Section 124.16. Dietary services.

 

(1)   Dietary service. The hospital shall have a dietary service to provide meals and other nutritional services for its patients. The dietary service shall be integrated with other services of the hospital. If a 24-hour dietary service is not provided, dietary facilities or another means shall be available for obtaining nourishments for patients as needed.

(2)   Definitions. In this section:

(a) "Dietetic service supervisor" means a person who:

1. Is a dietitian;

2. Is a graduate of a dietetic technician or dietetic assistant training program, corresponding or classroom, approved by the American dietetic association;

3. Is a graduate of a state-approved course that provided 90 or more hours of classroom instruction in food service supervision and has experience as a supervisor in a health care institution with consultation from a dietitian; or

4. Has had training and experience in food service supervision and management in military service which is equivalent to the preparation under subd. 2. or 3.

(b) "Dietitian" means a person who is any of the following:

1. Certified under s. 448.78 , Stats.

2. Licensed or certified as a dietitian in another state.

(3)   Staffing and functions.

(a) The dietary service shall be directed by a full-time dietetic service supervisor and shall be staffed by at least one dietitian who is full-time, part-time or serving as a consultant, and by administrative and technical personnel who are competent to perform their duties. There shall be written job descriptions for all dietary employees.

(b)

1. The dietetic service supervisor shall be responsible for the daily management of the service.

2. The dietetic service supervisor shall attend and participate in meetings of heads of hospital services and shall function as a key member of the hospital staff.

3. The dietetic service supervisor shall have regularly scheduled conferences with the chief executive officer or designee to provide information, seek counsel and present program plans for mutual consideration and solution.

4. The dietetic service supervisor shall ensure that conferences are held regularly within the service at all levels of responsibility to disseminate information, interpret policy, solve problems and develop procedures and program plans.

(c)

1. The dietitian shall develop written policies and procedures for food storage, preparation and service.

2. The dietitian shall be available for consultation on a daily basis.

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, participating appropriately in ward rounds and conferences, recording in medical records and sharing specialized knowledge with others on the medical team.

(d) Adequate numbers of staff dietitians shall be employed to meet the needs of the hospital.

(e) Adequate numbers of supervisors, who may be dietitians or other qualified personnel, shall be assigned to supervise dietary operations.

(f)

1. The number of personnel working in the dietary service shall be adequate to effectively perform all defined functions.

2. Dietary personnel shall have available a manual of regimens for therapeutic diets, approved jointly by the dietitian and medical staff. Diets served to patients shall be in compliance with these established diet regimens.

3. There shall be an inservice training program for dietary employees which shall include instruction in proper storage, preparation and serving of food, safety, appropriate personal hygiene and infection control.

(g) A hospital that contracts for its dietary service shall be in compliance with this section if the contracted service meets all applicable rules of this section.

(4)   Facilities.

(a) Adequate facilities shall be provided to meet the general dietary needs of the patients. These include facilities for the preparation of special diets.

(b) Sanitary conditions shall be maintained in the storage, preparation and distribution of food.

(c) All dietary areas shall be appropriately located, adequate in size, well-lighted, ventilated and maintained in a clean and orderly condition.

(d) Equipment and work areas shall be clean and orderly. Effective procedures for cleaning and sanitizing all equipment and work areas shall be consistently followed in order to safeguard the health of the patients.

(e) Lavatories specifically for handwashing shall include hot and cold running water, soap and approved disposable towels, and shall be conveniently located throughout the service area for use by food handlers.

(f) The dietary service, when inspected and approved by state or local health agencies as a food handling establishment, shall have written reports of the inspection on file at the hospital with notation made by the hospital of action taken to comply with recommendations.

(g) Dry or staple food items shall be stored at least 12 inches off the floor in a ventilated room which is not subject to sewage or wastewater back-flow or contamination by condensation, leakage, rodents or vermin.

(h) All perishable foods shall be refrigerated at the appropriate temperature and in an orderly and sanitary manner.

(i) Foods being displayed or transported shall be protected from contamination and held at proper temperatures in clean containers, cabinets or serving carts.

(j) Dishwashing procedures and techniques shall be well-developed and understood by the responsible staff, with periodic monitoring of:

1. The operation of the detergent dispenser;

2. Washing, rinsing, and sanitizing temperatures and the cleanliness of machine and jets; and

3. Thermostatic controls.

(k) All garbage and kitchen refuse not disposed of through a garbage disposal unit shall be kept in watertight metal or plastic containers with close-fitting covers and disposed of daily in a safe and sanitary manner.

(L) Food and non-food supplies stored in the same room shall be clearly labeled and shall be stored in separate areas.

(5)   Records.

(a) A systematic record shall be maintained of all diets.

(b) Therapeutic diets shall be prescribed by the physician in written orders in the medical record.

(c) Nutritional needs shall be met in accordance with current recognized dietary standards and in accordance with physicians' orders.

(d) The staff person who instructs the patient in home diet shall document the instruction in the medical record.

(6)   Sanitation.

(a) Kitchen sanitation.

1. 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 corrodible and easily accessible for cleaning.

2. Utensils shall be stored in a clean, dry place protected from contamination.

3. The walls, ceilings and floors of all rooms in which food or drink is stored, prepared or served shall be kept clean and in good repair.

(b) Washing and sanitizing of kitchenware.

1. All reusable tableware and kitchenware shall be cleaned in accordance with accepted procedures, which shall include separate steps for prewashing, washing, rinsing and sanitizing.

2. Dishwashing procedures and techniques shall be well-developed, understood by dishwashing staff and carried out in compliance with state and local government health protection rules and ordinances. To make sure that serviceware is sanitized and to prevent recontamination, correct temperature maintenance shall be monitored during cleaning cycles.

(c) Food sources.

1. All food shall be procured from sources that process the food under regulated quality and sanitation controls. This does not preclude the use of local produce.

2. The hospital may not use home-canned foods.

(d) Cooks and food handlers. Cooks and food handlers shall wear clean outer garments and hair nets or caps, and shall keep their hands clean at all times when engaged in handling food, drink, utensils or equipment.

(e) Refrigeration. All refrigerators shall have a temperature maintained at or below 40º F. (4º C.).

Cr. Register, January, 1988, No. 385 , eff. 2-1-88; CR 04-040 : r. and recr. (2) (b) Register November 2004 No. 587 , eff. 12-1-04; CR 10-091 : am. (5) (c) Register December 2010 No. 660 , eff. 1-1-11.