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Learning Guide
Food service quality
and nutrition
intervention audits
27456 Conduct food service quality audits and nutrition
intervention audits in an aged care, health, or disability
context
Name:
Workplace:
Issue 2.0
Level 3
8 credits
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Contents
Introduction .................................................................................................................................. 1
What is a food quality audit?........................................................................................................ 2
Audit tools................................................................................................................................. 3
The importance of food service quality audits ......................................................................... 4
The Ministry of Health’s Food and Nutrition Guidelines ............................................................. 6
Preparing to conduct an audit ...................................................................................................... 9
Knowing the purpose of an audit ............................................................................................. 9
Knowing the audit tool ........................................................................................................... 10
Organising the audit ............................................................................................................... 11
Explaining the purpose of the audit ....................................................................................... 11
Conducting a food quality service audit ..................................................................................... 12
Planned menus ....................................................................................................................... 12
Suitability for meeting the person’s needs ............................................................................ 15
Satisfaction ............................................................................................................................. 21
Food service quality in kitchens ............................................................................................. 22
Conducting a nutrition intervention audit ................................................................................. 23
Auditing therapeutic nutrition interventions ......................................................................... 23
Reporting back audit findings ................................................................................................. 27
Food service quality and nutrition intervention audits (US 27456) Learning Guide © Careerforce – Issue 2.0 | July 2015
Food service quality and nutrition intervention audits (US 27456) Learning Guide © Careerforce – Issue 2.0 | July 2015
Introduction
Many organisations provide meals to people who live in care. These
meals have to meet certain standards. You will learn how to conduct
audits for food to make sure they meet quality standards.
How to use your learning guide
This guide supports your learning and prepares you for the unit standard
assessment. The activities and scenarios should be used as a general
guide for learning.
This guide relates to the following unit standard:
 27456 Conduct food service quality audits and nutrition intervention
audits in an aged care, health, or disability context (level 3,
5 credits)
This guide is yours to keep. Make it your own by writing notes that help
you remember things, or where you need to find more information.
Follow the tips in the notes column.
You may use highlight pens to show important information and ideas,
and think about how this information applies to your work.
You might find it helpful to talk to colleagues or your supervisor.
Finish this learning guide before you start on the assessment.
What you will learn
This topic will help you to:
 understand food auditing for measuring quality and standards.

conduct a food service quality audit.

conduct a nutrition intervention audit.
Food service quality and nutrition intervention audits (US 27456) Learning Guide © Careerforce – Issue 2.0 | July 2015
1
What is a food quality audit?
An audit is a tool that is used to measure how well an organisation is
meeting its requirements for quality, standards or outcomes.
Many organisations are responsible for delivering meals to people who
live in care. These organisations have an obligation to provide meals that
meet certain standards. These standards come from two sources:
1 the organisation itself through its own policies and procedures.
2 external bodies such as the Ministry of Health.
These standards exist around:

food safety.

nutritional requirements, including special diets and therapeutic
interventions.

appropriate modifications to allow the meal to be easily consumed by
the person.

the consumer’s satisfaction with the food.
Food service quality audits determine how well an organisation is
meeting the required standards. These audits measure and provide
information on how well:

its own policies and procedures are being followed.

individual persons’ nutritional needs are being met based on:

the instructions from a dietitian.

the information in each person’s personal plan.

the Ministry of Health’s Food and Nutrition Guidelines.
Nutrition is key to maintaining a person’s function, energy levels, weight
and health. Having appetising meals that meet the person’s needs is
essential to ensuring that they receive appropriate and adequate
nutrition.
Audits are important for ensuring that people living in aged care or other
health contexts and people who require special diets and/or therapeutic
nutrition interventions receive meals that:

are safe.

look and taste appetising.

are physically able to be consumed (for example, appropriate texture
modification, correct feeding procedure).

meet their nutritional needs.

meet their cultural and religious needs.

