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

1. (1) The hospital shall have a full-time employee designated who—

   1. (A) Serves as director of dietary services;
   2. (B) Is responsible for the daily management of the dietary services; 19 CSR 30-20
   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 American Dietetic Association, or an associate degree in dietetics or food systems management; and
   4. (D) Has documented evidence of annual continuing education.
2. (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.

3. (3) The qualified dietitian shall ensure that high quality nutritional care is provided to patients in accordance with recognized dietary practices. When the services of a qualified dietitian are used on a part-time or consultant basis, the following services shall be provided on the premises on a regularly scheduled basis:

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

4. (4) The consultant or part-time dietitian shall assist the director of dietary services to ensure—

   1. (A) Patient and family counseling and diet instructions;
   2. (B) Nutritional screening within three (3) days of 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 assess ments within twenty-four (24) 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;
   5. (E) Participation in committee activities concerned with nutritional care; and
   6. (F) Planned, written menus for regular and modified diets.

5. (5) The director of dietary services or his/her designee shall be responsible for—

   1. (A) Representing the dietary 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 SENIOR SERVICES

dietary personnel;

1. (D) Interviewing the patients for food preferences and tolerances and providing appropriate substitutions;
2. (E) Monitoring adherence to the written planned menu; and
3. (F) Scheduling dietary services meetings.

1. (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.
2. (7) The director of dietary services shall be responsible for developing and implementing written policies and procedures and for monitoring to assure they are followed. Policies and procedures shall be kept current and approved by the chief executive officer or designee.
3. (8) Dietary services shall be staffed with a sufficient number of qualified personnel.
4. (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.
5. (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.
6. (11) At least three (3) meals or their equivalent shall be served approximately five (5) hours apart with supplementary feedings as necessary. There shall not be more than fourteen (14) hours between a substantial evening meal and breakfast.
7. (12) Dietary 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 inservice education meetings.
8. (13) The dietary services shall comply with

19 CSR 20-1.010 Sanitation of Food Services Establishments. Foods shall be prepared by methods that conserve nutritive value, flavor and appearance and shall be attractively served at acceptable temperatures. Potentially hazardous foods shall be served at temperatures specified in 19 CSR 20-1.010(4)(I) and (J), (5)(B)1.–3. and (H). (14) When there is a contract to provide dietary services to a hospital, the hospital is responsible for assuring that contractual services comply with rules concerning dietary services in hospitals.

AUTHORITY: sections 192.006 and 197.080, RSMo 2000 and 197.154, RSMo Supp. 2007.* This rule previously filed as 19 CSR 30-20.021(3)(B). Original rule filed June 27, 2007, effective Feb. 29, 2008. *Original authority: 192.006, RSMo 1993, amended 1995; 197.080, RSMo 1953, amended 1993, 1995; and 197.154, RSMo 2004.