adequacy of micronutrients. With the priority to meet protein and energy requirements, reference RDIs were not considered achievable and certain nutrients will require consideration in menu planning based on patient population).

A modelled fourteen day cycle with a hot and cold protein choice at breakfast, mid-mealsandfortifiedfooditemsmetestimatedproteinandenergyrequirements (energy 10,200kJ and 107g protein). All RDIs were also met except for folate, magnesium and zinc. For these nutrients only the Estimated Average Requirement (EAR) could be met for zinc. It was noted that EARs for folate and magnesium could not be met (75% and 93% respectively). Dietary fibrelevelsalsofellbelowAdequateIntake(AI)forthisgroup.Theprioritytomeet protein and energy requirements has resulted in certain micronutrient nutrients shortfalls that will require consideration in menu planning. Fibrefortificationmayalsorequireconsideration.Allfacilitieswillneed to consider whether they need to address this shortfall with their own menu based on the patient demographics.

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This menu was also assessed and met estimated protein and energy requirements for males aged 31 – 50 years. All RDIs for males aged 31 – 50 years were met except for folate and magnesium. EARs for these nutrients couldnotbemet(folate92%andmagnesium88%).Dietaryfibrealsofellbelow AIs for this group.

Short stay adult patient

Energy and protein requirements were derived from NRVs on the basis that RDI for protein for males aged 19 – 70 years is 0.84g/kg and the recommended Energy for sedentary males aged 19 – 70 years is 95 – 110kJ/kg/day.12

Energy 100kJ/kg/day: 76kg male 7,600kJ

Protein 0.84g/kg/day 76kg male 63.8g

Short stay menu

RDI reference values for males aged 51 – 70 years were utilised to assess sample menus for adequacy of micronutrients for short stay menu (i.e. those patients admitted for less than seven days who are not at risk of malnutrition nor require additional energy or protein, for example an admission for management of chest pain). The short stay menu was modelled to provide a minimum seven day cycle or reduced choice fourteen day cycle.

Minimum modelling provided an estimated energy level of 8,300 kJ and 76g protein meeting estimated requirements. All RDIs were met except for folate, magnesium, calcium and zinc however met EAR for calcium. Fibre levels also fell below AI values. Following this exercise, it was acknowledged that some vitamins and minerals will require special consideration in menu planning. Fibrefortificationmayalsorequireconsideration.Allfacilitieswillneedtoconsider whether they need to address this shortfall with their own menu based on the patient demographics.

Aged Care Reference Persons and Nutrient Targets

Standard and pureed 14 day cycle menus were modelled to meet requirements for males aged 70 years or older with an average weight 76kg. Energy and protein requirements were calculated utilising equations derived from literature31, 48,49 in aged care.

Energy 105kJ – 1,26kJ/kg/day 76kg male 7,320 – 9,580kJ

Protein 1.2g/kg: 76kg male 91.2g

Reference RDIs for males aged 70 years or older were used to assess micronutrient adequacy. Suggested Dietary Targets (SDTs) for disease prevention were not aplied to this group as they were felt to be inapropriate for aged care setting. Modelling was based on the use of small serves i.e. 75% of standard serve.

Analysis of the aged care menu revealed similar results to menus modelled for the acute setting with folate, magnesium and zinc not meeting reference RDIs. EAR value for zinc was met (110%) and was marginal for magnesium (99%).AIforfibrewasalsonotachieved.ForpureedmenutheonlyRDInotmetwasfolateandAIoffibrewasalsolow.Similarlytothestandardacutemenu, the priority to meet protein and energy requirements have resulted with certain micronutrient nutrients shortfalls that will require consideration in menu planning. All facilities will need to consider whether they need to address this within their own menu.

Paediatric Reference Person and Nutrient Targets

The reference child on whom recommendations are based is a 7 year old boy (23kg), on the 50th centile on the CDC 2000 growth charts. EnergyrequirementswereestimatedusingSchofieldequation50 and the 4 – 8 year olds RDI for protein was adapted from NHMRC NRVs.12

Energy 6,657kJ

Protein 20g/day

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Using reference RDIs for 4 – 8 year olds menus modelled met energy needs up to 7,700kJ and protein requirements. All RDIs were also achieved except forfolatehowevertheEARwasmetat119%.TheAIforfibrewasalsonotachieved. Menu choices were modelled on actual consumption and based on the understanding that at mixed adult and paediatric hospital, additional adult food would be offered to older children. Available serves were based on all choices available and those items on the ward at all times (i.e. fresh fruit, yoghurts, juice, milk drink, bread and spreads).

