1. Theme Meal: St. Patrick’s Day
Allison Kliewer
Baptist Health System Dietetic Internship
With
Texas Center for Infectious Disease
March 6, 2013

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Theme Meal Part One
The role as a director of dietary services is just one of the many roles that dietitians play.
According to the Academy of Nutrition and Dietetics a qualified dietitian must be utilized by
long term care facilities to plan, manage, and implement dietary service activities in order to
ensure that the residents receive adequate nutrition (2013). The dietitian must have training
and experience in budgeting and purchasing of food supplies, and in supervising institutional
food preparation, service and storage (2013). Long term care facilities must also have sufficient
dietary support personnel and sufficient staff preparation; there must be enough staff to
prepare and serve palatable, attractive, nutritionally adequate meals at proper temperatures
and times to support proper sanitary techniques being utilized (2013). To serve a theme meal, a
dietitian must be involved in all components of dietary service to ensure all guidelines and
policies are being followed, to evaluate the success of the meal, and to determine what can be
done to improve the quality and service.
The Texas Center for Infectious Disease (TCID) is a long term care facility with a unique
patient population. The patients suffer from tuberculosis (TB) and most have a drug resistant
form of TB. Many of the patients also suffer from psychiatric issues and substance abuse. Due
to their medical condition upon admittance, many patients stay at TCID for many months or
possibly years before they are healthy enough to be released. Therefore, to occupy time,
educate, and prepare the patients to be able to live on their own (without state support), the
patients have access to various activities while at TCID.

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Most of the patients admitted are malnourished and very underweight due to the
physiological effect TB has on the body. Nutrition and diet is very important for the patients so
that they may gain weight and recover from their disease/diseases. Dietary service plays a large
role on the patient’s recovery, furthermore, the patient’s interest in the food adds to their
timely recovery. Dietary services should meet and aim to exceed patient expectations to better
the food environment and food relationship for the patient.
The theme meal lunch provided traditional Irish menu options with the following
nutrient profiles (Table 1). The corned beef is not the healthiest item, however, it was decided
with the registered dietitian that the beef would be an item the patients had never been served
while at this facility. Initially a lamb stew was chosen as the main entrée. However, lamb was
the entrée for the previous theme meal and was found to be costly. Therefore, corned beef was
chosen to offer variety at a lower cost to the facility.

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Table 1
Theme meal Nutrient Analysis
Serving
Size
Total
Calories
Total
Fat
Saturated
Fat
Cholesterol Carbohydrates Protein Sodium Fiber
Mustard Glazed Corned
Beef
198 g 438 27 g 8.6 g 189 mg 13 g 23 g 846 mg 0 g
Red Potato Colcannon
1 cup 182 4 g 2 g 11 mg 31 g 6 g 653 mg 5 g
Fighting Green Irish
Salad 2 cups 113 7 g 1 g 0 mg 10 g 3 g 152 mg 3 g
Brown Soda Bread
1 slice 169 1.9 g 0.9 g 6 mg 32.4 g 6.2 g 355 mg 3 g
Lucky Apple Crumble
½ cup 264 5 g 0 g 0 mg 56 g 3 g 75 mg 3 g
Silver Oaks Communications. (2009). Nutrition Calc Plus 3.2. The McGraw Hill Companies.

5. To excite and involve the patients for the theme meal, flyers were posted around the
hospital in high traffic areas so that the patients and staff could read and plan for the meal. The
time, date, theme, and courses being served were included on the flyers. Furthermore, the
recreation director was contacted for participation in the theme meal. Ideas of crafts and
activities were provided for the recreation team so that the patients could participate in
activities specifically related to the theme meal. Marketing plays a role in any promotion. Bingo,
arts and crafts, and trivia were used for the theme meal marketing. The promotional material,
consumer survey, arts and crafts completed by the patients, and the meal can be viewed in
Appendix I.
The state facility receives budgeted funds every day for 72 people. The rate per person,
per day is $5.87 daily for all three meals. Breakfast cost $1.87 per meal, leaving $2.00 for lunch,
and $2.00 for dinner each day. Staff is allowed to purchase meals at $3.25 per meal, which is
recorded as profit. Although TCID is given money to provide for 72 patients, there are currently
only 44 patients at the hospital receiving meals from the cafeteria. Therefore, there is a cushion
for the cost of meals. The theme meal is given $144.00 (72 pt x $2.00) by the state and has
been made to serve 50 people; allowing $2.88 for each theme meal tray.
Texas Center for Infectious Disease is unique in many ways, for example, the kitchen
often purchases food from venues that are not in their contract such as HEB. This is due to the
fact that many of the patients are from other countries and request food items that are not
standard ordered items. Many patients are underweight, and weight maintenance and gain are
important to the treatment of the patients: TCID works to provide the patients with their

