Circular No. 18/2020/TT-BYT on nutrition activities in hospitals

CIRCULAR

REGULATIONS ON NUTRITION ACTIVITIES IN HOSPITALS

Pursuant to the Law on Medical Examination and Treatment No. 40/2009/QH12;

Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Examination and Treatment,

The Minister of Health issues this Circular to regulate nutrition activities in hospitals.

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation and Applicability

Article 1. This Circular stipulates professional nutrition activities, conditions for ensuring such activities, and responsibilities for implementing nutrition activities in hospitals.

Article 2. This Circular applies to agencies, organizations, and individuals related to nutrition activities in hospitals.

Article 2. Principles of Nutrition Activities in Hospitals

Clause 1. Hospitals must organize nutrition activities in conjunction with outpatient and inpatient medical services.

Clause 2. Patients seeking outpatient medical services shall be screened for nutritional risk factors; those admitted for inpatient care shall be screened and assessed for their nutritional status.

Clause 3. Patients shall be prescribed appropriate nutritional regimens based on their nutritional status and medical conditions.

Clause 4. Treating physicians and nutrition department physicians shall decide on the nutritional regimen for patients.

Clause 5. Personnel involved in nutrition work must have the appropriate professional qualifications for their assigned duties.

Chapter II

PROFESSIONAL NUTRITION ACTIVITIES IN HOSPITALS

Article 3. Screening Nutritional Risk Factors, Advising, and Prescribing Nutritional Regimens for Outpatients

Clause 1. Outpatients shall be screened for nutritional risk factors such as weight loss, reduced food intake, body mass index (BMI), and other risk factors.

Clause 2. Patients at nutritional risk, suffering from malnutrition, or having diseases related to nutrition shall be advised and prescribed appropriate therapeutic nutritional regimens, which shall be recorded in their outpatient medical records or medical files.

Article 4. Examination, Diagnosis, Assessment of Nutritional Status, Prescription of Treatment, and Monitoring of Nutritional Status for Inpatients

Clause 1. Inpatients shall be screened for nutritional risk factors, examined, diagnosed, and prescribed nutritional treatment within 36 hours from admission, and the information shall be recorded in their medical files.

Clause 2. Inpatients at nutritional risk shall be assessed for their nutritional status, diagnosed, prescribed appropriate therapeutic nutritional regimens, monitored, and reassessed throughout the treatment process.

Clause 3. Inpatients not at nutritional risk shall be rescreened every seven days during hospitalization and the information shall be recorded in their medical files.

Clause 4. Inpatients shall be prescribed daily nutritional regimens appropriate to their nutritional status and medical conditions, and the nutritional regimen code shall be recorded on the treatment sheet according to Decision No. 2879/QD-BYT dated August 10, 2006 of the Ministry of Health guiding hospital meal regimens.

Clause 5. For severely malnourished patients or those classified as Level I care, the treating physician must consult with a nutrition department physician or dietitian to prescribe and develop appropriate nutritional regimens based on their nutritional status and medical conditions.

Clause 6. Patients must be supported, monitored, and supervised in adhering to their prescribed nutritional regimens throughout the treatment process.

Article 5. Counseling and Communication on Nutrition

Clause 1. Hospitals shall develop counseling and communication materials on nutrition and food safety for patients and their families within the hospital.

Clause 2. Hospitals shall provide counseling and communication on nutrition and food safety to patients and their families.

Chapter III

Article 6. Conditions for Organizing Nutritional Activities in Hospitals

1. Organization of nutritional activities: Based on the regulations governing the organization and operation of hospitals, the establishment of a Nutrition Department or a Nutrition Unit within the clinical sector of the hospital shall be carried out as follows:

a) For hospitals with a scale of 100 beds or more, a Nutrition Department must be established. There must be at least one person specializing in nutrition for every 100 beds.

b) For hospitals with fewer than 100 beds, if a Nutrition Department cannot be established, there must be a Nutrition Unit or a full-time person responsible for nutrition.

2. The Nutrition Department must have the following units:

a) A nutrition counseling unit.

b) A therapeutic nutrition unit.

c) A food preparation and supply unit for dietary needs. If such a unit does not exist, the hospital must enter into a contract with external organizations or individuals to prepare meals on-site at the hospital, and these organizations or individuals must be subject to professional supervision and food safety oversight by the Nutrition Department.

