CHAPTER 111. DIETETIC SERVICES

GENERAL PROVISIONS

Sec.


111.1.    Principle.
111.2.    Organization and staffing.
111.3.    Dietitian.
111.4.    Staffing pattern.
111.5.    Patient nutritional care.
111.6.    Menus.
111.7.    Commercial food service.

DIETETIC FACILITIES


111.11.    Principle.
111.12.    Equipment.
111.13.    Handwashing facilities.
111.14.    Dry storage.
111.15.    Storage of perishable food.
111.16.    Refuse.

POLICIES AND PROCEDURES


111.21.    Principle.
111.22.    Food storage.
111.23.    Job description.
111.24.    Education programs.
111.25.    Infection control.
111.26.    Dishwashing.
111.27.    Nutritional aspects of patient care.

GENERAL PROVISIONS


§ 111.1. Principle.

 There shall be an organized dietetic service which shall effectively apply the principles of the science of nutrition to the nutritional care of patients and the preparation of palatable and appropriate food.

§ 111.2. Organization and staffing.

 The service shall be under the full-time direction of a person who is trained and experienced in food services administration and dietary management. If the director of the services is not the qualified dietitian, there should be an effective method of communication and a close working relationship between the director and dietitian.

§ 111.3. Dietitian.

 (a)  The dietary services shall have at least one qualified dietitian, either full-time, part-time, or as consultant. The resume of the dietitian shall be included in the personnel files. The dietitian shall have training and experience in nutrition, therapeutic diets, and nutritional food service management.

 (b)  If a consultant dietitian is used, there shall be a written contract which shall clearly define the responsibilities and frequency of visits of the consultant dietitian. This contract, together with the dietitian’s regular reports or running log of services performed, shall be available for review by the surveyors of the Department. The consultant dietician shall provide a minimum of four hours service per week.

§ 111.4. Staffing pattern.

 The number of personnel assigned to the dietary department shall be adequate to perform effectively all functions related to food service to meet the needs of patients. Supervisors of appropriate ability shall be assigned in such numbers as to provide a satisfactory span of control as well as to provide coverage for all hours of department operation.

§ 111.5. Patient nutritional care.

 The administration of the nutritional aspects of patient care shall be directed by a qualified dietitian or by other appropriate persons such as dietetic technicians or dietetic assistants who are supervised by the dietitian. Observations and information pertinent to special dietetic treatment shall be recorded in the medical record of the patient and discussed with the patient and his physician, if appropriate.

§ 111.6. Menus.

 All master menus shall be approved, dated and signed by the dietitian.

Authority

   The provisions of this §  111.6 issued under 67 Pa.C.S. § §  6101—6104; and Reorganization Plan No. 2 of 1973 (71 P. S. §  755-2).

Source

   The provisions of this §  111.6 amended September 19, 1980, effective September 20, 1980, 10 Pa.B. 3761. Immediately preceding text appears at serial page (37819).

§ 111.7. Commercial food service.

 A hospital which has a contract with an outside food management service shall require as a part of the contract that the company maintain at least the standards outlined in this chapter for the service. The contract shall be available for review by the surveyors.

DIETETIC FACILITIES


§ 111.11. Principle.

 The dietetic service shall have adequate space, equipment and supplies to perform the efficient, safe and sanitary operation of all functions assigned to it.

§ 111.12. Equipment.

 The type, size and layout of equipment shall provide for ease of cleaning, optimal workflow and efficient food production to meet the scope and complexity of the regular and therapeutic diet requirements of the patients. Equipment and work areas shall be clean and orderly. Effective procedures for cleaning all equipment and work areas shall be followed consistently to safeguard the health of the patient.

§ 111.13. Handwashing facilities.

 Handwashing facilities, with hot and cold running water, liquid soap or individual soap leaves and towels shall be available for use by food handlers.

§ 111.14. Dry storage.

 Dry or staple food items shall be stored in accordance with standard dry food storage techniques:

   (1)  Shelves shall be at a height above the floor as to facilitate cleaning, or the shelves shall be of solid construction and flush to the floor so as to eliminate the need for cleaning under them.

   (2)  The room provided for storage of dry or staple food items shall be ventilated and may not be subject to sewage or waste water back-flow.

   (3)  The food products shall be protected from contamination by condensation, leakage, mopping, insects, rodents or vermin.