cater to their personal preferences as appropriate.
Food service quality and nutrition intervention audits (US 27456) Learning Guide © Careerforce – Issue 2.0 | July 2015
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Audit tools
An audit is conducted with an audit tool. An audit tool identifies the
required standards to be met and allows you to record whether the
organisation’s practices meet those standards.
Audit tools can come in a range of structures and sizes. They may be
paper based or electronic. Audit tools usually consist of:

a set of questions and/or a checklist of key considerations or factors
that must be checked during the audit.

ratings or check boxes that allow the findings to be recorded. For
example:

present/not present.

compliant/not compliant.

meets standard/does not meet standard.

tick boxes to show an item is present or a process has been
completed.

a place for the auditor’s comments or notes.
With a paper based audit tool, the auditor carries the audit tool with
them. They will check and mark off each item in a systematic way. The
audit tool shows the areas that meet the required standards (are
compliant) and the areas that do not meet the standard (are
non-compliant).
An example audit tool is shown in the following diagram.
Source: New Zealand Dietetic Association: Menu Audit Tool for Aged Care
Facilities. Available from www.dietitians.org.nz
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The importance of food service quality audits
A food service quality audit is an audit of the provision of food services.
Food service includes all aspect of meal provision, such as:

menu planning.

food storage and preparation.

serving of meals.

safety and hygiene.

space and equipment requirements.

food presentation (where appropriate).

the consumer’s satisfaction with the food.
Food service quality audits are important because they help an
organisation to be confident that it is meeting its obligations to provide
people with appetising meals that meet their nutritional and personal
needs. Audits do this by giving an organisation assurance that it is:

operating with sound food safety principles and practices.

reducing risk associated with the transport, storage, preparation and
consumption of food.

improving and/or maintaining each person’s nutrition.
Audits are also important because they help an organisation to improve
the way it delivers food services. An audit may identify areas where the
organisation’s policies and procedures:

are working well.

are not being followed.

could be improved.
This is valuable information. The organisation can take the appropriate
corrective action to improve its performance. In this way, audits have an
important part to play in improving food service quality.
Food service quality and nutrition intervention audits (US 27456) Learning Guide © Careerforce – Issue 2.0 | July 2015
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Write
What food service audit tools does your workplace use?
List the audit tools used in your workplace here. You may like to attach
a copy to this learning guide to refer to.
Describe the purpose of two of these audit tools.
1
2
What areas are they used in?
1
2
What people are they used with?
Food service quality and nutrition intervention audits (US 27456) Learning Guide © Careerforce – Issue 2.0 | July 2015
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The Ministry of Health’s Food and
Nutrition Guidelines
The Ministry of Health has produced guidelines that identify the
nutritional requirements and support the health and wellbeing of healthy
people in five population groups.

infants and toddlers (0–2).

children and young people (2–18).

pregnant and breastfeeding women.

adults.

older people.
Healthy members of each population group need food from the four
major food groups each day. The four major food groups are:
1
vegetables and fruit.
2
breads and cereals.
3
milk and milk products.
4
lean meat, chicken, seafood, eggs, legumes (cooked dried beans,
peas and lentils), nuts and seeds.
The food and nutrition guidelines give information on the recommended
daily intakes/requirements for:

energy.

carbohydrates, fat and protein.

nutrients and minerals, such as iron, calcium, sodium, zinc, iodine,
selenium, fluoride, vitamin C, folate, thiamine, vitamin B12.

