481—51.20 (135B) Food and nutrition services.
	 51.20(1) Food and nutrition service definition. “Food service” means providing safe, satisfying, and nutritionally adequate food for patients through the provision of appropriate staff, space, equipment, and supplies. “Nutrition service” means providing assessment and education to ensure that the nutritional needs of the patients are met.
	 51.20(2) General requirements.
	  a.   	 All food shall be handled, prepared, served, and stored in compliance with the requirements of the 2005 Food and Drug Administration Food Code with Supplement adopted under provisions of Iowa Code section 137F.2.
	  b.   	 The food service shall provide food of the quality and quantity to meet the patient’s needs in accordance with the qualified health practitioner’s orders and, to the extent medically possible, to meet the current Recommended Dietary Allowances, adopted by the Food and Nutrition Board of the National Research Council, National Academy of Sciences, and the following:
	 (1) 	 Not less than three meals shall be served daily unless contraindicated.
	 (2) 	 Not more than 14 hours shall elapse between the evening meal and breakfast of the following day.
	 (3) 	 Nourishment between meals shall be available to all patients unless contraindicated by the qualified health care practitioner.
	 (4) 	 Patient food preferences shall be respected as much as possible, and substitutes shall be offered through use of appropriate food groups.
	 (5) 	 When food is provided by a contract food service, all applicable requirements set forth herein shall be met. The hospital shall maintain adequate space, equipment, and staple food supplies to provide patient food service in emergencies.
	  c.   	 Policies and procedures shall be developed and maintained in consultation with representatives of the medical staff, nursing staff, food and nutrition service staff, pharmacy staff, and administration to govern the provision of food and nutrition services. Policies and procedures shall be approved by the medical staff, administration, and governing body.
	  d.   	 A current diet manual approved by the dietitian and the medical staff shall be used as the basis for diet orders and for planning therapeutic diets. The diet manual shall be reviewed, revised and updated at least every five years. Copies of the diet manual shall be readily available to all medical, nursing, and food service personnel.
	  e.   	 Therapeutic diets shall be provided as prescribed by the qualified health care practitioner and shall be planned, prepared, and served with supervision or consultation from the licensed dietitian. Persons responsible for therapeutic diets shall have sufficient knowledge of food to make appropriate substitutions when necessary.
	  f.   	 The patient’s diet card shall state likes, dislikes, food allergies, and other pertinent information.
	  g.   	 Menus.
	 (1) 	 Menus for regular and therapeutic diets shall be written, approved, dated and available in the food service area at least one week in advance.
	 (2) 	 If meals served vary from the planned menu, the change shall be noted in writing as part of the available menu. A copy of the menu as served shall be kept on file for at least 30 days.
	 (3) 	 Menus should be planned with consideration for cultural and religious background and food habits of patients.
	 (4) 	 Standardized recipes with nutritional analysis adjusted to number of portions shall be maintained and used in food preparation.
	  h.   	 Food shall be prepared by methods that conserve nutritive value, flavor, and appearance. Food shall be served attractively at appropriate and safe temperatures and in a form to meet individual needs.
	  i.   	 Nutritional care.
	 (1) 	 Nutrition screening shall be conducted by qualified hospital staff to determine the patient’s need for a comprehensive nutrition assessment by the licensed dietitian.
	 (2) 	 Nutritional care shall be integrated in the patient care plan, as appropriate, based upon the patient’s diagnosis and length of stay.
	 (3) 	 The licensed dietitian shall record in the patient’s medical record any observations and information pertinent to medical nutrition therapy.
	 (4) 	 Pertinent dietary records shall be included in the patient’s transfer discharge record to ensure continuity of nutritional care.
	 (5) 	 Upon discharge, nutrition counseling and education shall be provided to the patient and family as ordered by the qualified health care practitioner, requested by the patient or deemed appropriate by the licensed dietitian.
	  j.   	 In-service training, in accordance with hospital policies, shall be provided for all food and nutrition service personnel. A record of subject areas covered, date and duration of each session, and attendance lists shall be maintained. In-service records shall be kept for a minimum of one year.
	  k.   	 On the nursing units, a separate patient food storage area shall be maintained that ensures proper temperature control.
	 51.20(3) Food and nutrition service staff.
	  a.   	 A licensed dietitian shall be employed on a full-time, part-time or consulting basis. Part-time or consultant services shall be provided on the premises at appropriate times on a regularly scheduled basis. These services shall be of sufficient duration and frequency to provide continuing liaison with medical and nursing staffs, advice to the administrator, patient counseling, guidance to the supervisor and staff of the food and nutrition service, approval of all menus, and participation in the development or revision of departmental policies and procedures and in planning and conducting in-service education programs.
	  b.   	 If a licensed dietitian is not employed full-time, then one must be employed on a part-time or consultation basis with an additional full-time person who has completed a 250-hour dietary manager course and who shall be employed to be responsible for the operation of the food service.
	  c.   	 Sufficient food service personnel shall be employed, oriented, trained, and their working hours scheduled to provide for the nutritional needs of the patients and to maintain the food service areas. If food service employees are assigned duties in other service areas, those duties shall not interfere with the sanitation, safety, or time required for food service work assignments.
	 51.20(4) Food service equipment and supplies. Equipment necessary for preparation and maintenance of menus, records, and references shall be provided. At least one week’s supply of staple foods and a reasonable supply of perishable foods shall be maintained on the premises. Supplies shall be appropriate to meet the requirements of the menu.
[ARC 9252B, IAB 12/1/10, effective 1/5/11]