THE HOSPITAL

NUTRITION AND DIETETICS

SERVICE
• Each hospital has a guiding
philosophy, which should be
articulated and embedded to the
staff of the various services.

• Each service, in turn, must

formulate its own PHILOSOPHY,
which shall provide the anchor
for its goals, objectives and
programs of service.
The following can serve as a guide in the
formulation of a philosophy for the Nutrition and
Dietetics Service (NDS):

1. The NDS is organized to promote optimal

nutrition and other related services for patients
and hospital personnel and other stakeholders
regardless of race, religion, social status,
and political belief through the provision of a
high quality food service;
2. The NDS considers that DIET is one of the
most critical attributes in human growth and
development directly related to good health.

It provides the most appropriate means of

maintaining vitality, developing resistance to
infections and organic deterioration, the
control of many disease processes, and
recovery of health and function following illness
and injury;
3. The NDS personnel must be oriented, guided
and regularly evaluated in their work within
the context of prevailing local conditions in
order to attain efficient output; and

4. The NDS goals can be best attained through

the cooperation, coordination, mutual
understanding, and dedication of all those
concerned with quality patient care.
The Nutrition and Dietetics Service supports the
mission and philosophy of the hospital in
promoting the health and nutritional status
of the patients through quality nutrition
service and care towards optimum health.
Vision
Excellent service in the practice of hospital
nutrition and dietetics towards the well-being of
patients and other stakeholders.

Mission
Comprehensive nutrition care through efficient
and effective food service delivery, nutrition
education, continuing research, learning and
development
Core Values: C-A-R-E

C - Commitment to Quality Service

The NDS pledge to provide comprehensive nutrition care
towards the well-being of clients. Excellence in all endeavors
describes its professional statements and actions. To be truly
science-based, it constantly interface with national and
international experts.

A - Accountability & Integrity

Trustworthiness is paramount to the NDS. To be always
trusted, honesty rules its thoughts, words
and conduct. The hallmark by responsibility towards the
welfare of its clients.
R - Resource Maximization
Efficiency in the delivery of nutrition services
through conscientious utilization of resources, it
always zealously tries to maintain or restore. To
further the limited resources, it innovates and
exercises creativity.
E - Empowered Leadership & Management
Nutrition and Dietetics Service leads initiatives towards
promoting health and wellness through
nutrition. An advocate of health through nutrition, the
NDS leads the advocacies for varied and
balanced food selection. It partners with patients, and
their families, physicians, other healthcare
professionals and the general public.
General Objective

To maintain and improve the health of patients

and stakeholders by providing high quality, safe,
and nutritious foods at minimum cost.
Specific Objectives

1. To prepare and to serve safe, nutritious, palatable and

appetizing food through good
planning and procurement within budget allocation.

2. To provide appropriate clinical and medical nutrition

therapy to clients and stake-holders.

3. To provide continuous in-service learning and

development to both nutrition and dietetic
staff, student affiliates and other allied health
professionals.
4. To conduct evidence-based researches in the field
of Nutrition and Dietetics practice in the hospital.

5. To promote and maintain multi-disciplinary

collaboration with highest ethical standards with other
allied, support services in the hospital and in the
community.

6. To equip the Nutrition and Dietetics Service with

adequate and responsive information system through
Integrated Hospital Operation and Management
Information System (IHOMIS).

7. To sustain compliance to quality standards with

International Organization for Standardization (ISO).
Strategic Goals

A. Clinical

Medical Nutrition Therapy is provided to support the

physician with the nutritional care of patients to
maintain and improve nutritional status.
Nutrition Care Process

Nutritional Care is an organized group of

activities allowing the identification of nutritional
needs and provision of care to meet these
needs.