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individual requests. Based on the monthly food service report from February, 2013, the facility
spent $1655.86 on food items purchased from HEB. Therefore, over ten percent of total food
cost is not on contract, which in turn raises the transportation cost of food because of the
numerous trips to HEB. The facility also has a total cost of $334.59 in stored food items,
including frozen, USDA, and dry storage (February, 2013). There were items required in the
theme meal that were not on contract with the facility and had to be picked up from HEB.
The total cost of the meal is based on the amount of product used and can be seen in
Table 2 along with the ingredient list, standardized amount needed, and amount purchased.
The recipes were standardized to fit the facility using Food for Fifty with the help of the head
cook. Pricing for the theme meal was solely based on food cost. Pricing excluded labor,
transportation, and inventory. The meal was estimated to have a food cost percentage of 163%
based on 50 meals served, 20 were staff meals at $3.25 and 30 were patient meals at the state
budgeted $2.00.

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Table 2
Theme Meal Cost Analysis
Ingredient Amount Needed
for Recipe
Standardized
Amount
Amount
Purchased
Cost of
Purchased Items
Total
Food Cost
All Purpose Flour 13 1/2 cup 7 lbs 50 lb bag 13.74 1.92
Whole Wheat Flour 10 cup 5 lbs 5 lb bag 2.98 2.98
Baking Soda 7 1/2 tsp 0.09 lbs
1 case (12 x 2
lb bags) 14.43 0.05
Salt 21 tsp 0.26 lbs 25 lb bag 3.77 0.04
Buttermilk 10 cup 0.6 gallon 2 half gallons 2.15 1.29
Small Red Potatoes 13 lbs 13 lbs 50 lb bag 22 5.72
Butter 2 sticks, 16 Tbls 0.5 lbs 30 lb case 74.85 1.25
Onions, Sliced 6 1/2 cup 3.4 lbs 50 lb bag 15 1.02
Cabbage 7 heads 7 heads 7 heads 1.5 1.50
low fat Milk 13 cups 6.5 pints 7x ½ pint 1.4 1.30
white Pepper 3 1/4 tsp 0.5 oz 1 BLT (4 oz) 2.58 0.32
Lemons 8 each 1 box 1 box 22.5 22.50
Lemon Juice 1 1/2 cup 0.37 quarts 1 quart 2.47 0.91
Canola Oil 15 1/2 cup .97 gallon 1 gallon 3.99 38.70
Sugar 6 tsp 0.08 lbs 50 lb bag 26.52 0.04
Pepper 1 1/2 tsp 0.02 lbs 4.25 lbs 24.31 0.11
Boston or Bibb Lettuce 12 heads 12 heads 1 case (24 ct) 26 13.00
Asparagus
12 cup (6
bunches) 6 bunches 6 bunches 2.98 2.98
Peas, Shelled 12 cups 6.25 lbs 20 lbs 13.9 4.34
Grape or Cherry
Tomatoes 6 pints 6 pints 6 pints 1.88 1.88
Light Brown Sugar 10 1/2 cup 5.5 lbs
1 case (12 x 2
lb bags) 26.13 5.99
Brown Mustard 12 oz 12 oz 1 each (12 oz) 5.4 64.80
Corned Beef (Beef brisket,
32 lbs) 26.62 lbs 26.62 lbs 4.25 per lb 4.25 4.25
Oats (42 OZ) 7 cup 56 oz
1 case (12 x
42 oz bags) 29.49 3.28
Ground Cinnamon 10 1/2 tsp 0.13 lbs 1 lb 4.42 0.57
Apple Juice Concentrate,
Frozen 12 oz 12 oz
1 can (12 fl
oz) 0.97 0.97
Apples, peeled, cored,
thickly sliced 42 cups 70 each
1 case (125
ct) 38.5 21.56
Total 388.11 203.29