fluids.
These guidelines have two parts:
1
a background paper that gives comprehensive and detailed
information on the nutritional requirements of these groups.
2
health education resources that summarise this information and
present it in an attractive and easy to understand way.
The food and nutrition guidelines are available from:
www.moh.govt.nz/foodandnutrition
The health education resources are available from:
www.healthed.govt.nz
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The Ministry of Health’s guidelines provide a framework or baseline
information that can be used to support the health and wellbeing of the
people in these population groups.
For healthy adults or older adults, menus and meals should be based on
these guidelines.
A person’s health and disability status and/or medical condition may
mean their nutritional needs are different to those of a healthy person.
Their needs may include a special diet or a therapeutic nutrition
intervention, for example, a lactose or gluten free diet, or one designed
for weight gain or loss.
Therapeutic nutrition interventions are planned and purposeful
treatments, including dietary supplements that aim to improve a person’s
nutritional status and/or reduce the risk of malnutrition.
For those people who need therapeutic nutrition interventions or special
diets there will be instructions from a dietitian or other appropriate
health professional.
The audit will need to measure the person’s nutritional intake against
their specific instructions as these will have been developed to ensure
that their particular needs are met.
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Write
How many servings a day do healthy members of each population group
need from the four major food groups? Check the Ministry of Health’s
Food and Nutrition Guidelines if you are unsure.
Age group
Vegetables
and fruit
Breads and
cereals
Milk and milk
products
Lean meat,
chicken,
seafood, eggs,
legumes, nuts
and seeds
Infants and
toddlers
(0-2)
Children and
young people
(2-18)
Pregnant and
breastfeeding
women
Adults
Older people
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Preparing to conduct an audit
Preparing for an audit is an important step in ensuring the audit runs
smoothly. Preparation involves:

knowing the purpose of the audit.

knowing the audit tool.

organising the audit.

explaining the purpose of the audit.
Knowing the purpose of an audit
Audits are more likely to be successful when they have a very clear
purpose. A clear purpose means you have to know what it is trying to
measure (the standards required or audit criteria) and how to measure if
those standards have been met.
Audit criteria are specific statements about the standard or outcome
relating to nutrition care and food service quality that is to be measured.
The standards or outcomes need to be specific and measureable so that
evidence can be gathered to show whether the standard is being met or
not.
For the audit to fulfil its purpose there must be clear identification of:

the information and/or evidence that is needed to show that the
standard or outcome is being met.

how this evidence will be gathered.
It is only with relevant and accurate information and/or evidence that the
audit will reveal how well the organisation is performing and meeting its
goals.
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To carry out a food services audit, you must have a good understanding
of nutrition and the food service sector. You will need to have enough
knowledge and experience in the following areas to be able to accurately
judge whether a standard has been met.
1 Technical knowledge. For example, knowledge of:

food hygiene and safety.

nutritional requirements.

the Ministry of Health’s Food and Nutrition Guidelines.

food and fluid modifications and when it is appropriate to use
these.

hazards during the preparation of food.
2 Understanding the instructions of a registered dietitian on a person’s
personal plan.
3 Knowing the policies, procedures and guidelines and being able to
interpret these in relation to food services and how they meet the
criteria set.
4 Professional conduct. Knowing how to behave in an ethical, impartial
and professional way.
Knowing the audit tool
The audit tool defines the scope of the audit. It sets the boundaries of
what will be checked and what the audit will and will not cover.
Most workplaces will have audit tools that are already prepared. These
will have been developed to cover the key areas that need to be checked.
Your responsibilities will be to make sure you understand how the audit
tool works. Understanding how the audit tool works involves knowing:

the structure and length of the tool.

the different sections of the tool.

the standards that must be met.

what evidence must be gathered to show that the standard has been
met.

how that evidence is to be gathered, for example, interviews with
staff and/or consumers, physical checking of organisational
documents, observation of kitchen practices and taking samples such
as menu cycles.

the criteria to determine if the standard has been met. For example, if
five items need to be present to meet the standard and only four
items are present, will the standard be met?
If interview questions are to be used, it is important that the staff and/or
the consumers of the food who need to be interviewed are identified and
that the questions actually measure what they need to measure.
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Organising the audit
Organising the audit involves making all the arrangements for the audit
to occur. It includes contacting and communicating with the organisation
to schedule dates that will be convenient for the audit to occur. It
involves giving the organisation information about:

the length of time the audit is expected to take (eg one or two days).

