Circular No. 08/2011/TT-BYT guiding nutrition and rationing work in hospitals

CIRCULAR

Guidelines on Nutritional and Dietary Management in Hospitals
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Pursuant to Decree No. 188/2007/NĐ-CP dated December 27, 2007 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health.

The Ministry of Health issues guidelines on nutritional and dietary management in hospitals and research institutes with hospital beds (hereinafter referred to as hospitals) as follows:

PART I

SPECIALIZED WORK ON NUTRITION AND DIETARY MANAGEMENT

Article 1. Outpatient Nutrition Consultation

Clause 1. Organize outpatient nutrition consultation, assessment, and advice.

Clause 2. Record special diet prescriptions for outpatients requiring dietary treatment in medical records or outpatient treatment prescriptions.

Article 2. Monitoring and Evaluating Inpatient Nutritional Status During Treatment

Clause 1. Upon admission, patients must be measured for height and weight and recorded in their medical files. Specialized departments may specify additional indices based on specific needs to assess nutritional status.

Clause 2. Organize interdisciplinary consultations between the Nutrition and Dietary Management Department staff and treating physicians regarding dietary plans for particularly nutrition-related cases.

Article 3. Nutritional Treatment Through Special Diets for Inpatients

Clause 1. Treating physicians must evaluate and record the patient's nutritional status upon admission and during treatment.

Clause 2. Physicians must prescribe daily diets suitable for the patient's condition and record the diet code according to the Minister of Health's regulations in the treatment form within the medical file.

Clause 3. Develop intervention plans for malnourished patients or those requiring nutritional support.

Clause 4. Create meal plans and diets appropriate to the patient's condition and implement special diets as prescribed by the Minister of Health.

Article 4. Organization of Nutritional and Dietary Services

Clause 1. Patients prescribed special diets by physicians shall be provided meals in their rooms.

Clause 2. Provide dietary services to patients at the hospital.

Clause 3. Ensure safe food handling, preparation, and transportation.

Article 5. Implementation and Inspection of Food Safety Regulations in Hospitals

Clause 1. Implement food safety laws at hospital facilities providing food and beverage services.

Clause 2. Inspect compliance with food safety regulations at hospital facilities providing food and beverage services.

Article 6. Nutrition and Dietary Education and Communication

Clause 1. Develop educational materials on nutrition, dietary management, and food safety and disseminate them to patients, family members, and healthcare workers in hospitals.

Clause 2. Conduct health education and provide guidance to patients and family members on following special diets and ensuring food safety.

Article 7. Training, Line Guidance, and Scientific Research

Clause 1. Organize training for hospital doctors, nurses, and midwives on nutrition and dietary management.

Clause 2. Conduct scientific research and apply research results to nutrition and dietary management work.

Clause 3. Participate in training students and interns on nutrition and dietary management and provide line guidance when assigned.

Chapter II

CONDITIONS TO ENSURE NUTRITIONAL AND DIETARY MANAGEMENT IN HOSPITALS

Article 8. Nutrition and Metabolism Departments in Hospitals

1. State-owned hospitals from Class III onwards shall establish a Nutrition and Metabolism Department; special-class hospitals shall establish a Nutrition and Metabolism Department or a Clinical Nutrition Center; other hospitals shall establish a department or a nutrition and metabolism unit according to their respective conditions.

2. The Nutrition and Metabolism Department or Unit, which belongs to the clinical departments, shall be under the responsibility of the Director or Deputy Director in charge of specialized matters.

3. Organization of the Nutrition and Metabolism Department or Unit:

a) Leadership of the Department or Unit includes the Head of the Department (Unit Leader) and the Deputy Heads of the Department (Deputy Unit Leaders).

deputy head (deputy team leader).

b) Chief Nurse of the Department.

c) Professional units:

c) Specialized Sections:

- Therapeutic Nutrition Section.

- Food Preparation and Supply Section: this section can be carried out by the hospital itself or contracted with individuals or units that meet the necessary conditions for preparing and supplying therapeutic diets. This section is subject to professional supervision and food safety oversight by the Nutrition and Metabolism Department.

