This program will discuss the CMS hospital conditions of participation requirements for dietary and food and nutrition services. It is an important part of the CMS survey, and this area has received increased scrutiny of their standards especially in the area of Infection Control. Following a survey, CMS prepares a list of deficiencies or citations noted during a survey. This program will cover the common deficiencies received by hospitals from CMS in this area.

CMS now permits the Medical Staff and Board to credential and privilege qualified dieticians and qualified nutritional specialists to order the patient’s diet. This includes therapeutic diet, supplemental feeding, and enteral nutrition. This is also allowed for CAHs including swing beds. CMS has provided additional information about the C&P process for dieticians and this issue will be discussed in detail.

This program will also cover the Joint Commission Provision of Care chapter standards related to dietary and the TJC dietary tracer information. The tracer is used to assess and determine the degree of compliance with standards and elements of performance related to nutrition care. The tracer used through dietetic and food services covers some of the same issues discussed during the CMS survey.

Learning Objectives:-

• Discuss that the Joint Commission has a tracer for food and dietetic services
• Describe that CMS has a section on food and nutrition services in the hospital condition of participation standards
• Recall that the Joint Commission provision of care chapter has several standards on dietetic services

Detailed Outline:-

Introduction

• Conditions of Participation Manual
• Deficiency reports
• Recent changes to regulations
  • Credentialing and privileging qualified dieticians and qualified nutritional specialist
• Organized dietary services
• Director and qualified dietary staff required
• Must meet nutritional needs of patients
• Policies required
• Director who is full time and qualified
  • Responsibilities to include in job description
• Dietary policies and procedures
  • Safety practices for food handling, emergency food supplies, orientation, work assignment, menu planning, purchasing of food and supplies, etc.
  • Safety practices for food handling, emergency food supplies, orientation, work assignments, menu planning, purchasing of foods and supplies etc.
• Survey procedure questions
• Diets and menus to meet the needs of patients
• Therapeutic diets and guidelines
• Nutritional needs in accordance with recognized dietary practices
• Requirement for a diet order
• Current therapeutic diet manual approved by MS and dietician

CAH Dietary Standards

• Dietary standards
• Credentialing of Dietician
• Dietary services standards

TJC Provision of Care Standards related to Dietary

• Nutritional Screen
• Time frame for screens
• Food and nutrition
• Person responsible for food and nutrition services
• Proper sanitation, temperature, etc. of food and nutrition
• What to do if patient refuses food
• Accommodation of special diets
• Accommodation of ethnic food and nutrition preferences
• Storage of food and nutrition
• Therapeutic diet manual
• Patient education on nutritional interventions, diets, supplements

Topics Discussed Throughout the Patient Tracer Activity

• Assessment, care planning
• Instructions by qualified staff
• Identification and nutrition risk
• Nutrition screening criteria
• Time frames for nutrition assessment and re-evaluation
• Measuring food consumption
• Special population needs
  • NPO, on vents, in isolation, getting hyperalimentation
• Procedure to follow if patient refuses meals
• Discharge education and referrals
• Communications between dietician and food services

Dietary and food services day-to-day operation information

• Director of dietary qualifications
• Responsibilities of dietary and food services leaders
• Emergency/disaster plans
• Hospital diets and menus
• Food preparation and storage
• Safe food handling and health of food service staff
• Contracts for services, food, nutrition support supplies and formulas
• Sanitation and infection control (pest control, chemicals)
• Quality improvement activities etc.

Who Should Attend?

• Dieticians
• Director of dietary
• Dietary staff
• Joint Commission liaison or accreditation director DNV Healthcare
• CMS or regulatory staff
• Compliance officer
• Chief Operating Officer
• Chief Nursing Officer
• Nurses and nurse managers
• Nurse educator
• Chief Medical Officer
• Medical staff
• Anyone else responsible for complying with the CMS, DNV Healthcare or Joint Commission standards that affect dietary and nutrition services