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Theme Meal Part Two
The theme meal was chosen for Thursday March 14, 2013 in celebration of St. Patrick’s
Day. The theme was to bring cultural awareness to the patients by celebrating a familiar
holiday. Traditional Irish food was the focus of the menu along with healthy cooking styles and
ingredients. The meal included red potato colcannon, fighting green Irish salad, brown soda
bread, lucky apple crumble, and mustard glazed corned beef. The beef chosen is not the
healthiest cut of meat, however, after communication with the facilities preceptor, corned beef
was chosen for the purpose of can cutting, and to offer the patients a meat that had not been
previously available.
Production was planned to serve 50 trays. The soda bread was made in four loaves and
cut into 12 diagonal slices, producing only 48 slices. The other menu items produced enough for
50 trays. The fighting green Irish salad ran out at 12:50 pm, ten minutes before lunch was over.
The servings, leftovers, and what was done with the food after the meal can be seen in Table 3.
Table 3
Production Analysis
Servings Made Servings Left
Over
Action
Mustard Glazed Corned Beef 50 12 Save and offer at dinner
Red Potato Colcannon 50 3-4 Throw out
Fighting Green Irish Salad 50 0 Ran out at 12:50 pm
Brown Soda Bread 48 6 Save and offer at dinner
Lucky Apple Crumble 50 20 Save and offer at dinner

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The amount of meals served was 46, showing that a meal for 50 is adequate. The
amount of food leftover was predicted as the amount is common for this facility. The salad
proved to be liked by the consumers due to the fact that the salad ran out. The apple crumble
had the most leftover, but this can be due to the fact that the consumers had three different
dessert options to choose from. It is important to note that the administration staff was sent
home early, before lunch, due to a maintenance issue. Therefore, there could have easily been
over 50 trays served had they been there. The average trays served in the TCID facility is 50 for
lunch, however, due to the popularity and success of the previous Navajo theme meal, the staff
and patients might have been looking forward to another theme meal so that the turnout was
still good at 46 trays.
The planned budget was less than $400 total for the theme meal. This is over twice as
much as what is given for a lunch meal by the state ($144). The budget is not strictly controlled
due to the fact that the cafeteria is receiving more money from the state than what they are
using on the patients. As discussed earlier, the facility receives money to provide for 72
patients, while there are only 44 patients in the hospital at this time. Therefore, the theme
meal was allowed to exceed the $144 budget. The actual food cost was $203.29 going over the
state allotment by $59.29, but under the facilities budget by $196.71. The forecasted food cost
percentage was 163 percent and the actual food cost percentage was 177 percent. This is
because there were only 46 trays served during the meal instead of 50 that was estimated.
There were 18 staff trays, out of the 46 trays, served at $3.25 providing a $58.50 profit.
However, the profit difference did not make up for the total cost of food, and the meal cost the
facility $88.79.

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A questionnaire was developed to target the consumer population. The purpose of the
survey was to assess how the consumers perceived the meal and meal service. The survey was
based on an agreement scale (A= agree, D= disagree, NE= neither agree nor disagree, N/A= not
applicable). The rating scales included neither agree/disagree and not applicable so that the
consumer did not feel pressured into an answer. Compared to other scale surveys, the
agreement scale is more difficult and requires the surveyor to completely understand the
statement being rated. The survey developed had seven statements for the consumer to rate
and an open-ended option so that comments about the meal experience could be left. As
discussed with the facility’s preceptor, the survey might be a little difficult for the patients, but
it was agreed that a challenge would be beneficial to the patient population. In other TCID
activities, the patients are encouraged to practice their English and written communication
skills, so the survey was concluded to be appropriate. The survey was personally handed to
each consumer after the consumer sat down. The consumer was encouraged to take the survey
on their own time and told that there are no right or wrong answers. The surveys were picked
up when finished as indicated by the consumer.
The results from the consumer survey can be seen in Table 4. There were a total of 37
(80%) surveys completed. There were approximately six people (loose estimate, based solely on
observations) who took the meal tray to-go and did not receive a survey. Two surveys left a
question blank; therefore, those questions were adjusted for 36 total surveys.