who will need to be involved from the organisation, such as managers,
kitchen staff, carers.

who else will need to be involved, such as consumers or external
contractors.

what documentation the auditors will need access to.

what resources the auditors will need to conduct the audit, for
example, a room to work in.
It is important that the audit is organised with enough time for the
organisation to make the appropriate arrangements for the audit to run
smoothly. It is often helpful to have an audit timetable. This schedules
each stage of the audit so everyone knows what is happening at any one
time. For example, the timetable can show where the audit will take
place, meetings/interviews that have been scheduled and/or when
observations will be occurring.
Explaining the purpose of the audit
Explaining the purpose of the audit involves making sure that the people
in the organisation who will be involved or affected by the audit are
aware that it is occurring and what its purpose is. This is to facilitate the
co-operation and support of the people involved in the audit.
Explaining the purpose of the audit includes:

identifying who will be conducting the audit (membership of the audit
team).

explaining your role.

explaining the benefits of the audit.

explaining the process that will occur and what will happen at each
stage/step.
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Conducting a food quality service audit
Food service quality audits are based on:

the Ministry of Health’s Food and Nutrition Guidelines.

suitability for meeting the person’s needs as identified in their
personal plan.

the consumer’s satisfaction with the food.

food service quality in kitchens following the organisation’s policies
and procedures.
Food service quality involves ensuring that people receive nutrition in
accordance with the Ministry of Health’s Food and Nutrition Guidelines.
Auditing this involves analysing the menus, the number of servings and
the nutritional requirements planned for people.
It is important to remember that organisations base their menus on the
Ministry’s guidelines to feed all the people within their care. From this
general menu, modifications are then made to meet the needs of
individual person. For example, a low calorie dessert is offered to a
diabetic person instead of the main dessert option.
Planned menus
The meals given to a person will be part of a planned menu. This menu
will cover a period of time, for example four weeks. Menus are planned
to allow the person to have meals that consistently provide for their
nutritional needs but also give variety.
An audit of a menu may check that:

meals include food from the main food groups. These include the
recommended daily servings from the four main food groups – fruit
and vegetables, breads and cereals, milk and milk products and lean
meat, chicken, seafood, eggs, legumes (cooked dried beans, peas and
lentils), nuts and seeds.

a variety of foods is provided and a person’s preferences are taken
into account.

seasonal fruit and vegetables are included.

a variety of preparation methods, such as frying, roasting, steaming
are used to prepare food.

an assortment of flavours, textures, colours per meal, per day and per
week is provided.

sugar levels of foods on the menu are appropriate for the person.
Food service quality and nutrition intervention audits (US 27456) Learning Guide © Careerforce – Issue 2.0 | July 2015
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
high sodium (salt) menu items (eg corned beef, bacon) are limited to
once per day.

people have available a variety of fluids, such as water, tea, coffee,
juice, cordials, milk and high energy or protein beverages, throughout
the day to enable the daily requirements to be met.

portion sizes meet the required standards as determined by the
Ministry of Health’s Food and Nutrition Guidelines.
An audit tool will contain specific standards to measure. Auditing planned
menus may involve the following steps as outlined in the flowchart.
Audit of menus
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Write
Choose a healthy adult on a ‘normal’ diet. Obtain a copy of a full day’s
menu that applies to this person. Audit the menu to determine whether
the person received the requirements as outlined in the Ministry of
Health’s Food and Nutrition Guidelines.
An example of an audit tool is provided in the table below from the New
Zealand Dietetic Association: Menu Audit Tool for Aged Care Facilities. You
may use this or any other audit tool, for example, an audit tool your
organisation uses.
Menu planning audit
Organisation
Name of auditor:
Standard
Date:
Compliant
Not yet
compliant
Comments
Recommended
corrective action
1.1 At least three
servings of
vegetables each day.
1.2 At least two servings
of fruit each day.
1.3 At least one serving
of fruit or vegetable
offered each day is
fresh.
1.4 At least three
servings of milk or
milk products are
offered each day,
including incidental
use in beverages.
1.5 At least 100 gm of
cooked chicken,
seafood, eggs, dried
beans and lentils is
available per day.
1.6 Fish (including
canned) is offered at
least three times per
fortnight and
includes some fatty
fish.
Did this meet the person’s personal plan?
Did this meet your organisation’s policies and procedures?
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Suitability for meeting the person’s needs
Food service quality audits aim to determine how well the meals and
nutrition provided meet individual needs. Determining this involves
auditing:

how clearly the person’s needs are identified in their personal plan.

how appropriate the meals and snacks provided are.
Clear identification of the person’s needs
The person’s needs should be documented in their personal plan. A
personal plan will have a nutrition component. This might be an
additional supporting document.
The meals a person receives must meet their nutritional needs as well as
be served in a way that makes it possible for them to be consumed.
A person’s health and disability status may mean that the way they
receive their food must change, such as texture modification or enteral
feeding.
Enteral feeding is tube feeding via the small intestine. It can be
nasogastric (through the nose and into the stomach) for short term
treatment or via a tube surgically inserted into the stomach or jejunum
(second part of small intestine) for long term management.
These people may have instructions from a dietitian and a speech
language therapist to ensure they receive adequate nutrition in an
appropriate way.
Nutritional requirements
Any modifications needed to areas such as food selection or consistency
will be recorded in a personal plan. These instructions will also reflect any
special additional requirements, such as low fat, high fibre, low sodium,
lactose free, gluten free. The instructions for any therapeutic nutrition
interventions will be recorded.
An audit should check that the nutrition component of the person’s
personal plan is being implemented and monitored.
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The nutrition component of the person’s personal plan may be audited to
check:

that the nutrition component of the plan is up-to-date and reflects the
person’s current needs.

that all instructions for the person’s nutrition, including special dietary
requirements are documented and the information is readily available
to appropriate staff, for example, portion size, texture modification,
eating aids, assistance with feeding, behaviour support and any
therapeutic nutrition interventions.

that the nutrition component of the plan is reviewed as set out in the
organisation’s policies and procedures. For example, if the
organisation’s policy states a six-monthly review, then there is
evidence of that review occurring every six months.

that the nutrition plan is revised in response to the person’s changing
needs. For example, updated in response to instructions from a
dietitian or doctor or reassessment of the person.

the person’s weight is taken and recorded as per the instructions of
the dietitian or other health professional.

that monitoring is occurring to ensure implementation of the plan, for
example, observation at meal times, documentation or notes taken by
staff.
Information and relevant data that may be gathered as a part of this
auditing process can include:

consumer/patient notes.

records of discussions from staff meetings/shift changeover.

records that monitor daily intake of food and/or fluid to track and
evaluate the implementation and monitoring of the plan.
Safety and security
Information relating to safety and security will include the level of
support, supervision or assistance with eating and drinking needed to
ensure a person’s comfort, safety, independence and dignity.
This information may also include any relevant details about:

allergies or food intolerances.

eating habits and behaviours.

strengths and abilities.

the need for assistive devices.

the use of seating modifications and body position.
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Personal preferences
These may include:

diet choice such as vegan or vegetarian.

likes and dislikes.

cultural or religious needs, for example, halal meat or kosher foods.