Other assumptions used in modelling included:

• additional juice (100ml) at breakfast;

• half main protein serves;

• half serve* of ice cream and fruit with main meal;

• half serve* of high protein dessert at light meal;

• as mid-meal snacks; and

• one milk drink and two soft drinks or cordials per day. *Note: A half serve was set as half the minimum portion size on p 28 i.e. ice cream = 40g serve.

Mental Health and Acquired Brain Injury Reference Person and Nutrient Targets

Inordertodeterminetherepresentativeprofileofareferencepersonforthisgroup, mean age, heights and weights were sourced from the Queensland Mental Health Benchmarking Unit (QMHBU) data.8, 9 From this data, a reference male with an average adjusted weight of 80kg*, height of 175cm and age of 44 years was determined.

To allow for variation in mobility a range for energy requirements has been developed based on two Physical Activity Levels (PALs); 1.2 (bed rest) to 1.4 (very sedentary). Estimated energy requirements were calculated using the Harris-Benedict equation, with the RMR being reduced by 840kJ/day as the Harris-Benedict equation has been found to overestimate RMR in men taking antipsychotic medications.51 It is acknowledged that some individuals within this group will have higher energy requirements based on age, body weight/body composition and PALs; it is recommended that facilities consider whether they need to address this with their own menu based

on the consumer group. Protein requirements were calculated based on the RDI for males aged 31 – 50 years.12

Energy (PAL 1.2 – 1.4) Males 7,700 – 9,100kJ/day

Protein 0.84g/kg: Males 67g/day

To address the issues of chronic disease prevention, where possible, reference Suggested Dietary Targets (SDTs) and Acceptable Macronutrient Distribution Ranges (AMDRs) in addition to RDIs and EARs for males aged 31 – 50 years were used to assess nutrient adequacy.12 For the standard texture menu, as modelled against the reference male, all RDIs and EARs were met; however, Vitamin C and Potassium did not meet the SDT minimum at 97% and 90% respectively. Sodium exceeded the SDT maximum (137%), however,wasbelowtheUperLevel(UL)of2,300mg.Thetexturemodifiedmenu did not meet the RDIs for folate (90%), magnesium (84%) and zinc (99%), however, when compared against the EARs all were met although magnesiumremainedmarginal(101%).ThetexturemodifiedmenudidnotmeettheSDTminimumsforfibre(70%),vitaminC(82%)andpotassium(99%); Sodium exceeded the SDT maximum (127%), however, was below the Uper Level (UL) of 2,300mg.

Evidently, the micronutrients that were found to fall below the RDI and potentially those that fell below the SDT will require special consideration in each facility undertaking menu planning for these population groups. Fibrefortificationmayalsorequireconsiderationforthetexturemodifiedmenu. It was noted that bread made a large contribution to the sodium content in the standard texture menu. It is acknowledged that bread is a popular staple and it is impracticable to reduce the quantity of bread solely to reduce sodium. Hence, efforts need to be made to provide meals with lower sodium content whist still providing acceptable taste. Soup contributed to a largeportionofthesodiuminthetexturemodifiedmenu,sourcingreducedand low sodium soups is highly recommended. Both the standard texture menuandthetexturemodifiedmenuFellwithintheAcceptableMacronutrientDistribution Ranges (AMDRs) for percentage of energy from protein, fats and carbohydrates.

*Note: Adjusted Ideal Body Weight (IBW) = [(Actual Body Weight – IBW) x 0.25] + IBW IBW = weight at BMI 25

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APENDIX 3 Example menu for different cycle lengths. Seven day menu cycle Total 35 hot choices – three lunch, two dinner

7 day menu cycle (two lunch items apear on the menu – an alternative item is available if requested) (repeats)

MEAL – WEEK 1 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

Lunch – full Roast Beef Pork in Plum Sauce

Chicken Rissoles Roast Lamb Crumbed Fish Lentil Burger Roast Chicken

Lunch – soft Steamedfishinlemon sauce

Lamb rissoles Macaroni Cheese Satay Chicken Fettuccini Carbonara

Chicken Cacciatore

Sweet & sour pork

Lunch – Salad Ham Roast Beef Salmon Meat Loaf Roast Chicken Ham Roast Lamb

Lunch – alt Chilli Beans Vegetarian Quiche Chefs Special Tofu & vege stir fry Pumpkin & chick pea curry