- Administrative Section.

4. Hospitals with a network of nutrition and metabolism: each clinical department shall appoint one doctor or nurse to participate in the nutrition and metabolism network.

Article 9. Human Resources for Nutrition and Metabolism Work

1. Leadership:

a) For the Department: the Head of the Department must be a doctor or a bachelor's degree holder in nutrition and metabolism or a university graduate trained in nutrition and metabolism.

b) For the Unit: the Unit Leader may be a doctor or a bachelor's degree holder in nutrition and metabolism or a university graduate trained in nutrition and metabolism.

2. Professional Staff: based on the scale of the hospital, the composition includes doctors, nurses, nutritional technicians, bachelor's degree holders in nutrition and metabolism, and personnel trained in food science and food processing.

3. Employees and service staff in the Nutrition and Metabolism Department must ensure they have adequate health as per current regulations and undergo regular health check-ups every six months, and are provided with complete uniforms as required.

Article 10. Tasks of the Nutrition and Metabolism Department and Other Positions

1. Tasks of the Nutrition and Metabolism Department

a) Implementing therapeutic diets for patients in the hospital according to current regulations and providing nutritional support (enteral, parenteral) for patients in clinical departments within the hospital.

b) Examining, consulting, and treating patients through dietary therapy.

c) Educating and disseminating information about nutrition and food safety to patients and other groups within the hospital.

đ) Monitoring the quality of nutrition, metabolism, and food safety for food preparation and supply units, food and beverage services within the hospital.

e) Conducting training, directing lower-level facilities on nutrition, metabolism, and food safety.

f) Conducting scientific research and applying advancements in nutrition, metabolism, and food safety technology in treatment, disease prevention, and health improvement.

2. Tasks of Other Positions

Shall be decided by the hospital director in accordance with the guidelines set forth in the Appendices issued together with this Circular (from Appendix 1 to Appendix 6).

Article 11. Infrastructure

1. The Nutrition and Metabolism Department (or Unit) shall organize the following work areas based on specific conditions at a minimum:

a) Administrative Room.

b) Kitchen Area for Food Preparation, Storage of Food, Milk Mixing, Meal Preparation, and Sample Retention.

c) Dining Area for Patients, Hospital Medical Staff, and Other Groups.

d) Based on practical needs, beds for nutritional recovery treatment, consultation rooms, and nutrition communication rooms may be arranged.

2. The Nutrition and Metabolism Department (or Unit) shall have a clean water supply system, waste disposal system, toilets, and fire prevention equipment.

3. The food preparation section shall be designed in a unidirectional flow. The food preparation and supply area in the hospital must comply with food safety laws and regulations.

Article 12. Equipment and Tools

Section (or team) of Nutrition and Dietetics shall have the following equipment and tools:

1. Tools for nutritional examination and consultation services: scales, height measurement devices, and other tools meeting the specialized requirements of each hospital.

2. Specialized tools: cooking stoves, food preservation and preparation tools, food storage tools, sample food storage tools, washing and tool preservation systems.

3. Means to transport meals to patients.

4. Quick safety food testing kits.

5. Office equipment: computers, printers, cabinets, desks and chairs.

6. Other tools as required by specialized needs.

Chapter III

RESPONSIBILITIES FOR IMPLEMENTATION

Article 13. Responsibilities of the Hospital Director

1. Issuing specific regulations on nutrition and dietetic work within the hospital.

2. Investing funds for upgrading infrastructure, equipment, and annual regular funding for nutrition and dietetic work.

3. Ensuring sufficient human resources, means, equipment, chemicals, and materials for the implementation of nutrition, dietetic, and food safety practices within the hospital.

4. Organizing inspections on the implementation of Circulars guiding nutrition and dietetic work within the hospital.

5. Promoting competitive activities and implementing rewards and disciplinary actions regarding nutrition and dietetic work within the hospital.