social and emotional needs that may involve adaptations to the meal
time environment.
When auditing whether the food service quality is suitable for a person, it
is important to check that the person is not being served food items that
they will be unable to eat.
Appropriate meals and snacks
Meals and snacks given to the person should be audited to ensure they
are compliant with the instructions on the personal plan. If the person
requires a special diet, then the audit must check that this is the meal the
person receives.
The audit should check the organisation’s processes for delivering any
nutritional supplements to people. Nutritional supplements are often
used to supplement a person’s normal eating and drinking and must be
given in accordance with the instructions on the person’s personal plan.
Where nutritional supplements are being given as a complete food, the
audit should check the organisation’s processes to monitor the amount
consumed or wasted. Procedures associated with the giving of nutritional
supplements, such as documenting amounts and times given, regular
monitoring of the person’s body weight must be audited to ensure they
are being followed.
Meal is appropriate for the person to consume
An audit should check that people are receiving meals that are
appropriate for them to consume. For example, if a person requires a
texture modified meal, did they actually receive that texture modified
meal and was the texture modification correct?
Every texture modified food or fluid will have a standard to be met.
Modified fluids are:



Level 150 (Mildly thick).
Level 400 (Moderately thick).
Level 900 (Extremely thick).
Modified foods are:



Texture A (Soft).
Texture B (Minced and moist).
Texture C (Smooth pureed).
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Example procedures for auditing are described in the following flowcharts. The
word ‘client’ in diagram refers to the consumer, the person consuming the meal.
Audit of appropriateness of texture modified food
Audit of if food is appetising
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Meal is appetising
People will be encouraged to eat, and therefore obtain good nutrition, if
the food is appetising and inviting to eat (well presented). It is very
important that food is appealing, particularly for people who are unwell,
experience a lack of motivation to eat (for example, through side effects
of medications) or have difficulty chewing or swallowing.
Determining if a meal is appetising can involve the auditor evaluating a
meal given to the person against a set of characteristics, such as, aroma,
temperature, appearance, taste, texture and presentation.
Characteristic
Description
Aroma
A food item with an acceptable aroma has a pleasant
aroma. Food that has been modified should have an
aroma similar to unmodified food.
Temperature
A food item with an acceptable temperature is served at
an appropriate temperature (hot foods served hot and
cold foods served cold).
Appearance
A food item with an acceptable appearance will look
appetising. Appetising includes shape, size, colour, surface
condition, pleasing arrangement of the items on the plate.
Texture modified foods resemble unmodified foods.
Taste
A food with an acceptable taste has an appropriate taste.
There is no unpleasant after-taste.
Texture
Texture is the structure and feel of the food item. A food
item with an acceptable texture will have an appropriate
consistency. For example, crunchy salad or smooth
mashed potatoes. Unacceptable textures include watery
soup, lumpy mashed potatoes, limp or soggy salad.
Presentation
The meal is attractively presented.
The auditor can evaluate these characteristics by tasting or sampling the
food the person would receive.
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Write
Identify three people you work with. Make sure each person has a
different medical diagnosis. You will need a copy of their personal plan.
Complete the table below.
Person 1
Person 2
Person 3
What is their age group?
For example: older adult
What is the medical
diagnosis of person? For
example: dementia,
diabetic.
What are their nutritional
needs as identified in
their personal plan?
What special dietary
considerations does the
person have?
What food modification is
the person receiving (if
any)? For example:
modified fluids or texture,
enteral feeding.
What personal, cultural or
religious preferences
need to be taken into
account?
Is the person satisfied
with their food? If not,
what would improve this?
What other
considerations would
need to be audited to
ensure needs are being
met? Eg frail, so fortified
high-protein supplements.
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Satisfaction
Satisfaction is a key part in getting people to eat the meals that have
been prepared for them. Auditing people’s satisfaction comes from
obtaining feedback from them.
Determining people’s satisfaction and enjoyment of the meals can also
be obtained through interviews or discussions with them. Questions can
be designed to elicit their feedback and comments can be recorded by
the auditor on the tool. Either one, or a number of people can be
interviewed to audit satisfaction.
Example questions that may be asked include:
“How was your meal?”
“Does the food taste good?”
“Does the food look good?”
“Are the hot foods hot enough?”
“Are the cold foods cold enough?”
“Do you usually get enough to eat?”
“Do you eat most of the food you receive at each meal?”
“If you do not like the meal served, are you offered another choice?”
People can be given a choice of answering ‘yes’ or ‘no’ or marking a scale.
It is also important to meet the person’s cultural, religious and personal
preferences in food.
Find out what audit tool your workplace uses to measure people’s
satisfaction.
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Food service quality in kitchens
Organisations have policies and procedures to define acceptable
standards of service, ensure consistency of practice and deliver quality
services. Effective policies and procedures:

define and communicate the standards and outcomes required.

define and communicate the systems and processes to be followed to
achieve those standards.

define and communicate acceptable and best practice.

ensure food safety and hygiene at all times.

promote consistency in service delivery.
Policies and procedures must be written and located in a way that makes
them accessible to all staff so they can be understood and followed.
The role of an audit is to measure how well an organisation’s practice
meets the standards set in their policies and procedures. People rely on
an organisation to deliver food to meet certain standards, such as
consistently appealing, health and safety standards and nutritional and
personal requirements. Adherence to policies and procedures by all staff
is critical to ensuring food safety and hygiene.
The policies and procedures that are audited may vary depending on the
type and scope of audit being performed. Examples of the types of
policies and procedures that may be audited include:

food purchasing guidelines and requirements.

standards for special diets that specify amounts, types and
modifications to foods.

food production, including:

food safety and hygiene.

cleaning schedules.

waste management.

service of food and the provision of appropriate assistance to people.

standardisation of recipes.

communication and documentation to keep, maintain and convey
information relating to food production and person’s nutritional
needs.
The scope of the audit will determine the specific policies and procedures
that are audited and the evidence that needs to be used.
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Conducting a nutrition intervention
audit
Some people will require additional nutrition support through nutrition
interventions. These people may have been identified through nutrition
screening tools. Alternatively, the particular health or disability status of
a person may mean they cannot consume food in the conventional way.
Thus, nutrition interventions such as special diets, nutritional
supplements or enteral feeding are required.
As these people must also receive adequate and appropriate nutrition, it
may be necessary to conduct nutrition intervention audits.
Any therapeutic nutrition interventions must be consistent with the
Ministry of Health’s Food and Nutrition Guidelines. The purpose of the
nutrition intervention will be to provide, as closely as possible, nutrition
that meets the recommended intakes as stated in the guidelines.
A dietitian or a doctor will give instructions as to what appropriate
nutrition interventions should be and how these interventions will be
assisting a person’s nutritional status. The instructions will be recorded
on the individual’s personal plan and these instructions will be a key part
of the audit.
Auditing therapeutic nutrition interventions
The purpose of auditing therapeutic nutrition interventions is to ensure
that the person is receiving nutrition that meets the instructions of the
registered dietitian and conforms as much as possible to the Ministry of
Health’s Food and Nutrition Guidelines.
Audits may be required to ensure that the dietitian’s instructions are
being followed for people:

on special diets.

receiving nutritional supplements.

receiving enteral feeding.
The person’s personal plan must be followed, including any personal,
cultural or religious preferences and any other needs.
The person’s data must be recorded and monitored. This includes:

weight records.

food and fluid intake records.

level of ability to access food independently at meal times.
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Auditing special diets
The audit process for people on special diets is essentially the same as for
healthy people. Your workplace will have audit tools to use or you will
follow a process similar to that of auditing the meals given to healthy
adults.
Considerations for auditing people on special diets may include:

special dietary needs are documented in the person’s personal plan
and the information is readily available to the appropriate staff.

staff responsible for the provision of meals have adequate training in
providing meals to people on special diets.

a nutritional and varied diet is provided.

acceptable and appropriate snacks are provided between meals.

suitable drinks are available.

