Title: IDENTIFICATION OF RD ORDER WRITING PRACTICES INNEW JERSEY: AN ASSESSMENT OF CURRENT PRACTICE ANDFUTURE NEEDS

Author(s): R. A. Brody, L. Byham-Gray; Graduate Programs inClinical Nutrition - School of Health Related Professions, Universityof Medicine and Dentistry of New Jersey, Newark, NJ

Learning Outcome: To explore nutrition order writing practices ofRDs in New Jersey acute and long-term care facilities.

Text: According to state regulations in New Jersey (NJ), theRegistered Dietitian (RD) can recommend diet and feeding regimensto physicians but cannot write diet orders; only a licensed physicianis permitted to order diets and supplements. This project sought toassess RD order writing practices and to ascertain perceived barriersfor obtaining order writing privileges. A survey was sent viaelectronic mail in March 2006 to a convenience sample of 44NJ Clinical Nutrition Managers (CNMs). Twenty-four (54.5%) of theCNMs responded, representing primarily acute care facilities (n�22,92%) from throughout NJ. Ninety-six percent (n�23) of therespondents reported that RDs in their facilities are not permitted towrite orders in the medical record, independent of a physician.Verbal and telephone orders were accepted by RDs in 42% (n�10)and 54% (n�13) of facilities, respectively. Seventy-five percent (n�18)of respondents reported that RDs in their facilities can addcommercial supplements or modulars to patient trays without aphysician order; only 11% (n�2) write the supplement order in themedical record. Diet/feeding protocols are used in 46% (n�11) offacilities. Twenty-nine percent (n�7) of CNMs have attempted toobtain nutrition order writing privileges for RDs. Perceived barriersto achieving these privileges include lack of facility and physiciansupport, staffing shortages, staff with entry level competencies, stateregulations, and lack of licensure. RDs in NJ have limited autonomyin implementing nutrition care plans. Documentation of outcomes tojustify policy changes is crucial to shifting order writing practices inNJ.

Funding Disclosure: None

Title: THE INTRODUCTION OF A DONATED BREAST MILKPROGRAM IN A PEDIATRIC HEALTHCARE SETTING

Author(s): S. K. Kinzler; Nutrition, Children’s Hospital ofPhiladelphia, Philadelphia, PA

Learning Outcome: To teach the benefits of developing a DonatedBreast Milk Program and its process implementation into a PediatricFormulary Program

Text: It has been well documented that premature infants benefit fromhuman milk’s rich nutrients and disease fighting protection for optimalnutrition. Donated Breast Milk is an option when the baby’s mother isunable or unwilling to provide her own milk. In October 2006, TheChildren’s Hospital of Philadelphia (CHOP) implemented a DonatedBreast Milk program to positively impact the health and nutrition ofthese patients. Adding Donated Breast Milk into a formulary requiresunique program planning. Implementation included training of theFormula Technicians. Key learning strategies included review of thebenefit of Donated Breast Milk. A site visit to the supplier-a localMother’s Milk Bank was a valuable step for staff to understand howBreast Milk is pasteurized and processed. A new pass throughrefrigerator and freezer was added for access from storage to productionfor the Donated Breast Milk. A fluorescent green label was developed foridentification by healthcare staff. Procedures were added to receive,record batch/lot, expiration and patient receipt. Hazardous Analysis ofCritical Control Points of the process flow was assessed for food safety.Quality Control measures include routine monitoring of logs, labelingand observation of program practices. Trending Patient/Volume usage isreported through Hospital channels. Staff competency has beenmonitored against the training objectives. A multidisciplinary teamconducts unannounced audits for the Formulary program standardsincluding Donated Breast Milk procedure compliance. On-going reviewfor process improvement continues as this key program becomes acritical part of the pediatric formulary and optimizes nutrition topatients at CHOP.

