<p> SUBJECT: OFFERING SUBSTITUTES FOR FOOD REFUSALS</p><p>POLICY: When a patient/resident refuses to eat food served, a substitute of similar nutritional value is offered.</p><p>DATE EFFECTIVE: ______DATE REVISED: ______DATE REVIEWED: Annually APPROVED BY: ______ISSUING DEPARTMENT: Nutritional Services APPROVED FOR USE IN: ______</p><p>PROCEDURE:</p><p>1. The Nutritional Services Department should keep an accurate list of patient’s/resident’s food preferences and dislikes. When disliked foods are on the menu, a substitute of similar nutritional value will be provided.</p><p>2. If a patient/resident receives an item he/she does not want or refuses to eat, the nursing staff contacts the Nutritional Services Department and an item of similar nutritive value will be sent. The patient/resident will be encouraged to give input for his/her choice of a substitute. </p><p>3. Food substitutions will be provided within a reasonable time of determining the patient or resident’s wishes. </p><p>4. All efforts will be made to serve the menu as posted. If a substitution must be made, then a food item of similar nutritional value will be used. </p><p>5. A substitute should be offered any time that a patient/resident consumes less than 75% of their meal and/or less than 50% of an individual food item. A standard Menu Substitutions List such as the following should be developed and posted: </p><p>When Patient/Resident Consumes <50% of: Offer: Entrée/Meat 2-3 oz. Alternate meat or entrée item 1/2 c. cottage cheese 2 oz. cheese 2 cooked eggs or 1/2 c. egg substitute Sandwich with 2 oz. meat, cheese or peanut butter Milk 8 fl. oz. 1 c. yogurt 1-1/2 oz. cheese 1 c. chocolate milk 1 c. pudding or custard Dessert Alternate menu dessert (if diet allows) 1 serving of fruit (fresh, frozen, canned) 1/2 c. ice cream, sherbet, sorbet, frozen yogurt or pudding. If above choices are refused, facility may offer: 6-8 oz. commercial milkshake 4-5 oz. high protein pudding Other supplement of choice</p><p>Adapted with permission from Policy & Procedure Manual, Becky Dorner & Associates, Inc. 2005.</p>