Chefs Special Plain Omelette

Sandwicht Chicken & Hommos

Ham & cheese Roast beef Salmon & cream cheese

Ham & Cheese Roast Lamb Corn Beef & pickle

Lunch dessert Apricots and custard

Pineaple Sponge & custard

Peaches and custard

FruitTrifle Chocolate Cake & Ice-cream

Diced peaches & pears and custard

Aple Pie and custard

Tea - full Lamb (Kofta) Meatballs

Silverside & white sauce

Roast Pork Braised Steak & onions

Chicken in apricot sauce

Lamb Korma Beef Pie

Tea – soft Chickenfingers Salmon Bake Curried beef Steamed pork dumplings

Veal & tomato casserole


Fish cakes

Tea - salad Egg & Cheese Falafel Chicken Caesar 4 bean salad Roast Pork Corn Beef Mexican Bean

Sandwich Assorted Assorted Egg & lettuce Assorted Falafel & salad swich/wrap

Cheese Assorted

Tea – dessert 1 Lemon Cheesecake (HP)

& ice-cream

Baked Egg Custard & stewed aple

Banana Cake & Custard

Creamed Rice (HP) & peaches

Aple crumble & custard

Crème Caramel & Banana

Bread & Butter pudding (HP) &

peaches

Tea –dessert 2 Chocolate Mousse & Pears

Apricots & Ice-cream

Vanilla slice & ice -cream

Fruit Salad & Ice cream


Strawberry Mousse & diced

aple

Fruit Salad & ice-cream

Page 58

14 day menu cycle (two lunch, two dinner) (repeats)


Lunch – full Roast Beef Pork in Plum Sauce

Chicken Rissoles Roast Lamb Crumbed Fish Lentil Burger Roast Chicken

Lunch – Soft Fettuccini Carbonara

Lamb rissoles Macaroni Cheese Satay Chicken Steamedfishinlemon sauce

Chicken Cacciatore

Sweet & sour pork

Lunch – Salad Ham 4 bean salad Roast Lamb Salmon Roast Chicken Meat Loaf Roast Beef

Lunch Sandwich Egg & cheese Chicken & Hommos

Roast beef Ham & cheese Roast Lamb Salmon & cream cheese

Roast Beef



Peaches and custard




Tea - full Lamb (Kofta) Meatballs

Peaches and custard

FruitTrifle Braised Steak & onions


Crumbedfish Beef Sausages

Tea – soft Plain Omelette Salmon Bake Curried beef Pumpkin & chick pea curry

Beef in red wine casserole


Lentil & Potato Cottage Pie

Tea Sandwich Assorted Assorted Egg & lettuce Assorted Falafel & salad swich/wrap

Egg & lettuce Assorted

Tea dessert Lemon Cheesecake (HP)

& ice-cream






Bread & Butter pudding (HP)

& peaches

Page 59

14 day menu cycle (repeat)


Lunch – full Roast Lamb Meat Balls & gravy Lamb Korma Roast Beef Chicken Pie Pork Sausages Vegetarian Lasagne

Lunch – soft Savoury Mince Salmon Bake Cottage Pie Steamed Fish in lemon sauce

Macaroni Cheese Beef Stroganoff

Lunch – salad Turkey Egg & Cheese Chicken Caesar Ham Roast Pork Mexican Bean Corn Beef

Lunch Sandwich Corn Beef & pickle Roast Pork & aple sauce

Falafel & salad swich/wrap

Cheese & Egg Roast beef Chicken & Hommos

Salmon & cream cheese

Lunch dessert Chocolate Mousse & Pears






aple

Fruit Salad &

ice-cream

Tea – full Beef Pie Chicken in apricot sauce

Silverside & White Sauce

Roast Chicken BBQ Pork ribs Crumbed Fish Chicken Rissoles

Tea – soft Vegetable Quiche Beef casserole Pumpkin & chick pea curry

Lamb & tomato casserole

Beef curry Lentil & Potato Cottage Pie


Tea Sandwich Assorted Assorted Assorted Assorted Egg & Lettuce Assorted Cheese & tomato

Tea dessert FruitTrifle Lemon Cheesecake (HP) & ice-cream


Bread & Butter pudding (HP) &

peaches

Chocolate Cake & Ice-cream



Page 60

21 day menu cycle (one lunch, two dinner or two lunch, one dinner – if full option on lunch or dinner then soft sandwiches and soup are an option for the soft diets) (repeats)


Lunch - full/soft Cottage Pie Salmon Bake Savoury Mince Cheese Omelette Beef Stroganoff Lentil & potato pie Spaghetti Bolognaise

Lunch – Salad Ham Roast Beef 4 bean salad Roast Chicken Salmon Meat Loaf Roast Lamb