Article 7. Personnel Specializing in Nutrition

1. The Head of the Nutrition Department must be a full-time employee specializing in nutrition, including:

a) A medical doctor or general practitioner with at least six months of training in clinical nutrition.

b) A nutritionist with a bachelor's degree or higher if the hospital does not have a doctor meeting the requirements set forth in point a of this Clause.

2. Personnel specializing in therapeutic nutrition are medical doctors or general practitioners with certification in clinical nutrition or a nutritionist.

1. The hospital must allocate physical facilities to ensure nutritional activities as follows:

a) The Nutrition Department or Nutrition Unit.

b) The meal preparation area and dining room must be designed, constructed, and arranged at a distance from the autopsy area, waste storage areas, laundry areas, isolation areas for infectious diseases, and must meet the legal requirements for food safety.

2. Pediatric and Neonatal Departments must have a milk preparation area: The milk preparation area must have instructions on how to prepare milk; hot and cold water; clean water, hand washing sink, and hand washing solution.

Chapter IV

RESPONSIBILITIES FOR IMPLEMENTATION

Article 9. Tasks of the Nutrition Department or Nutrition Unit

1. Advising hospital leadership on nutritional activities within the hospital.

2. Developing and implementing technical procedures for clinical nutrition within the hospital.

3. Organizing and conducting examination, counseling, and treatment activities using appropriate dietary regimens based on the nutritional status and disease conditions of patients.

4. Organizing the development of appropriate dietary regimens based on the nutritional status and disease conditions of inpatient patients.

5. Coordinating with clinical departments to prescribe dietary regimens for patients suffering from severe malnutrition and those classified as level one care.

6. Managing food supplies, preparing, and providing dietary regimens for bedridden patients. Monitoring and supervising food safety within the hospital.

7. Inspecting and supervising the implementation of regulations concerning nutritional activities in clinical departments and throughout the hospital.

8. Serving as the focal point for developing advisory and communication materials on nutrition and food safety for patients, patient families, and other groups within the hospital.

9. Conducting training and directing lower-level facilities on nutrition and food safety.

10. Engaging in scientific research and applying advancements in nutrition and food safety technology in treatment, disease prevention, and health improvement.

Article 10. Tasks of other clinical departments in organizing nutritional activities

1. Receive and organize the implementation of dietary regimens for patients.

2. Guide and supervise patients to follow dietary regimens as prescribed.

3. Coordinate with the Nutrition Department or nutrition section to inspect and supervise professional regulations on nutritional activities and to promote and advise on nutrition for patients and their families within the department.

Article 11. Responsibilities of the Hospital Director

1. Issue regulations on nutritional activities in the hospital.

2. Organize the implementation of nutritional activities in the hospital and bear full responsibility for nutritional activities in the hospital.

3. Establish a nutrition network in the hospital according to professional requirements, including the participation of clinical departments and related sections involved in nutritional activities.

4. Ensure material resources, equipment, supplies, human resources, and annual operating funds for nutritional activities.

Article 12. Responsibilities of professional positions in nutrition

1. Head of the Nutrition Department or person in charge of the nutrition section:

a) Organize the implementation of tasks of the Nutrition Department as stipulated in Article 9 of this Circular and be responsible before the Hospital Director for organizing professional nutritional activities in the hospital.

b) Manage, inspect, supervise, urge, and direct the implementation of professional regulations on nutrition and food safety in the hospital.

c) Inspect and require clinical departments to strictly implement dietary regimens appropriate to the nutritional status and pathology of patients. Report to the Hospital Director any violations by individuals, departments, and rooms in implementing nutritional regulations in the hospital.

d) Require units and individuals to cease providing nutritional services if they violate food safety regulations and report to the Hospital Director for timely measures.

đ) Participate in the Drug and Treatment Council, Scientific Research Council, and other relevant councils in the hospital as assigned by the Hospital Director.

e) Perform other tasks as assigned by the Hospital Director.

