Current through Register Vol. 35, No. 11, June 11, 2024
Section 7.7.2.28 - DIETARY SERVICESThe hospital shall provide a 24-hour dietary service or contract for a 24-hour dietary services which meets the requirements of this section, and which shall provide meals and other nutritional care to its patients. The dietary service shall be integrated with other services of the hospital.
A. Administrative.(1) There shall be written policies and procedures for food storage, preparation and service and clinical aspects developed by the dietitian.(2) There shall be a qualified person serving as full-time director of the service who shall be responsible for the daily management aspects of the service.(3) The dietitian shall participate in the nutritional aspects of patient care by means that include assessing the nutritional status of patients, instructing patients, recording diet histories, interpreting and integrating therapeutic principles, participating appropriately in patient rounds and conferences, and recording in medical records and sharing specialized knowledge with others on the medical team.(4) There shall be written job descriptions for all dietary employees.(5) The dietitian shall be responsible for maintaining a current diet manual for therapeutic diets, approved jointly by the dietitian and a qualified member of the medical staff. The dietetic manual shall be developed on recognized current therapeutic practices. The dietitian shall recommend this manual to a qualified member of the medical staff for approval for use in the facility. All changes must be submitted to a qualified member of the medical staff for approval prior to inclusion in the manual.(6) There shall be an in service training program for dietary employees which shall include instruction in proper storage, preparation and serving food, safety, appropriate personal hygiene and infection control.(7) A menu cycle shall be available and posted. Substitutions of equal nutritional value are acceptable and shall be noted. The hospital must keep for 30 days a record of each menu as served.(8) A hospital that contracts for its dietary services shall be in compliance with this section if the contracted services meets all applicable rules of this section.B. Facilities.(1) Adequate facilities shall be provided to meet the dietary needs of the patients.(2) Sanitary conditions shall be maintained for the storage, preparation and distribution of food.(3) All dietary areas shall be appropriately located, adequate in size, well-lighted, ventilated and maintained in a clean and orderly condition.(4) Equipment and work areas shall be clean and orderly. Effective procedures for cleaning and sanitizing all equipment and work areas shall be followed consistently to safeguard the health of the patients, staff and visitors.(5) Lavatories specifically for hand-washing shall include hot and cold running water, soap, and disposable towels or air dryers, and shall be conveniently located throughout the service area for use by dietary staff.(6) The dietary service shall have written reports of the most recent environmental or licensing inspection on file at the hospital with notation made by the hospital of action taken to comply with recommendations or citations.(7) Dry or staple food items shall be stored off the floor in a ventilated room which is not subject to sewage or waste water back-flow or contamination by condensation, leakage, rodents or vermin.(8) All perishable foods shall be refrigerated and the temperature maintained at, or below, 40 degrees Fahrenheit.(9) Hot food shall be maintained at 140 degrees Fahrenheit, or higher.(10) Foods being displayed or transported shall be protected from environmental contamination and maintained at proper temperatures in clean containers, cabinets or serving carts.(11) Dishwashing procedures and techniques shall be well-developed and understood by the responsible staff, with periodic monitoring of the operation of the detergent dispenser, washing, rinsing, and sanitizing temperatures and the cleanliness of machine and jets, and thermostatic controls.(12) A daily log of recorded temperatures for all refrigerators, freezers, steam tables and dishwashers must be maintained and available for inspection for 30 days.(13) All garbage and kitchen refuse not disposed of through a garbage disposal unit shall be kept in watertight containers with close-fitting covers and disposed of daily in a safe and sanitary manner.(14) Food and non-food supplies shall be clearly labeled and dated and shall be stored in separate areas.(15) No hazardous non-food items shall be stored in the proximity of materials that could compromise the safety of the food supply.(16) The dietitian shall be responsible for, and active in, the hospital's quality improvement program.C. Records.(1) A systematic record shall be maintained of all diets.(2) Therapeutic diets shall be prescribed by an authorized individual in written orders on the medical record.(3) Nutritional needs shall be in accordance with physicians' orders and, to the extent medically possible, in accordance with the "recommended daily dietary allowance" of the food and nutrition board of the national research council, national academy of sciences. A current edition of these standards shall be available in the dietary service.(4) The qualified staff person who instructs the patient in home diet shall document this in the medical record.D. Sanitation. All practices shall be in accordance with the standards of the New Mexico environment department.(1) Kitchen sanitation.(a) Equipment and work areas shall be clean and orderly. Surfaces with which food or beverages come into contact shall be of smooth, impervious material free of open seams, not readily corrosible and easily accessible for cleaning.(b) Utensils shall be stored in a clean, dry place protected from contamination.(c) The walls, ceiling and floors of all rooms in which food or drink is stored, prepared or served shall be kept clean and in good repair.(2) Washing and sanitizing of kitchenware.(a) All reusable tableware and kitchenware shall be cleaned in accordance with procedures as outlined by the New Mexico environment department, which shall include separate steps for pre-washing, washing, rinsing and sanitizing.(b) Dishwashing procedures and techniques shall be well-developed, understood by dishwashing staff and carried out according to policy. To make sure that service ware is sanitized and to prevent recontamination, correct temperature maintenance shall be monitored during cleaning cycles.(3) Canned or preserved foods. (a) All processed food shall be procured from sources that process the food under regulated quality and sanitation controls. This does not preclude the use of local fresh produce.(b) The hospital may not use home-canned foods.(4) Cooks and food handlers. Cooks and food handlers shall wear clean outer garments and hair nets or caps and gloves as needed, and shall keep their hands clean at all times when engaged in handling food, drink, utensils or equipment. Food handlers must obtain a tuberculosis test, prior to employment and as often as required thereafter according to hospital policy.(5) Milk. (a) Raw milk shall not be used.(b) Milk for drinking shall be grade A pasteurized whole milk (3 1/4%) milk fat or greater and not less than (8 ¼% milk solids, not fat) or any other grade A fluid milk product as defined in the New Mexico Restaurant Act (includes skim milk, low-fat milk, and cream products) unless otherwise requested by the patient or as a part of a therapeutic diet.(c) Condensed, evaporated, and/or dried milk products which are recognized nationally, may be employed as "additives" in cooked food preparation but shall not be substituted or served to patients (adult, child, or infant) in place of milk as approved for drinking purposes. These products shall be handled and stored in accordance with the requirements of the current dietary practices.7.7.2.28 NMAC - Rp, 7.7.2.28 NMAC, 06-15-04; 7.7.2.28 NMAC - Rn, 7.7.2.27 NMAC, 03-15-06