Collection of Meal Intake Data (food and fluid)



Overview and Instructions

for Meal Food and Fluid Intake Estimation Method

Overview

The Food and Fluid Estimation Diagram (FFED) for estimating food and fluid intake at meals was developed specifically for, and validated in, the routine nursing home environment. Previously, the only validated meal intake estimation methods available were designed for occasional use in plate waste studies and/or have been validated with highly trained researchers or nutrition professionals making the estimates. (Validation studies for this the FFED have been submitted for publication in peer review journals).

The main advantages of the FFED system are the increased accuracy of food intake estimates and the availability of separate fluid intake estimates for meals.

Food and Fluid Estimation Diagram (FFED).

1. This meal intake estimation method requires that a pre-printed Food and Fluid Estimation Diagram (FFED), ~ 1/3 of an 8½ X 11 sheet of paper, is delivered with each resident meal (See Appendix A for both breakfast and lunch/dinner meal FFEDs). This pre-printed FFED can be delivered with resident meals any number of ways, for example:

a. The FFED can pre-printed on the back of computer-generated resident meal tickets which are placed on resident trays at the beginning of tray line;

i. Perforated 8½X 11 paper (perforated into thirds) can be purchased from Sysco and pre-printed on one side with the FFED. This paper can then be used in a conventional desk jet or laser printer to print the resident’s “meal ticket” on the other side.

b. The FFED can be placed on the resident tray in combination with a laminated tray card or other usual tray identification method;

c. The FFED can be placed next to each resident’s meal when it is served.

Estimation of Intake Using the FFED.

2. After the resident has completed his/her meal, but before the dishes have been cleared, the responsible staff member marks the FFED with the amount consumed of each food item. It is imperative that this recording be done while the tray is in clear view of the estimator, i.e. not from memory (See Instructions for Marking the FFED, below).

a. Staff should initial the completed FFED.

b. The resident name, meal and date should be recorded if the FFED is not pre-printed with this information.

c. The staff member who is responsible for this may vary between facilities or between dining areas in a given facility. Likely staff includes: CNAs, nurses, food and hydration aides, volunteers and dining room facilitators.

Collection of Completed FFEDs.

3. Completed FFEDs need to be collected shortly after each meal. This can be accomplished a number of ways, including:

a. several strategically located “drop boxes,” e.g. the dining area, nursing station, or TV room;

b. a staff member/dining facilitator that is responsible for collecting FFEDs and checking for completeness;

c. “drop boxes” on the tray carts which are subsequently emptied into a bin in the dish room.

4. Staff who will be completing the tallying and trending may find it most efficient to organize completed FFEDs alphabetically or by room number after each meal. Alternatively, FFEDs from all 3 meals may be organized at one time on the following day.

5. Completed FFEDs for all 3 meals of a given day should be placed in a common location for tallying and trending to occur the next day.

Tallying and Trending the FFED

6. The staff member designated to complete the tallying and trending should work in a quiet location where papers can be spread out. Materials required include:

a. An inexpensive scientific calculator with “statistics functions;”

b. Previous day’s completed FFEDs;

c. Binder (s) of Food and Fluid Intake Tracking forms for each unit (Appendix B).

7. FFEDs should be organized alphabetically or by room number.

a. Inexpensive “sorters/alphabetizers” can be purchased from office supply stores for this purpose.

8. All the FFEDs from an individual resident should be laid out on the workspace for tallying.

a. The calculator with “statistics functions” should be used to calculate the % of food consumed for the entire day previous (See Instructions for Calculating and Trending Meal Food and Fluid Intake, below).

i. This value should be rounded to the nearest 10% and graphed on the respective resident’s Food and Fluid Intake Tracking form (Appendix B).

b. The calculator should then be used to total (add) the fluid consumed during meals for the entire day previous.

i. This value should also be graphed on the respective resident’s Food and Fluid Intake Tracking form. (See Instructions for Calculating and Trending Meal Food and Fluid Intake).

c. Repeat process with remaining residents

Calorie Counts.

9. When a physician has ordered a “Calorie Count,” the FFEDs for that resident can be set aside for the DTR, RD or Diet Clerk to evaluate further.

a. The “Exchange System” can be applied very easily to the FFED to determine, kcal, carbohydrates and protein intake.

Meal/Food Consumption Assessment.

10. When a resident is not consuming enough food to maintain his/her body weight, it is often useful for the RD/DTR to evaluate the resident’s usual meal/food intake pattern. For this purpose, the FFEDs for particular residents can be provided on request for more thorough evaluation by nutrition staff.

Discard FFEDs after Tallying and Recording.

11. After all of the previous day’s FFEDs have been tallied and recorded, they may be discarded.

Instructions for Marking the Food and Fluid Estimation Diagram (FFED)

1. Remove the resident’s Food and Fluid Estimation Diagram (FFED) (Appendix A) from the meal tray and place in a safe area in front of the resident’s meal while he/she is eating.