Sandwich Chicken & Hommos

Ham & cheese Salmon & cream cheese

Roast beef Ham & Cheese Roast Lamb Corn Beef & pickle

Lunch dessert Chocolate Mousse & Pears






aple


Tea - full Silverside & white sauce


Lamb (Kofta) Meatballs

Braised Steak & onions

Roast Pork Crumbed lamb cutlets

BBQ pork ribs

Tea – soft Vegetable Quiche Lamb rissoles Macaroni Cheese Satay Chicken Fish cakes Chicken Cacciatore

Meat Loaf & gravy

Sandwich Assorted Assorted Assorted Assorted Assorted Assorted Assorted


& ice-cream

Baked Egg Custard & stewed

aple






& peaches

Page 61

21 day menu cycle (repeat)


Lunch - full/soft Steamed Fish in lemon sauce

Irish Stew Beef Casserole Chicken Rissoles Savoury omelette Sweet & sour pork Cottage Pie

Lunch – Salad Turkey Egg & Cheese Ham 4 bean salad Roast Pork Corn Beef Chicken Caesar

Sandwich Roast Lamb Chicken & Hommos Salmon & cream cheese

Ham & Cheese Roast beef Egg & Cheese Corn Beef & pickle



Peaches and custard




Tea - full Roast Beef Pork in plum sauce Quiche Lorraine Roast Lamb Lentil Burger Crumbed Fish Roast Chicken

Tea – soft Plain Omelette Curried beef Pumpkin & chick pea curry

Salmon Bake Veal & tomato casserole


Macaroni Cheese



& ice-cream




& peaches





Lunch - full/soft Beef stroganoff Chicken Rissoles Lamb rissoles Seafood Mornay Savoury Mince Irish Stew Roast Chicken

Lunch – Salad Egg & Cheese Turkey Mexican Bean Ham Roast Pork Chicken Corn Beef

Sandwich Chicken & Hommos

Ham & cheese Roast beef Salmon & cream cheese

Roast Chicken Ham & Cheese Egg & cheese

Lunch dessert Diced peaches & pears and custard

Strawberry Mousse & diced aple


Peaches and custard


Chocolate Cake & Ice-cream

FruitTrifle

Tea - full Roast Lamb Pork Sausages Chicken Pie Roast Beef Chicken in Apricot Sauce

Meat Balls & gravy Lamb Korma

Tea – soft Vegetable Quiche Steamed Fish in lemon sauce

Macaroni Cheese Butter Chicken Lentil & potato pie Fettuccini Carbonara

MexicanChilliBeans


Tea dessert Baked Egg Custard &

stewed aple

Lemon Cheesecake (HP) & ice-cream






& peaches

Page 62

14 day Smooth puree and Minced and moist (repeats)


Lunch - Minced & moist

Cottage Pie & Gravy

Salmon Bake & white sauce

Savoury Mince & gravy

Cheese Omelette & tomato sauce

Beef Stroganoff & gravy

Lentil & potato pie & tomato sauce

Minced Spaghetti Bolognaise & tomato sauce

Lunch – Smooth puree

Cottage Pie Salmon Bake Savoury Mince Cheese Quiche (no base)

