Section 11-93-8 - Dietetic service(a) The food and nutrition needs of patients shall be met through a nourishing, well-balanced diet in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council and adjusted for age, sex, activity, and disability.(b) At least three meals shall be served daily, at regular times with: (1) Not more than a fourteen hour span between a substantial evening meal and breakfast on the following day.(2) Between meal nourishments consistent with need shall be offered routinely to all patients.(c) All modified diets shall be: (1) Prescribed by the patient's physician with a record of the diet as ordered kept on file.(2) Planned, prepared, and served by qualified personnel using the current Hawaii Dietetic Association manual or the American Dietetic Association manual, or both.(3) Reviewed and adjusted as needed.(d) Therapeutic diets shall be planned by a qualified dietitian, as prescribed by the patient's physician. Nutrition assessment and dietary counseling shall be provided by a dietitian when indicated for a patient. Nutrition plans and follow-ups shall be documented in the individual medical record.(e) Food services, meal planning and storage: (1) Menus: (A) Shall be written at least one week in advance;(B) Shall provide a sufficient variety of foods served in adequate amounts at each meal, and be adjusted for seasonal changes along with patient's preferences as much as possible;(C) Shall consist of a different menu for each day of the week;(D) Shall be filed and maintained with any recorded changes, for at least three months;(E) Shall be reviewed for nutritional adequacy by the dietitian or the dietitian designee if patient selective menus are used;(F) Shall be available for at least three to five days meal service in the case of a disaster. These menus shall be integrated into the disaster plan of the facility.(2) Records of food purchased shall be filed and maintained for at least thirty days.(3) Storing and handling of food: (A) All food shall be procured, stored, prepared, distributed, and served under sanitary conditions.(B) Dry or staple food items shall be stored above the floor in a ventilated room not subject to seepage or waste water backflow, or contamination by condensation.(C) Perishable foods shall be stored at the proper temperatures to conserve nutritive values and prevent spoilage.(4) Food service: (A) Food shall be served in a form consistent with the needs of the patient and his ability to consume it.(B) Food shall be served with appropriate utensils.(C) All equipment and work areas shall be promptly cleaned in accordance with acceptable written procedures.(D) Handwashing facilities, including hot and cold water, soap, and paper towels adjacent to work areas shall be provided.(E) Individuals needing special equipment, implements, or utensils to assist them when eating shall have such items provided.(F) If a patient misses a meal, a substitute meal shall be provided with equal nutritive value.(f) Organization and staffing. (1) The dietary department shall be directed by a dietitian and have sufficient dietitians and trained personnel to carry out the dietetic services. In facilities licensed for less than twenty-five patients, the dietary department may be directed by a full time trained dietetic service supervisor with consultation from a dietitian.(2) If the food service is directed by a dietetic service supervisor, there shall be frequent and regularly scheduled consultations by a dietitian. Consultation, training, and inservice education shall be appropriate to the staff and patient needs and shall be documented.(3) There shall be appropriate coordination between dietetic services staff and other hospital departments in the planning and evaluation of patient care.(4) The policies and procedures for the dietary department shall be current, and planned or reviewed by the dietitian at least annually.(5) Inservice training shall be provided at least quarterly for all dietary staff.(6) The current Hawaii Dietetic Association diet manual shall be readily available to all medical, nursing, and food service personnel.[Eff. 3/3/86; am AUG 3, 1992] (Auth: HRS §§ 321-9, 321-11) (Imp: HRS §§ 321-9, 321-11)