§ 111.15. Storage of perishable food.

 Perishable foods shall be refrigerated at the appropriate temperature and in an orderly and sanitary manner as provided in regulations of the Department of Environmental Resources, set forth in 7 Pa. Code § §  78.21—78.24, 78.31 and 78.32 (Reserved). Foods being displayed or transported shall be protected from contamination and held at proper temperatures in clean containers, cabinets or serving carts.

§ 111.16. Refuse.

 Leakproof, nonabsorbent containers with close-fitting covers shall be used for the disposal of garbage and kitchen refuse. Garbage and kitchen refuse shall be removed from the dietetic department in a manner which does not permit transmission of disease or create a nuisance or a breeding place for flies, insects or rodents. Garbage containers shall be thoroughly cleaned inside and out, each time emptied. Places in which refuse is stored shall be tightly sealed and leak-proof.

POLICIES AND PROCEDURES


§ 111.21. Principle.

 There shall be written policies and procedures to govern all dietetic service activities. These policies should be developed by the dietetic service in cooperation with personnel from other departments or services which are involved with dietetic service, and they shall be reviewed at least once every 2 years, revised as necessary, and dated to indicate the time of last review.

§ 111.22. Food storage.

 There shall be written policies and procedures for food storage, preparation and service.

§ 111.23. Job descriptions.

 Job descriptions shall be written for all classifications of dietetic services personnel. They shall be made available to dietetic services personnel.

§ 111.24. Education programs.

 Education programs, including orientation, on-the-job training, in-service education, and continuing education programs shall be offered to dietetic services personnel. The programs shall include instruction in personal hygiene; in the proper inspection, handling, preparation, and serving of food; and in the proper cleaning and the safe operation of equipment. Current reference materials should be conveniently located, accessible, and available.

§ 111.25. Infection control.

 There shall be procedures to control employes with infections and open lesions. Routine health examinations and infection control procedures shall meet at least the standards set forth in 7 Pa. Code § §  78.41—78.43 (Reserved). A dietician, dietetic technician, or dietetic assistant shall serve on any appropriate hospital infection control committees. These committees may be combined, and dietetic services infection control activities may be included among the responsibilities of the committee established pursuant to §  147.21 (relating to infection control).

§ 111.26. Dishwashing.

 (a)  Dishwashing procedures and techniques shall be well developed, understood, and carried out. Dishwashing procedures shall be at least those set forth in 7 Pa. Code § §  78.61—78.65 (Reserved).

 (b)  There shall be periodic checks at established intervals of:

   (1)  washing, rinsing, and sanitizing temperatures and cleanliness of machines and jets; and

   (2)  thermostatic controls.

 (c)  Records of all checks required by subsection (b) shall be maintained.

§ 111.27. Nutritional aspects of patient care.

 (a)  The administration of the nutritional aspects of patient care shall be under the direction of a qualified dietitian.

 (b)  Therapeutic diets, when appropriate, shall be prescribed in written or- ders on the medical record by the physician and shall be instructive, accurate and as complete as possible.

 (c)  The dietitian shall have available an up-to-date manual of regimens for therapeutic diets, approved jointly by the dietetic and medical staff, which shall be available to dietetic supervisory personnel. There shall be a standardized recipe file.

 (d)  Patients’ nutrition needs shall be met in accordance with the current Recommended Dietary Allowance of the Food and Nutrition Board, National Research Council, or shall be in accordance with physician’s orders.

 (e)  The dietitian shall be responsible for the development of a nutritional care plan in compliance with physician’s orders to meet the needs of the patient for the maintenance of health, prevention of disease, and treatment through diet modification and normal nutritional counseling. The nutritional care plan shall be integrated into the total care plan of the patient and shall be included on his discharge plan and in transfer orders to any nursing facility or home health agency to the extent necessary for continuity of care.

 (f)  The director of dietetic services should attend and participate in meetings of heads of departments and function as an integral member of the hospital staff.

 (g)  The director of dietetic services should have regularly scheduled conferences with the chief executive officer or his designee, to keep him informed, to seek his counsel, and to present program plans for mutual consideration and solution.

 (h)  Conferences should be held regularly within the dietary services department at all levels of responsibility, to disseminate information, interpret policy, solve problems, and develop procedures and program plans.



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