Current through Reg. 49, No. 38; September 20, 2024
(a) A limited
services rural hospital (LSRH) shall have organized dietary services that are
directed and staffed by adequate qualified personnel.
(1) An LSRH that has a contract with an
outside food management company or an arrangement with another hospital may
meet this requirement if the food management company or other hospital:
(A) has a dietitian who serves the LSRH on a
full-time, part-time, or consultant basis;
(B) maintains at least the minimum
requirements specified in this section; and
(C) provides for the frequent and systematic
liaison with the LSRH medical staff for recommendations of dietetic policies
affecting patient treatment.
(2) The LSRH shall ensure that there are
sufficient personnel to respond to the dietary needs of the patient population
being served.
(b) The
LSRH shall employ a full-time staff who is qualified by experience or training
to serve as director of the food and dietetic service and is responsible for
the daily management of the dietary services. The director shall:
(1) comply with a job-specific position
description;
(2) clearly delineate
responsibility and authority;
(3)
participate in conferences with administration and department heads;
(4) establish, implement, and enforce
policies and procedures for the overall operational components of the LSRH's
dietary department that include:
(A)
integration of the food and dietetic service into the LSRH-wide quality
assessment and performance improvement program and infection control
program;
(B) the frequency of meals
served;
(C) nonroutine occurrences;
and
(D) identification of patient
trays; and
(5) maintain
authority and responsibility for at least the following:
(A) providing orientation and
training;
(B) evaluating staff
performance;
(C) providing work
assignments;
(D) supervising work
and food handling techniques including kitchen sanitation and acceptable
hygiene practices of food service personnel;
(E) procuring food, paper, chemical, and
other supplies, including implementing a first-in first-out rotation system for
all food items;
(F) ensuring there
is a four-day food supply on hand at all times;
(G) planning the menu; and
(H) ensuring compliance with Texas
Administrative Code Title 25 Chapter 228 (relating to Retail Food
Establishments).
(c) The LSRH shall employ a qualified
dietitian who works full-time, part-time, or on a consultant basis. If the LSRH
chooses to employ the dietician on a consultant basis, such services shall
occur at least once per month for not less than eight hours. The dietitian
shall:
(1) be currently licensed under the
laws of this state to use the titles of licensed dietitian or provisional
licensed dietitian, or be a registered dietitian;
(2) maintain professional practice
standards;
(3) supervise the
nutritional aspects of patient care;
(4) assess the nutritional status and
nutritional regimen adequacy, as appropriate;
(5) provide diet counseling and teaching, as
appropriate;
(6) document
nutritional status and pertinent information in patient medical records, as
appropriate;
(7) approve menus;
and
(8) approve menu
substitutions.
(d) The
LSRH shall employ administrative and technical personnel competent in their
respective duties. The administrative and technical personnel shall:
(1) participate in established departmental
or LSRH training pertinent to assigned duties;
(2) conform to food handling techniques in
accordance with subsection (b)(5)(D) of this section;
(3) adhere to clearly defined work schedules
and assignment sheets; and
(4)
comply with job-specific position descriptions.
(e) An LSRH shall ensure menus meet the needs
of the patients.
(f) A physician
responsible for the care of the patients shall prescribe therapeutic diets. The
LSRH's dietary department shall:
(1) establish
procedures for processing therapeutic diets, including:
(A) accurate patient
identification;
(B) transcription
from nursing to dietary services;
(C) diet planning by a dietitian;
(D) regular review and updating of diet when
necessary; and
(E) written and
verbal instruction to patient and family, which shall be in the patient's
primary language, if practicable, prior to discharge;
(2) ensure a qualified dietitian plans
therapeutic diets in writing;
(3)
ensure a qualified dietitian approves menu substitutions;
(4) document pertinent information about the
patient's response to a therapeutic diet in the patient's medical record;
and
(5) evaluate therapeutic diets
for nutritional adequacy.
(g) An LSRH shall meet patient nutritional
needs in accordance with recognized dietary practices and in accordance with
orders of a physician or appropriately credentialed practitioner responsible
for the care of the patients. The LSRH shall meet the following requirements.
(1) Menus shall provide a sufficient variety
of foods served in adequate amounts at each meal according to the guidance
provided in the Recommended Dietary Allowances (RDA), as published by the
National Research Council.
(2) The
LSRH shall not exceed 15 hours between providing the last meal of the day
(i.e., dinner) and the breakfast meal, unless a substantial snack is provided.
The LSRH shall adopt, implement, and enforce a policy on the definition of
"substantial" to meet each patient's varied nutritional needs.
(h) An LSRH shall have a current
therapeutic diet manual approved by the dietitian and medical staff readily
available to all medical, nursing, and food service personnel. The LSRH shall:
(1) revise the therapeutic manual as needed
and at least every five years;
(2)
ensure the therapeutic manual:
(A) is
appropriate for the diets routinely ordered in the LSRH;
(B) has standards in compliance with the RDA;
and
(C) contains specific diets
which are not in compliance with RDA; and
(3) ensure staff use the therapeutic manual
as a guide for ordering and serving diets.