Article 14. Responsibilities of Heads of Functional Departments

1. Cooperating with the Section (or team) of Nutrition and Dietetics in organizing the implementation of regulations related to nutrition and dietetics within their respective fields of responsibility.

2. Cooperating with the Section (or team) of Nutrition and Dietetics to develop specific regulations on nutrition and dietetics for approval by the Director and supervising the implementation of these regulations.

3. The Finance and Accounting Department shall cooperate with the Section (or team) of Nutrition and Dietetics to ensure transparency in revenue and expenditure for patient meal programs.

Article 15. Responsibilities of Heads of Clinical Departments

1. Implementing regulations on nutrition, dietetic, and food safety work.

2. Supervising doctors, nurses, and midwives in implementing care and nutrition regulations for patients.

3. Organizing guidance for patients, family members, and visitors to comply with nutrition and dietetic regulations related to patients, their families, and visitors.

4. Promptly identifying and reporting cases of foodborne infections and unsafe food to the Section of Nutrition and Dietetics and hospital leadership for timely resolution.

5. Collaborating with the Section of Nutrition and Dietetics to organize health education on nutrition and dietetics for patients and their families; inspecting and evaluating nutrition and dietetic work during treatment.

Article 16. Responsibilities of Treating Doctors

1. Monitoring and checking patient feeding and food safety measures related to patients.

2. Providing necessary patient information to the Section of Nutrition and Dietetics for appropriate feeding regimes.

3. Proactively inviting Nutrition and Dietetics staff to participate in consultations for cases related to nutrition or requiring nutritional support.

Article 17. Responsibilities of the Head Nurse of Clinical Departments

1. Check the daily compilation of dietary regimens for patients according to the physician's prescription and report to the Nutrition and Metabolism Department to prepare the dietary regimen for patients in the department.

2. Organize the reception of meals and assist patients with eating in the department.

3. Inspect the implementation of dietary regimens by healthcare staff and patients in the department.

Article 18. Responsibilities of the Head of the Microbiology Department

1. Timely notify the Nutrition and Metabolism Department, Infection Control Department, and clinical departments about the results of foodborne pathogen testing.

2. Coordinate with the Nutrition and Metabolism Department and clinical departments to conduct food safety inspections within the hospital.

Article 19. Responsibilities of the Head of the Infection Control Department

1. Identify and report cases of infections related to food consumption to the Nutrition and Metabolism Department.

2. Collaborate with the Nutrition and Metabolism Department in infection control activities to ensure food safety.

Article 20. Responsibilities of the Head of the Pharmacy Department

1. Provide information on therapeutic nutritional products, intravenous feeding solutions, digestive support medications (protein, fat, carbohydrates, minerals, vitamins) relevant to nutrition and metabolism to the Nutrition and Metabolism Department.

2. Collaborate with the Nutrition and Metabolism Department to propose procurement, supply, and use of chemicals necessary for nutrition and metabolism activities and food safety.

Article 21. Responsibilities of Hospital Staff

1. Participate in training courses and continuing education on nutrition and metabolism.

2. Adhere to regulations concerning nutrition, metabolism, and food safety.

Article 22. Responsibilities of Patients, Patient Relatives, and Visitors

1. Follow the physician's prescription regarding dietary regimens.

2. Comply with hospital guidelines on nutrition and metabolism for patients.

3. Cooperate with healthcare personnel to assist patients with eating.

Chapter IV

IMPLEMENTING PROVISIONS

Article 23. Effectiveness of Implementation

This Circular takes effect from March 1, 2011.

Repeal the Regulation on Nutrition Department Operations and the Regulation on the Functions and Duties of the Head of the Nutrition Department issued together with Decision No. 1895/1997/BYT-QĐ dated September 19, 1997, of the Minister of Health.

Article 24. Implementation Organization

The Director of the Department of Medical Examination and Treatment, the Directors of hospitals under the Ministry of Health, the Directors of Health Services of provinces and centrally-administered cities, and the Heads of Health Services of other sectors are responsible for organizing the implementation and monitoring the enforcement of this Circular./.