10A NCAC 13B .4702      ORGANIZATION

(a)  The nutrition and dietetic services shall be under the full-time direction of a person who is trained or experienced in food services administration and therapeutic diets. The director shall be one of the following:

(1)           A qualified dietitian;

(2)           Bachelor's degree in Foods and Nutrition or Food Service Management;

(3)           Dietetic Technician Registered (DTR); or

(4)           Certified Dietary Manager (CDM); or

(5)           An individual who is enrolled in a program to complete the minimum qualifications in Paragraph (a)(1)(2)(A)(B)(C) of this Rule.

(b)  The nutrition and dietetic services of the facility shall have at least one dietitian either full-time, part-time, or as consultant. The qualifications of the dietitian shall be included in the personnel files. If the director of nutrition and dietetic services is not a registered dietitian, there shall be an established method of communication between the director and the dietitian which ensures that the dietitian supervises the nutritional aspects of patient care and ensures that quality nutritional care is provided to patients. Dietitians or qualified designees shall attend and participate in meetings relevant to patient nutritional care, including but not limited to patient care conferences and discharge planning.

(c)  When a dietitian serves only in a consultant capacity, the facility management shall establish and maintain a written contract with the individual defining the responsibilities of the dietician including requirements for submission of written reports to the hospital administrator and the director of the nutrition and dietetic services describing the extent and quality of the services provided. Frequency of visits of the consultant dietitian shall be defined in the contract. The consultant dietitian shall provide, on site, no less than eight hours of service every two weeks to provide the nutritional aspects of patient care including but not limited to the following:

(1)           approval of regular and modified menus, including standardized recipes;

(2)           performance of nutritional assessments;

(3)           development of nutrition care plans;

(4)           provision of nutrition therapy;

(5)           participation in development of policies and procedures; and

(6)           monitoring and evaluation of the effectiveness and appropriateness of nutrition and dietetic services.

(d)  The facility shall establish and maintain written policies and procedures to govern all nutrition and dietetic service activities. These policies shall be developed by the nutrition and dietetic services in cooperation with personnel from other departments or services which are involved with nutrition and dietetic services and they shall be reviewed at least every three years, revised as necessary, and dated to indicate the time of last review. Administrative policies and procedures concerning food procurement, preparation, and service shall be written by the director of the nutrition and dietetic services. Nutritional care policies and procedures shall be written by the qualified dietitian. The nutrition and dietetic service policies and procedures shall include, but not be limited to the following:

(1)           provision of food and nutrition therapy prescriptions/orders;

(2)           development, approval and provision of regular and modified menus, including standardized recipes;

(3)           food purchasing, storage, inventory, preparation and service;

(4)           identification system designed to ensure that each patient receives appropriate diet as ordered;

(5)           ancillary dietetic services, as appropriate, including food storage and kitchens on patient care units, formula supply, cafeterias, vending operations and ice making;

(6)           preparation, storage, distribution, and administration of enteral nutrition programs;

(7)           assessment and monitoring of patients receiving enteral and total parenteral nutrition;

(8)           personal hygiene and health of dietetic personnel;

(9)           infection control measures to minimize the possibility of contamination and transfer of infection, including establishment of monitoring procedure to ensure that personnel are free from communicable infections and open skin lesions; and

(10)         pertinent safety practices, including control of electrical, flammable, mechanical, and radiation hazards.

(e)  Nutrition and dietetic services shall be provided by qualified personnel under supervision to meet needs of patients. The director of the nutrition and dietetic services shall require that personnel assigned to the department perform all functions necessary to meet the nutritional needs of patients. The director or qualified designee shall attend and participate in meetings, including that of department heads, and function as an integral member of the facility.

(f)  A facility which has a contract with an outside food management service, shall require as a part of the contract that the company complies with all applicable requirements and standards outlined in Section .4700 of this Subchapter for such service. The contract shall be available for review by the Division.

History Note:        Authority G.S. 131E-79;

RRC objection due to lack of statutory authority Eff. July 13, 1995;

Eff. January 1, 1996;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 22, 2017.