2. Tasks of nutrition professionals:

a) Examine, advise, and treat diseases related to nutrition using appropriate dietary regimens for the nutritional status and pathology of inpatient and outpatient patients.

b) Collaborate with treating doctors and nutrition department doctors to examine, advise patients, and prescribe cases with nutritional pathologies or those requiring combined treatment with nutrition or consult treating doctors to prescribe dietary regimens.

c) Develop and apply appropriate dietary regimens for the nutritional status and pathology of patients.

d) Consult with clinical departments to intervene nutritionally when required. đ) Inspect and supervise nutritional activities and the provision of dietary regimens as prescribed.

e) Implement communication tasks about nutrition and food safety for targets within the hospital.

g) Perform other tasks as assigned by the Head of the Department.

Article 13. Responsibilities of other professional positions in professional nutritional activities

1. Responsibilities of treating doctors:

a) Prescribe appropriate dietary regimens for the nutritional status and pathology of patients under their care. Monitor and inspect the implementation of dietary regimens and food safety related to patients.

b) Request the nutrition treatment section of the Nutrition Department to participate in consultations for cases related to nutrition or cases of malnutrition, combined diseases, severe diseases.

c) Consult with nutrition department doctors or nutritionists to develop and prescribe appropriate dietary regimens for patients with severe malnutrition and patients classified for level I care.

d) Provide all necessary patient information to the Nutrition Department or nutrition section to apply appropriate pathological dietary regimens.

2. Responsibilities of ward heads of clinical departments:

a) Organize the implementation of daily dietary regimen summaries as prescribed by treating doctors and transfer data to the Nutrition Department or nutrition section to prepare dietary regimens for patients in the department.

b) Organize the reception, support, and supervision of patients implementing dietary regimens in the department.

c) Organize the implementation of nutritional counseling and communication for patients in the department.

3. Responsibilities of nursing staff:

a) Conduct nutritional risk factor screening for patients.

b) Provide support, monitor, advise, and supervise the implementation of dietary regimens by patients and record files as prescribed.

Article 14. Responsibilities of Patients and Their Relatives

1. Adhere to and implement dietary instructions for patients and food safety regulations at the hospital.

2. Cooperate with healthcare staff to assist patients in following dietary regimens.

Chapter V

IMPLEMENTATION PROVISIONS

Article 15. Effective Date

1. This Circular takes effect from January 1, 2021.

2. Circular No. 08/2011/TT-BYT dated January 26, 2011 of the Ministry of Health guiding nutritional activities and food control in hospitals shall cease to be effective from the date this Circular comes into force.

Article 16. Transitional Provisions

1. The Head of the Nutrition Department who was appointed before the effective date of this Circular but does not meet the requirements stipulated in Clause 1, Article 7 of this Circular shall continue to hold the position and must complete training to meet the standards before January 1, 2025.

2. Those currently working in nutrition-related positions in hospitals must complete training in nutrition to meet the requirements stipulated in Clause 2, Article 7 of this Circular before January 1, 2025.

3. Hospitals with a Nutrition Center shall organize, operate, and have functions and tasks as specified for the Nutrition Department under this Circular.

Article 17. Reference Provisions

In cases where referenced documents in this Circular are replaced or amended, the replaced or amended documents shall apply.

Article 18. Responsibilities for Implementation

1. The Department of Medical Examination and Treatment is responsible for organizing the implementation, inspection, and supervision of the execution of this Circular nationwide. Develop specialized materials, conduct training sessions, and provide guidance to units on implementing nutritional activities in hospitals.

2. Departments and Bureaus under the Ministry of Health shall direct the implementation of nutritional activities in hospitals based on their assigned functions and responsibilities.

3. Provincial Health Services:

a) Are responsible for organizing the implementation, inspection, and evaluation of the execution of this Circular within their jurisdiction.

b) Assign personnel to be in charge of nutrition at the Provincial Health Service. The person in charge of nutrition must have a bachelor's degree or higher in general medicine or nutrition.

c) Report periodically at the end of each year or as required by competent state management agencies on the results of the implementation of this Circular.

4. Health services of Ministries and Sectors are responsible for organizing the implementation, inspection, and supervision of the execution of this Circular at subordinate hospitals. During the implementation process, if there are difficulties or obstacles, they should report to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution.

During the implementation process, if there are difficulties or obstacles, they should report to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution./.