| (ii) maintain standards for professional practice;
(iii) supervise the nutritional aspects of patient
care;
(iv) make an assessment of the nutritional status and
adequacy of nutritional regimen, as appropriate;
(v) provide diet counseling and teaching, as appropriate;
(vi) document nutritional status and pertinent information
in patient medical records, as appropriate;
(vii) approve menus; and
(viii) approve menu substitutions.
(C) There shall be administrative and technical personnel
competent in their respective duties. The administrative and technical
personnel shall:
(i) participate in established departmental or hospital
training pertinent to assigned duties;
(ii) conform to food handling techniques in accordance
with paragraph (2)(E)(viii) of this subsection;
(iii) adhere to clearly defined work schedules and
assignment sheets; and
(iv) comply with position descriptions which are job
specific.
(2) Director. The director shall:
(A) comply with a position description which is job
specific;
(B) clearly delineate responsibility and authority;
(C) participate in conferences with administration
and department heads;
(D) establish, implement, and enforce policies and
procedures for the overall operational components of the department
to include, but not be limited to:
(i) quality assessment and performance improvement
program;
(ii) frequency of meals served;
(iii) nonroutine occurrences; and
(iv) identification of patient trays; and
(E) maintain authority and responsibility for the following,
but not be limited to:
(i) orientation and training;
(ii) performance evaluations;
(iii) work assignments;
(iv) supervision of work and food handling techniques;
(v) procurement of food, paper, chemical, and other
supplies, to include implementation of first-in first-out rotation
system for all food items;
(vi) ensuring there is a four-day food supply on hand
at all times;
(vii) menu planning; and
(viii) ensuring compliance with Chapter 228 of this
title (relating to Retail Food).
(3) Diets. Menus shall meet the needs of the patients.
(A) Therapeutic diets shall be prescribed by the physician(s)
responsible for the care of the patients. The dietary department of
the hospital shall:
(i) establish procedures for the processing of therapeutic
diets to include, but not be limited to:
(I) accurate patient identification;
(II) transcription from nursing to dietary services;
(III) diet planning by a dietitian;
(IV) regular review and updating of diet when necessary;
and
(V) written and verbal instruction to patient and family.
It shall be in the patient's primary language, if practicable, prior
to discharge. What is or would have been practicable shall be determined
by the facts and circumstances of each case;
(ii) ensure that therapeutic diets are planned in writing
by a qualified dietitian;
(iii) ensure that menu substitutions are approved by
a qualified dietitian;
(iv) document pertinent information about the patient's
response to a therapeutic diet in the medical record; and
(v) evaluate therapeutic diets for nutritional adequacy.
(B) Nutritional needs shall be met in accordance with
recognized dietary practices and in accordance with orders of the
physician(s) or appropriately credentialed practitioner(s) responsible
for the care of the patients. The following requirements shall be
met.
(i) 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 Food and Nutrition Board, Commission on Life Sciences, National
Research Council, Tenth edition, 1989, which may be obtained by writing
the National Academies Press, 500 Fifth Street, NW Lockbox 285, Washington,
D.C. 20055, telephone (888) 624-8373.
(ii) A maximum of 15 hours shall not be exceeded between
the last meal of the day (i.e. supper) and the breakfast meal, unless
a substantial snack is provided. The hospital shall adopt, implement,
and enforce a policy on the definition of "substantial" to meet each
patient's varied nutritional needs.
(C) A current therapeutic diet manual approved by the
dietitian and medical staff shall be readily available to all medical,
nursing, and food service personnel. The therapeutic manual shall:
(i) be revised as needed, not to exceed 5 years;
(ii) be appropriate for the diets routinely ordered
in the hospital;
(iii) have standards in compliance with the RDA;
(iv) contain specific diets which are not in compliance
with RDA; and
(v) be used as a guide for ordering and serving diets.
(e) Emergency services. All licensed hospital locations,
including multiple-location sites, shall have an emergency suite that
complies with §133.161(a)(1)(A) of this title (relating to Requirements
for Buildings in Which Existing Licensed Hospitals are Located) or §133.163(f)
of this title, and the following.
(1) Organization. The organization of the emergency
services shall be appropriate to the scope of the services offered.
(A) The services shall be organized under the direction
of a qualified member of the medical staff who is the medical director
or clinical director.
(B) The services shall be integrated with other departments
of the hospital.
(C) The policies and procedures governing medical care
provided in the emergency suite shall be established by and shall
be a continuing responsibility of the medical staff.
(D) Medical records indicating patient identification,
complaint, physician, nurse, time admitted to the emergency suite,
treatment, time discharged, and disposition shall be maintained for
all emergency patients.
(E) Each freestanding emergency medical care facility
shall advertise as an emergency room. The facility shall display notice
that it functions as an emergency room.
(i) The notice shall explain that patients who receive
medical services will be billed according to comparable rates for
hospital emergency room services in the same region.
(ii) The notice shall be prominently and conspicuously
posted for display in a public area of the facility that is readily
available to each patient, managing conservator, or guardian. The
postings shall be easily readable and consumer-friendly. The notice
shall be in English and in a second language appropriate to the demographic
makeup of the community served.
(2) Personnel.
(A) There shall be adequate medical and nursing personnel
qualified in emergency care to meet the written emergency procedures
and needs anticipated by the hospital.
(B) Except for comprehensive medical rehabilitation
hospitals and pediatric and adolescent hospitals that generally provide
care that is not administered for or in expectation of compensation:
(i) there shall be on duty and available at all times
at least one person qualified as determined by the medical staff to
initiate immediate appropriate lifesaving measures; and
(ii) in general hospitals where the emergency treatment
area is not contiguous with other areas of the hospital that maintain
24 hour staffing by qualified staff (including but not limited to
separation by one or more floors in multiple-occupancy buildings),
qualified personnel must be physically present in the emergency treatment
area at all times.
(C) Except for comprehensive medical rehabilitation
hospitals and pediatric and adolescent hospitals that generally provide
care that is not administered for or in expectation of compensation,
the hospital shall provide that one or more physicians shall be available
at all times for emergencies, as follows.
(i) General hospitals, except for hospitals designated
as critical access hospitals (CAHs) by the Centers for Medicare &
Medicaid Services (CMS), located in counties with a population of
100,000 or more shall have a physician qualified to provide emergency
medical care on duty in the emergency treatment area at all times.
Cont'd... |