2. After resident has finished eating, retrieve the FFED for recording of meal intake. If the resident’s name and the date are not pre-printed on the FFED, record this information at this time.

3. While the tray is in view, fill out the FFED.

4. Carefully view the food items to see what was served and what was eaten. Starting with the upper left-hand side of the FFED, determine if the food item was served. If it was served, mark an X on the picture that represents how much of that food item was eaten by the resident.

a. For example, if toast was served for breakfast and the resident ate ¼ of a slice, mark an X on the picture of the toast on the breakfast ticket that represents 25% eaten.

b. If the item was not served, draw a line through the name of that item.

c. If the item was served but given to another resident, mark the picture representing “Ate None” on the estimation sheet.

5. Continue down the FFED for all food items listed.

a. If an item is served but is not on the FFED, write the food item in the “Misc.” section and mark X in the box under the appropriate amount eaten.

b. At lunch/dinner write in any supplements served under “Misc.”

6. Mark the amount consumed of each of the fluids on the right side of the FFED.

a. Lift drinks, if necessary, to determine how much fluid remains unconsumed.

b. Mark all beverages, even those without calories.

7. Once all food and fluid items on the resident tray are evaluated, initial the FFED and deposit in the manner designated in your facility.

Instructions for Calculating and Trending Meal Food

and Fluid Intake

1. Locate all 3 FFEDs for a given resident from the previous day before calculating total percentage of food eaten for that day (or fewer, if FFEDs are not available for all three meals).

a. Materials:

i. Calculator with “statistics functions”

ii. Binder (s) of resident’s Food and Fluid Intake Tracking forms (Appendix B) for each unit being tallied

iii. Pen

Calculation of % of Meals Eaten

2. Calculate the % of food eaten for the entire day:

a. Turn on the calculator by pressing the “on” button.

b. One at a time, enter the % eaten for each of the caloric food or drink items served at breakfast, lunch and dinner.

i. Enter the % eaten of the first item served and then press the “(+“ (Big E) key (for example, 25 (+).

1. You should see “n = 1” appear in the window, which means you have entered the value for one item

ii. Enter in the value for next meal item and again hit the “ (+“ (Big E) key.

1. You should see “n = 2”, “n = 3”, etc. appear in the window as you enter the remaining items.

iii. Enter the values for the food items down the left side of the FFED, but skip the items with a line drawn through them as they were not served during this meal.

iv. Continue entering the fluid items, except for coffee, tea and water, or any other items that don’t have any calories.

v. Once all the calorie-containing items from breakfast, lunch and dinner have been entered, you need have the calculator determine the average, or “mean” of all of the items.

1. This calculation will usually be indicated by an” X” on the calculator. If the “X” is printed above a button instead of on the button itself, you will need to hit the “2nd” key first and then the key directly below the “X “ symbol.

2. The value you see is the average of all of the food items served.

Graphing of % of Meals Eaten

3. Find resident’s Food and Fluid Intake Tracking form for the current resident.

4. Round the average intake to the nearest 10%.

a. If the second number is less than 5, round down. If the second number is 5 or greater, round up.

5. Mark the rounded % of food eaten on the resident’s Food and Fluid Intake Tracking form.

a. If all 3 FFEDs were available for the calculation, mark a ( (dot) on the graph corresponding for the % intake on that day.

b. If there were fewer than 3 FFEDs used in the calculation, mark either a “2” or a “1” (corresponding the number of meals) instead of a ( on the graph to indicate the % intake on that day.

c. Initial the bottom on the appropriate date (date the FFEDs were completed).

Calculation of cc of Fluid Consumed

6. Use the calculator to add the fluid numbers of all marked fluid items (breakfast, lunch and dinner).

a. Fluid items are easily identified as they are on the right side of the FFED and have small numbers printed in the boxes.

b. Enter the number in the marked box of the first fluid item and hit “+.”

c. One by one, enter the values for each fluid consumed followed by the “+.”

d. After all of the values have been entered, hit the “=.”

Graphing of cc of Fluid Consumed

7. Mark the final value for cc of fluid consumed on the resident’s Food and Fluid Intake Tracking form.

a. The graph for fluids consumed at meals is located above the area that % meal intake was recorded.

b. If all 3 FFEDs were available for the calculation, mark a ( (dot) on the graph corresponding with total fluid consumed (1000cc, 1400cc, etc.) on that day.

c. If there were fewer than 3 FFEDs used in the calculation, mark either a “2” or a “1” (corresponding the number of meals) instead of a ( on the graph to indicate the fluids consumed with meals that day.

Resetting Calculator for Subsequent Calculations

8. Before you move on to the calculations for the next resident, you must “reset” the calculator by turning it “OFF” and then back “ON.”

a. If you do not turn the calculator “OFF” between residents, the calculator will think you are still entering numbers for the previous resident.

i. If the window shows anything except “n=1” when you start entering the numbers for a new resident, you forgot to turn the calculator off between residents. Turn the calculator off and start again with the calculations for the current resident.

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