Funding Disclosure: ARAMARK Corporation

Title: INSTITUTIONAL FOODSERVICE BENCHMARKING: SURVEYOF ADMINISTRATORS’ ATTITUDES AND CURRENT PRACTICES

Author(s): S. N. Bright,1 J. Kwon,2 C. Bednar,2 J. Newcomer3; 1FoodProduction and Service, Wilford Hall Medical Center, San Antonio, TX,2Nutrition and Food Sciences, Texas Woman’s University, Denton, TX,3School of Management, Texas Woman’s University, Denton, TX

Learning Outcome: The participant will be able to identify currentbenchmarking practices by institutional foodservice administrators andbarriers to benchmarking.

Text: Benchmarking is an ongoing process that gathers information toevaluate best practices and improve performance. Despite possiblechanges and benefits, research reporting current foodservicebenchmarking is limited. A nationwide survey of foodserviceadministrators was conducted to determine current practices andadministrators’ attitudes toward benchmarking. A questionnaire wasdeveloped to include demographic information, attitudes towardbenchmarking, and current benchmarking practices, validated by anexpert panel, and pilot-tested prior to data collection. A random sample of600 foodservice administrators from healthcare, school, correctional, anduniversity facilities received questionnaires, and 121 provided usable data.Results revealed that performance measures used most often were foodcost percentage (n�102, 84%), labor cost percentage (n�86, 71%), andpercent customer satisfaction with service (n�66, 55%). Over half ofrespondents agreed that benchmarking was important in performing theirjobs (61%); however, fewer (48%) reported their knowledge level aboutbenchmarking as above average. Forty-one percent indicated that theyneeded training on how to collaborate with benchmarking partners, and amajority preferred professional association meetings (70%) and internetbased training (69%) as training methods. Over time, the knowledge andperceived importance of benchmarking did not change, and foodserviceadministrators who reported lower knowledge levels about benchmarkingdid not perceive a need for more benchmarking knowledge. Other projectstaking priority, low confidence in the accuracy of other people’s data, andthe lack of trained personnel were found to be the top three perceivedbarriers to using benchmarking. Results of this study suggest a trainingopportunity for foodservice administrators on benchmarking.

Funding Disclosure: None

Title: FORMULA ORDER CLARIFICATION PROJECT: AMULTIDISCIPLINARY APPROACH

Author(s): C. A. Conkin,1 T. L. Whaley,1 P. A. Ahern,1 L. T. Reding,2

T. L. Soccier3; 1Food and Nutrition Services, Texas Children’sHospital, Houston, TX, 2Nursing, Texas Children’s Hospital, Houston,TX, 3Pharmacy, Texas Children’s Hospital, Houston, TX

Learning Outcome: Learner will be able to identify steps needed tosuccessfully implement a multidisciplinary process to increaseformula order accuracy: team development, process review, formdesign, staff education and metrics.

Text: Enteral, formula and breastmilk orders can become complex asproducts are modified to meet specific patient needs. When formulaorders were reviewed, it was found that 41% were unclear. These ordersrequired follow-up calls by the formula room for clarification due toincomplete information or question regarding the transcription of thephysician order into the electronic order system. When the process forformula orders, production and delivery was analyzed, it was evidentthat a system approach to formula orders was needed. Amultidisciplinary team including representatives from Food andNutrition, Nursing, Pharmacy, Information Services, Lactation Supportand physicians was formed to improve the clarity of the physician orderand transcription accuracy into the electronic order system. A physicianorder form was developed that incorporated all infant, breastmilk andenteral formula information in one place. It more closely mirrored theelectronic order system, allowed for modifications of products includingpharmacy additives, standardized units for ordering calorie levels andmodular components and provided all nursing administrationinstructions. A process for use of the form on all initial and modifiedorders was also developed. The form was piloted in the critical careareas followed by hospital wide implementation. Order form compliancewith the physicians was 90%. Use of the form demonstrated a reductionof orders needing clarification from 41% to 3.1%. Transcription accuracyimproved by 33%. A user survey also found 86% of staff reported theybelieved the form improved patient safety. Additional benefits includedeasier reconciliation of orders and order changes.

Funding Disclosure: None

MONDAY, OCTOBER 1

POSTER SESSION: SCIENCE/EDUCATION/MANAGEMENT/FOODSERVICE/CULINARY/RESEARCH

A-70 / August 2007 Suppl 3—Abstracts Volume 107 Number 8