people’s preferences are included in the meals where possible.
Auditing the provision of nutritional supplements
Nutritional supplements can include:

nutritionally complete pre-packed drinks. Examples of oral nutritional
supplements are Fortisip, Ensure, Sustagen, Fibresource.

vitamin/mineral tablets.

extra calcium in powdered milk.
Nutritional supplements aim to improve the person’s overall food and
fluid intake to improve their nutritional status. It is important that the
total intake from normal food plus the nutritional supplements provides
a balanced mix of energy, protein and micronutrients.
As vitamins and minerals can be harmful if given in excessive doses, it is
important that the amount of vitamins and minerals received does not
exceed the upper limits. The Ministry of Health’s Food and Nutrition
Guidelines give information on amounts of micronutrients suitable for
healthy older adults.
A dietitian will give instructions as to what supplements are to be given
and how often they are to be given to ensure that the person receives an
appropriate level of support.
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Considerations for auditing people receiving nutritional supplements may
include:

the correct nutritional supplement is given to the right person at the
right time and that there is a system in place to ensure this is done
and recorded.

the person is not receiving an excessive dose of vitamins or minerals
from the total food and nutritional supplements consumed.

the person receives pre-packaged drinks that are to their liking, for
example, a flavour they enjoy or a mixture of flavours for variety.

adequate monitoring of the effectiveness of the nutritional
supplements is occurring. This may include:

regular monitoring of the person’s BMI, weight and nutritional
status.

regular reassessment by a dietitian.

there are no adverse effects of the supplement, for example,
nausea or diarrhoea.

the supplement is not interfering with prescription medications.

any wastage of the supplement.
Fortisip is a nutritional supplement.
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Auditing people receiving enteral feeding
People receiving enteral feeding should have all relevant information
relating to the feeding on their personal plan, for example:
 the name of the product/formula they are being fed and the correct
rate of flow.

feeding volume.

method of administration, for example, rate of feeding, temperature
of feeding.

times of feeding.

precautions to maintain hygiene and prevent bacterial contamination.

flushing instructions and medication administration.

disposal or washing of feeding bags.

positioning instructions.

monitoring criteria, such as weight records and weight goals.

instructions for any leftover product.

instructions for any oral feeding, such as ice chips.
When conducting the audit, you should observe the feeding procedure
and complete the audit. Each individual audit criteria is observed or
checked and then marked as compliant or as not meeting the required
standard. Any issues are noted for reporting back to the organisation. It is
important to be aware of how the audit should be conducted so that the
dignity of the person is maintained.
Auditing the provision of enteral feeding can include the following areas:

the person’s personal plan contains all information relating to the
enteral feeding.

the formula is prepared in a clean and safe manner.

the correct product is used.

the correct amount of product is given.

the person is positioned correctly during the enteral feeding.

the person is positioned correctly for the required length of time after
the enteral feeding.

the correct rate of flow for the product/formula is given.

the procedure to flush the tube is done correctly.

the bag is washed and stored according to the organisation’s policies
and procedures.

all records of the feeding are accurate and complete.

appropriate monitoring of the person’s nutrition status occurs.
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Reporting back audit findings
The purpose of audits is to give the organisation information about their
performance. At the end of the audit, a report should be prepared that
communicates the audit findings to the organisation. The audit report
must be signed by the auditor and should identify areas where the
organisation:

meets the required standards.

needs to improve its performance.
Reporting back the audit findings is an essential part of the auditing
process. Each audit allows the organisation to further improve its
performance so that quality standards are maintained or enhanced.
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Write
What audit tool do you use to audit the provision of nutritional
supplements? You may like to attach a copy to this learning guide to
refer to.
What audit tool do you use to audit enteral feeding? You may like to
attach a copy to this learning guide to refer to.
How do the criteria in the audit tool you use differ from what is in this
learning guide?
List the procedure you follow in reporting the findings of your audits.
Include who you report to, how you report, what feedback you give
when standards are not met and what happens as a result of your
findings.
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