Spreading Guidelines

Menu Spreading Guidelines

1. PUREé puree recipes should be the primary puree recipe chosen, when applicable. 2. When spreading to a pureed diet, the following guidelines and concepts will be used: a. search a PUREé recipe that is similar to the regular menu item.

For example: baked chicken as regular recipe, use PUREé chicken #122362 3. In absence of a similar PUREé recipe, spread the regular menu item to the puree diet using the following category guidelines: starch, vegetable, fruit, mixed dishes, garnishes, and desserts. 4. Pureed portion amounts will follow portion size standards. 5. Menu spreads will indicate the following, but not limited to: a. Recipe b. Portion c. Utensil d. Instructions used for each individual portion. 6. When slurry foods are required, the slurried baked products recipe in this guide book and corresponding technique should be followed. A slurry is a soft, moist mixture often used for people with swallowing problems. The moisture of the liquid makes it easier for someone with swallowing problems to swallow soft bread products.

Starch

• Starch PUREé recipes available are: - PUREé rice, egg noodles (see spreadsheet for recipe #s) • When a PUREé recipe is not available, spread the regular recipe to the puree diet and notate, “PUREE” in the comments field. • Egg noodles are the preferred product for any pureed pasta foods. • For all rice lunch and dinner dishes, the PUREé Rice recipe #134600 is preferred. • Mashed potatoes are their own recipe and should be used for potato recipes – example: DO NOT puree any potato that has been baked, fried, roasted or have skin on potatoes, etc... • Portion sizes are the same as the regular recipe.

Vegetable

• Vegetable PUREé recipes available are: - Asparagus, carrots, green beans, peas, spinach, broccoli, yellow split pea, Brussel sprouts, rutabaga, etc... • If a PUREé recipe is not available, spread the regular recipe to the puree diet and in the notes section indicate “PUREE.” - NOTE: Pureed mixed vegetables are not acceptable. Do one of the following: • Choose one of the vegetables from the mix. For example: - if carrot is part of the mixed veg, use a PUREé carrot recipe, #122365, for the pureed diet OR puree them separately and plate a smaller portion of each vegetable - NEVER puree raw vegetables, for example: leaf lettuce - Portion sizes are the same as the regular recipe • NOTE: regarding residents on a renal diet – do not use mashed potatoes to thicken vegetables, use the Simply Puree recipes found in Webtrition instead.

Fruit

• The following Fruit PUREé recipes are available: - Fresh Fruit: Watermelon, cantaloupe, honeydew, pineapple - Canned: Mandarin orange, peach, and pear. - NOTE: Xanthum gum is used as the thickening agent in PUREé fruits. • If the regular menu item is not allowed on the pureed diet, substitute an appropriate menu item”. Choose a similar pureed canned fruit recipe that is as close to the regular recipe as possible. - Only certain fresh fruits may be pureed, (no seeded fruits) such as those available through PUREe program. Bananas are the exception. • Portion sizes are generally the same as the regular recipe, or 4oz • NOTE: Make sure the Community Specific Diet Addendums are updated to reflect the use of fresh fruits for purees.

Proteins & Casseroles (Mixed Dishes)

• The following PUREé protein recipes are available: - Beef, chicken, ham, pork, salmon, white fish, turkey, PUREé protein template. - NOTE: Cannelini beans and egg whites are used as the thickening agent for protein PUREé recipes. • If a PUREé recipe is not available, spread the regular menu item to the puree diet and notate, “puree using #134828” and then add the PUREé puree thickener recipe #134828 to the menu spread under thickener-texture modified. For example: if Beef Burgundy is the regular recipe, then spread the Beef Burgundy recipe to the pureed diet, then in the notes section indicate “puree using #134828”, and add PUREé puree thickener recipe under condiments. • Certain protein portions are 1oz greater than original core recipe to allow for comparable protein content to the original recipe. For example; if a chicken breast portion on a regular recipe is 3oz, we serve a 4oz portion for purees. • ALLERGEN NOTE: Residents with an egg allergy should not receive PUREe Entrée recipes due to the addition of egg whites. • NOTE: regarding residents on a renal diet or phosphorous restrictions, PUREé recipes should be avoided due to the beans used for thickening.

Garnishes

• The following PUREé protein recipes are available: - Beef, chicken, ham, pork, salmon, white fish, and turkey, PUREé protein template (see spreadsheet for recipe #s) - NOTE: Cannelini beans and egg whites are used as the thickening agent for protein PUREé recipes.

Desserts

• If a slurry or smoothie method is required for desserts, please utilize appropriate Webtrition recipes. - Common slurry recipes are: cakes, cookies, donuts, and muffins. - Common smoothie recipes are: pies, layered desserts, and parfait. • Common portion sizes are 4oz. • Obtain approval for the use of slurry recipes by SLP and access slurry recipes in Webtrition” When a slurry, smoothie, or similar puree recipe is not available, spread the regular recipe and indicate in the notes section, “PUREE”.

PUREé Level 4 IDDSI Description

APPEARANCE: No Lumps FORK TEST: Food sits in a mound on fork and does not drip or flow through fork. SPOON TILT TEST: Holds shape on spoon and slides off spoon. Puree needs to be able to be put in the mouth and swallowed whole. No chewing and no bolus formation skills should be needed. PUREE CONSISTENCY:

Slurried Baked Products

• Prep time is five minutes. • Total time is 45 minutes (based on product).

Item to Slurry

• Breakfast bread (biscuit) • Cake (without icing or nuts) • Muffin (without nuts, fruits, grains, or any item that cannot be softened by liquid) • Rolls (no whole grain items)

Slurry Mixture

Plating To Slurry

Holding

Note: Only baked goods without nuts, fruit, hard items or whole grains can be slurried.

Note: Allow for time so that the product is softened by the slurry liquid (allow at least 30 minutes).

Garnish

• All slurried items are best presented with a complimenting sauce such as vanilla custard or a strained fruit puree. • Breakfast items should be served with softened butter and fruit jelly. • Prepare the Thick & Easy using the directions on the package • Prepare to nectar consistency for liquid • The liquid used should be one of flavor (orange juice, apple juice, or simple syrup) • Simple syrup is sweetened water

• Place the slurried item on the plate which it will be served once dipped in the liquid for softening. • Method 1: Dip the item completely into the slurry liquid and plate for presentation. Allow to absorb for a minimum of 30 minutes. This depends on the fat content of the product being slurried. The higher the fat, the longer the soaking will take. • Method 2: (not recommended) you can pour the liquid over the item and allow to soak.

• Keep all slurried products moist. Mist spray the product as needed. • Place plates onto sheet pans and use cup to raise the plastic wrap so that it does not touch the food.