59A-3.240. Nutritional Services

All licensed hospitals shall have a dietetic department, service or other similarly titled unit which shall be organized, directed and staffed, and integrated with other units and departments of the hospitals in a manner designed to assure the provision of appropriate nutritional care and quality food service.

(1) The dietetic department shall be directed on a full-time basis by a registered dietitian or other individual with education or specialized training and experience in food service management, who shall be responsible to the chief executive officer or his designee for the operations of the dietetic department.

(2) If the director of the dietetic department is not a registered dietitian, the hospital shall employ a registered dietitian at a minimum on a part-time or consulting basis to supervise the nutritional aspects of patient care and assure the provision of quality nutritional care to patients. The consulting dietitian shall regularly submit reports to the chief executive officer concerning the extent of services provided.

(3) Whether employed full-time, part-time or on a consulting basis, a registered dietitian shall provide the following services to the hospital on the premises on a regularly scheduled basis:

(a) Liaison with administration, medical and nursing staffs;

(b) Patient and family counseling as needed;

(c) Approval of menus and modified diets;

(d) Required nutritional assessments;

(e) Participation in development of policies, procedures and continuing education programs; and

(f) Evaluation of dietetic services.

(4) Annually, a registered dietitian shall conduct a review and evaluation of the dietetic department to include:

(a) A review of menus for nutritional adequacy;

(b) A review of tray identification methods, patients who are not receiving oral intake, and the elapsed time between the evening meal and the next substantial meal;

(c) A review of the counseling and instruction given to patients and their families with special dietary needs;

(d) A review of committee activities concerning nutritional care; and

(e) A review of the appearance, palatability, serving temperature, patient acceptability and choice, and retention of nutrient value of food served by the dietetic department.

(5) Nothing in this section shall prevent a hospital from employing an outside food management company for the provision of dietetic services, provided the requirements of this section are met, and the contract specifies this compliance.

(6) The dietetic department, service or other similarly titled unit shall employ sufficient qualified personnel under competent supervision to meet the dietary needs of patients.

(7) Personnel in the dietetic department shall receive, as appropriate to their level of responsibility, instruction in:

(a) Personal hygiene and infection control;

(b) Food handling, preparation, serving and storage; cleaning and safe operation of equipment;

(c) Waste disposal;

(d) Portion control;

(e) Diet instruction; and

(f) The writing of modified diets and the recording of pertinent dietetic information in the patient’s medical record.

(8) Personnel in the dietetic department shall receive quarterly in-service training of which a record shall be kept by the dietetic department.

(9) The dietetic department, service or other similarly titled unit shall be guided by written policies and procedures that cover food procurement, preparation and service. Dietetic department policies and procedures shall be developed by the director of the dietetic department with nutritional care policies and procedures developed by a registered dietitian, shall be subject to annual review, revised as necessary, dated to indicate the time of last review, and enforced. Written dietetic policies shall include the following:

(a) A description of food purchasing, storage, inventory, preparation, service, and disposal policies and procedures.

(b) A requirement that diet orders be recorded in the patient’s medical record by an authorized individual before the diet is served to the patient.

(c) A requirement that the proper use and adherence to standards for nutritional care, including dietary reference intakes are specified by the provider’s diet manual.

(d) A requirement for patients who are on oral intake and do not have specific dietary requirements, that a minimum of three meals or their equivalent be provided daily, with not more than a 15 hour span between the evening meal and breakfast.

(e) A requirement that temperatures for holding and serving cold foods be below 45 degrees F, and for hot foods be above 140 degrees F.

(f) A requirement that a supply of non-perishable foods sufficient to serve a hospital’s patients for a minimum of a one week period be available.

(g) A requirement that written reports of sanitary inspections be kept on file, with a record of actions undertaken to comply with recommendations.

(h) A description of the role of the dietetic department in the hospital's internal and external disaster plans.

(i) Menus.

(j) The role of the dietetic department in the preparation, storage, distribution and administration of enteric feeding, tube feeding and total parenteral nutrition programs.

(k) Alterations in diets or diet schedules, including the provision of food service to patients who do not receive regular meal service.

(l) Ancillary dietetic services, as appropriate, including food storage and kitchens on patient care units, formula supply, cafeterias, vending operations and ice making.

(m) Personal hygiene and health of dietetic personnel.

(n) A description of dietetic department policies and procedures designed to provide for infection control including a monitoring system to assure that dietetic personnel are free from communicable infections and open skin lesions.

(o) A description of the identification system used for patient trays and other methods for assuring that each patient receives the appropriate diet as ordered,

(p) Safety practices, including the control of electrical, flammable, mechanical, and as appropriate, radiation hazards.

(10) The dietetic department shall be designed and equipped to facilitate the safe, sanitary, and timely provision of food service to meet the nutritional needs of patients.

(11) The dietetic department shall have adequate equipment and facilities to prepare and distribute food, protect food from contamination and spoilage, to store foods under sanitary and secure conditions, and to provide adequate lighting, ventilation and humidity control.

(12) The dietetic department shall thoroughly cleanse and sanitize food contact surfaces, utensils, dishes and equipment between periods of use, shall ensure that toilet, hand-washing and hand-drying facilities are conveniently available, and provide for dishwashing and utensil washing equipment that prevent recontamination and are apart from food preparation areas.

(13) The dietetic department shall ensure that all walk-in refrigerators and freezers can be opened from inside and that all food and nonfood supplies are clearly labeled. Where stored in the same refrigerator, all nonfood supplies and specimens shall be stored on separate shelves from food supplies.

(14) The dietetic department shall implement methods to prevent contamination in the making, storage, and dispensing of ice.

(15) The dietetic department shall ensure that disposable containers and utensils are discarded after one use, and that worn or damaged dishes and glassware are discarded.

(16) The dietetic department shall hold, transfer, and dispose of garbage in a manner which does not create a nuisance or breeding place for pests or otherwise permit the transmission of disease.

(17) Information on specifications, operation and maintenance of all major and fixed dietetic department equipment shall be maintained. A preventive and corrective maintenance program on such equipment shall be conducted and recorded.

(18) Dietetic services shall be provided in accordance with written orders by the health professional responsible for the patient and appropriate information shall be recorded in the patient’s medical record. Such information shall include:

(a) A summary of the dietary history and a nutritional assessment when the past dietary pattern is known to have a bearing on the patient’s condition;

(b) Timely and periodic assessments of the patient’s nutrient intake and tolerance to the prescribed diet modification, including the effect of the patient’s appetite and food habits on food intake and any substitutions made; and

(c) A description or copy of diet information forwarded to another organization when a patient is discharged.

(19) Within 24 hours of admission and within 24 hours of any subsequent orders for diet modification, the diet order shall be confirmed by the practitioner responsible for the patient receiving oral alimentation.

(20) Each hospital shall establish appropriate quality control mechanisms to assure that:

(a) All menus are evaluated for nutritional adequacy.

(b) There is a means for identifying those patients who are not receiving oral intake.

(c) Special diets are monitored.

(d) The nutritional intake of patients is assessed and recorded as appropriate.

(e) Effort is made to assure appetizing appearance, palatability, proper serving temperature, and retention of nutritional value of food.

(f) Whenever possible, patient food preferences are respected and appropriate dietary substitutions are made available.

(g) Surveys of patient acceptance of food are conducted, particularly for long-stay patients.

Rulemaking Authority 395.1055 FS. Law Implemented 395.1055 FS. History–New 8-15-18.