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Table 4
Survey Results
A D NE N/A
The foodservice staff appeared professional 35(94%) 0 2(5%) 0
The food was at the proper temperature (whether hot or
cold) when served
34(92%) 0 3(8%) 0
The foodservice staff were polite and responded to any
questions I had
37(100%) 0 0 0
Foods on the serving line appeared attractive 32(89%) 1(3%) 3(8%) 0
The quality of ingredients meets my expectations 31(86%) 0 4(11%) 1(3%)
The flavor of the food meets my expectations 33(89%) 0 3(8%) 1(3%)
I would like to have this meal again 31(84%) 2(5%) 3(8%) 1(3%)
Results displayed as n(%); number of consumers with percent of total in parenthesis.
Of the 37 completed surveys, 27 agreed to every statement on the survey, while eight
answered differently, and two left a question blank. There were eight comments left for those
who agreed to all seven questionnaire statements. The statements are listed below:
Improve tea; too much water
Tea too watery
Soup is great
String beans need more flavor
Fun menu today, thank you. Soda bread, pea salad and beef were all very good
I’d like to come again
I appreciated the effort that goes into having meals and different foods. Thanks
Good survey. Good food, real good job with temperatures, and always good flavor
The consumers were not limited to the theme meal menu options and other options

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were available. The first four statements listed do not apply to the theme meal, rather to the
facility as they are about regular food items and the beverage. The last four statements do
apply and reveal an appreciation of the meal. There were four comments left from those whom
did not agree to all seven of the questionnaire statements or who left a statement blank. The
statements are listed below:
Maybe a little more spices, but that’s my opinion
Liked the salad with asparagus, meat was great/tender
Uniforms would make professional
Cook the asparagus longer, and then chill. It was tough.
There were three comments left from the ten that did not agree to every statement. The
first statement listed was from a survey that agreed to all, but left one question blank and
therefore, was not included with the other agree surveys.
Seventy-three percent of those who took the survey agreed to all questionnaire statements
and therefore, agreed that the foodservice staff appeared professional, the food was at the
proper temperature, staff was polite, foods were attractive, ingredients met expectations,
flavor met expectations, and they would like to have the St. Patrick’s Day meal again. The
question that had the lowest amount of agree ratings was the statement that the consumers
would want the meal again (n= 31). This shows that Irish food might not be accepted as well as
other food items. This could be due to the lack of exposure, or simply that this population does
not enjoy typical Irish food.
The theme meal went as planned with no surprises or mishaps. The staff working at the
TCID facility was very helpful and greatly contributed to the success of the meal. I personally did

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not enjoy much of the meal with the exception of the salad. However, the asparagus was not
cut as thin as the recipe suggested, and therefore was a bit tough to eat. Also, the salad bar was
not large enough to hold the theme salad and was placed on a table rather than ice. I would
have liked to have the asparagus thinly cut and the salad served on ice to maintain proper cold
temperatures.

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References
Academy of Nutrition and Dietetics Quality Management Committee. (2013). Academy of
Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and
Standards of Professional Performance for Registered Dietitians. Journal of the Academy
of Nutrition and Dietetics. In press.
Silver Oaks Communications. (2009). Nutrition Calc Plus 3.2. The McGraw Hill Companies.
West, B., Shugart, G., & Wilson, M. (1979). Food for Fifty. 6th
ed. John Wiley & Sons. NY

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Appendix I

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oin us for lunch Thursday the 14th of March from
11:30 am to 1:00 pm to celebrate a St. Patrick's Day
meal in the TCID dining room. We will be serving
traditional St. Patrick's Day foods that we hope for
you to enjoy!
(Same standard price for staff!)
On the Menu:
ighting Irish Green Salad
ed Potato Colcannon
oda Bread
rown Sugar and Mustard Glazed Corned Beef
ucky Apple Crumble
J
F
R
S
B
L
For each petal on the shamrock
This brings a wish your way-
Good health, good luck, and happiness
For today and everyday

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Rate the following statements according to the scale by marking:
A= Agree D= Disagree NE= Neither Agree nor Disagree N/A= Not Applicable
Please list anything that would have made this meal and experience more favorable.
Thank you for your time and participation. “May your blessings outnumber the shamrocks that grow,
and may trouble avoid you wherever you go.” -Irish Blessing
A D NE N/A
The foodservice staff appeared professional
The food was at the proper temperature (whether hot or cold)
when served
The foodservice staff were polite and responded to any
questions I had
Foods on the serving line appeared attractive
The quality of ingredients meets my expectations
The flavor of the food meets my expectations
I would like to have this meal again

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