PURPOSE: This rule specifies the manner in which food and nutrition services shall be organized and integrated in a hospital.

1. (1) The hospital shall have an employee or contracted individual designated who—

   1. (A) Serves as director of food and nutrition services;
   2. (B) Is responsible for the daily management of the food and nutrition services;
   3. (C) Is qualified by education, training, and experience in food service management and nutrition through an approved course for certification by the Dietary Managers Association or registration by the Commission on Dietetic Registration of the Academy of Nutrition and 19 CSR 30-20

Dietetics, or an associate degree in dietetics or food systems management; and

1. (D) Has documented evidence of annual continuing education.

1. (2) When the director is not a qualified dietitian, a qualified dietitian shall be employed on a part-time or consultant basis. The dietitian shall make visits to the facility to assist in meeting the nutritional needs of the patients and the scope of services offered.

2. (3) The director shall ensure that a qualified dietitian provides high quality nutritional care to patients in accordance with recognized dietary practices as evidenced by the following:

   1. (A) Continuing liaison with the administration, medical staff, and nursing staff; and
   2. (B) Evaluation and approval of the planned written menus including regular and routine modified diets for nutritional adequacy.

3. (4) The director or designee shall ensure the following:

   1. (A) Patient and family counseling and diet instructions;
   2. (B) Nutritional screening within twentyfour (24) hours of inpatient admission to identify patients at nutritional risk. The hospital shall develop criteria to use in conducting the nutritional screening and staff who conduct the screening shall be trained to use the criteria;
   3. (C) Comprehensive nutritional assessments within seventy-two (72) hours after screens on patients at nutritional risk, including height, weight, and pertinent laboratory tests;
   4. (D) Documentation of pertinent information in patient’s records, as appropriate; and
   5. (E) Participation in committee activities concerned with nutritional care.

4. (5) The director or designee shall be responsible for—

   1. (A) Representing the food and nutrition service in interdepartmental meetings;
   2. (B) Recommending the quantity and quality of food purchased;
   3. (C) Participating in the selection, orientation, training, scheduling, and supervision of food and nutrition personnel;
   4. (D) Developing a procedure to provide appropriate substitutions or a selective menu for patients with food preferences and/or intolerances;
   5. (E) Monitoring adherence to the written planned menu; and
   6. (F) Scheduling food and nutrition services meetings. SENIOR SERVICES
5. (6) When the qualified dietitian serves as a consultant, written reports shall be submitted to and approved by the chief executive officer or designee concerning the services provided.
6. (7) The director shall have the authority to implement written policies and procedures governing food and nutrition services and shall have the responsibility for evaluating and monitoring to ensure they are followed. The policies and procedures shall include processes to ensure appropriate nutritional care and clinically-indicated nutritional interventions are provided during the admission. Nutritional care planning shall be a component of the overall discharge plan when clinically indicated. Policies and procedures shall be reviewed and kept current per hospital policy and readily available to staff.
7. (8) Food and nutrition services shall be staffed with a sufficient number of qualified personnel.
8. (9) Menus shall be planned, written, and followed to meet the nutritional needs of the patients as determined by the recommended dietary allowances (RDA) of the Food and Nutrition Board of the National Research Council, National Academy of Sciences, or as modified by physician’s order.
9. (10) Diets shall be prescribed in accordance with the diet manual approved by the qualified dietitian and the medical staff. The diet manual shall be available to all medical, nursing, and food service personnel.
10. (11) At least three (3) meals or their equivalent shall be offered with supplementary snacks as necessary.
11. (12) Food and nutrition records shall be maintained which include: food specifications and purchase orders; meal count; standardized recipes; menu plans; nutritional evaluation of menus; and minutes of departmental and in service education meetings.
12. (13) The food and nutrition services shall comply with 19 CSR 20-1.025 Sanitation of Food Establishments.
13. (14) When there is a contract to provide food and nutrition services to a hospital, the hospital is responsible for assuring that contractual services comply with rules concerning food and nutrition services in hospitals.

AUTHORITY: section 192.006, RSMo 2000, and sections 197.080 and 197.154, RSMo Supp. 2013.* This rule previously filed as 19 CSR 30-20.021(3)(B). Original rule filed June 27, 2007, effective Feb. 29, 2008. Amended: Filed Dec. 31, 2013, effective Aug. 30, 2014.

*Original authority: 192.006, RSMo 1993, amended 1995; 197.080, RSMo 1953, amended 1993, 1995; and 197.154, RSMo 2004.