Beef Stroganoff Lentil & potato pie Spaghetti Bolognaise

Lunch dessert – Minced & moist

Chocolate Mousse & Diced

Pears

Diced Apricots & Ice-cream

Vanilla slice (custard only) & ice –cream/

caramel custard

Diced Fruit Salad & Ice cream/

yoghurt



aple

Coconut & Pineaple Pudding

Lunch dessert – smooth puree

Chocolate Mousse & SP

Pears

SP Apricots & Ice-cream/Custard


caramel custard

SP Fruit Salad & Ice cream/

yoghurt

SP peaches & pears and custard

Strawberry Mousse & SP aple

Coconut & Pineaple pudding

Tea - Minced & moist

Minced Chicken in apricot sauce

Minced Silverside & white sauce

Lamb (Kofta) Meatballs & mint

yoghurt/ gravy

Minced Braised Steak & onions

Minced Steamed fish&lemon

sauce

Minced Lamb & mint gravy

Minced BBQ pork & BBQ sauce

Tea – Smooth puree

SP chicken in apricot sauce

SP silverside & white sauce

SP lamb & mint yoghurt sauce

SP Braised Steak & onion gravy

SPSteamedfish&lemon sauce

SP Lamb & mint gravy

SP BBQ pork & BBQ sauce

Tea dessert -Minced & moist

Lemon Cheesecake

(HP) no base & ice-cream/lemon

sauce

Baked Egg Custard & diced aple


Creamed Rice (HP) & diced peaches


Crème Caramel custard & mashed Banana & caramel sauce or custard

Bread & Butter pudding (HP) & diced peaches

Tea dessert – smooth puree

Lemon Cheesecake

(HP) no base & ice-cream/ lemon

sauce

Baked Egg Custard & SP aple

SP Aple crumble & custard

SP Creamed Rice (HP) & SP peaches

SP Banana Pudding & Custard

Crème Caramel custard & SP

Banana & caramel sauce or custard

SP Bread & Butter pudding

(HP) & SP peaches

Page 63


Lunch - Minced & moist

Vegetable Quiche no base & cheese

sauce

Minced Roast Beef & gravy

M& M Macaroni Cheese

Minced Chicken & satay sauce

Fish cakes & white sauce

Minced Chicken Cacciatore

Meat Loaf & gravy

Lunch – Smooth puree

Savoury Baked egg custard & cheese sauce

SP Roast Beef & gravy

SP macaroni cheese

SP chicken & satay sauce

SPfishcakes&white sauce

SP chicken cacciatore

SP Meat Loaf & gravy

Lunch dessert – Minced & moist

Minced Aple Pie & custard

Pineaple Mousse & diced aple

Crème Caramel custard &

caramel sauce or custard

Diced Fruit Salad & ice-cream/

custard

Diced Pineaple Sponge & custard

Chocolate Cake & Ice-cream/ vanilla

custard

FruitTrifle(madewith diced fruit)

& ice-cream/ custard

Lunch dessert – smooth puree

Puree Aple Pie & custard

Pineaple Mousse & diced aple

Crème Caramel custard &

caramel sauce or custard

SP Fruit Salad & ice-cream/ custard

SP Pineaple Sponge & custard

SP Chocolate Pudding & Ice-cream/ vanilla

custard

SPFruitTrifleinlayers & ice-

cream/ custard

Tea - Minced & moist

Minced Lamb Korma

Chicken rissoles & gravy

Minced Beef Casserole

Minced Roast Pork & gravy & aple

sauce

Minced Irish Stew Minced curried beef & gravy

Minced Sweet & sour pork

Tea – Smooth puree

SP Lamb Korma SP Chicken rissoles & gravy

SP Beef Casserole SP Roast Pork & gravy & aple sauce

SP Irish Stew SP Curried Beef & gravy

SP Sweet & sour pork

Tea dessert -Minced & moist

Baked Egg Custard & diced

aple

Cheesecake (HP) Base only & ice-

cream/strawberry sauce

Apricot crumble & custard

Bread & Butter pudding (HP) & diced peaches

Creamed Rice (HP) & diced peaches


caramel custard

Berry & aple crumble &

custard

Tea dessert – smooth puree

Baked Egg Custard &

SP aple

Cheesecake (HP) Base only & ice-

cream/strawberry sauce

SP Apricot crumble &

custard

SP Bread & Butter pudding (HP) & SP

peaches

SP Creamed Rice (HP) & SP peaches


caramel custard

SP berry & aple crumble

& custard

Page 64

APENDIX 4 Minimum serve sizes used in modelling

SamplemenusweremodelledonsevendaysofintakeusingminimumservesizesasspecifiedinSection2p18–24.Thetablebelowoutlines examples of the types of items and quantities. For paediatrics modelling, the assumptions outline in Apendix 2 were also utilised i.e. half serves. Foragedcare,smallserves(75%ofstandardserve)werealsoutilisedtoreflectactualintake.

MEAL ITEM QUANTITY

Breakfast Cereal 20g

Milk 100mL

Yoghurt 100g

Juice 100mL

Bread 2 slices

Margarine 2 x 7g

Jam 2 x 7g

Sugar 1 x 5g

Morning Tea Cheese 15g

Savoury biscuit 3 biscuits

Lunch Soup (powder) 160mL

Sandwich(proteinfilling>8g) 4 points

Side salad 140g

Custard 100mL

Tinned fruit 80g

Afternoon tea ½ sandwich 2 points

Tea 150mL

MEAL ITEM QUANTITY

Dinner Meat 100g

Vegetables 3 x 75g

Bread 1 slice

Margarine 1 x 7g

Fresh fruit 100g

Super Milk 150mL

Sweet biscuits 2 biscuits

Documents

Queensland Health Nutrition Standards for Meals and Menus · The health outcomes and experience of those in our care can be improved with quality meals and good nutrition. The Queensland