An organized approach to nutrition intervention

that consists of assessing, planning,
implementing, and evaluating. It parallels the
nursing care process, but focuses on
nutrition concerns.
B. Administrative functions are aimed at:

1. Establishment of policies and standards

2. Implementation of procedures concerned with budget and
financial control
3. Development and planning of menus
4. Purchasing, receiving and proper storage of foods
5. Production and provision of safe, sanitary, nutritious, and
palatable food
6. Utilization of available manpower and other resources
7. Accuracy of updated records and reports.
C. Education and research functions are aimed at:

1. Nutrition education of the patients, hospital

personnel and other stakeholders
2. Research and development in nutrition and
dietetics.
3. Update on the knowledge and skills of personnel in
food service management and
nutrition and dietetics
4. Training of student affiliates on nutrition and
dietetics
Standards

Standards are tools to monitor and evaluate the

performance of Hospital Nutrition and Dietetics
Service (NDS)
Standard I: Organization, Staffing, and
Manpower Development

The Nutrition and Dietetics Service should be

managed by a Registered Nutritionist-Dietitian with
adequate number of staff as approved by the
Department of Budget and Management.
There shall be clearly stated goals, objectives,
mission, vision and procedures for the Nutrition
and Dietetics Service developed by the Nutrition
and Dietetics personnel and in consonance with
the framework of the hospital.
The NDS shall post organizational chart with the
updated PRC license of all RND staff. It shall
indicate the routes of intra-departmental
communication. Integrated planning on nutrition
dietetics with other divisions/departments in the
hospital shall be encouraged.
Job descriptions should be adopted for all
classifications of personnel. The organizational chart,
job description, and the procedure manual should be
reviewed periodically, revised as necessary, and dated
to indicate the time of last review. There shall be regular
rotation of RNDs in all units.
The NDS must have the required
number of qualified Nutritionist-
Dietitians duly registered with the
Professional Regulation
Commission (PRC) based on
Section 29 of RA 10862.
the NDS must have adequate number of appropriately
qualified personnel based on the staffing pattern approved
by the DOH.

The CHIEF DIETITIAN shall have the authority and

responsibility of ensuring that the established policies are
carried out; that overall coordination and integration of the
therapeutic and administrative nutrition and dietetics
services are maintained; and that a review and evaluation of
the quality, safety, and appropriateness of the
nutrition and dietetics functions are performed.
Standard II: Human Resource Learning
and Development

The staff are provided with appropriate

orientation, continuous learning and
development for
competency.
Newly hired personnel shall undergo orientation and on-
the job training. A continuous training program is required.
All personnel should demonstrate competence in:

• Personal hygiene and infection control

• Proper inspection, handling, preparation, serving, and
storing of food
• Proper care and safe operation of equipment
• General food service sanitation and safety
• Occupational health and safety
• Proper methods of waste disposal
• Portion control
• Preparation of Diet Tags
• Basic Diets
• Nutrition screening and assessment
• Recording of pertinent nutrition and dietetics information
• Disaster and Health Emergency Preparedness
Standard III: Policies and Procedures

The Chief ND in collaboration with the other

services should develop policies and procedures on
the management of NDS and total patient care
which should be reviewed and revised periodically
with date and time of last review.
There shall be policies and procedures relating
to the following:

• Department goals and objectives, organization and

staffing;

• Duties and responsibilities of nutrition and dietetics

personnel with job descriptions, functions and working
hours;

• Personnel policies, including those related to health,

personal hygiene and sanitation;
• Administrative policies and procedures;

• Total Quality Management (TQM) policies;

• Nutritional screening, assessment and Nutrition Care

Plan management;

• Administration and management of enteral and

parenteral nutrition therapy;
 TOTAL QUALITY MANAGEMENT (TQM) POLICIES
 
A holistic organization-wide approach in maintaining and improving quality service. It
requires a highly proactive, highly participative style of management. It is a philosophy that gives
major emphasis on the continuous process of quality improvement with the effective use of
resources and sustained patient and client’s satisfaction as its ultimate goal. The very purpose of
managing quality is to establish a system that measure and manages care in a way to provide the
best of care for all clients/patients. To achieve this would require a deliberate effort for managers
at every level of the organization to initiate and maintain quality.
The common guiding principles in the TQM practice can be summarized in the acronym
ACCEPT.
A – aim for patient’s satisfaction
C – communicate and coordinate all activities
C – cooperate towards continuous improvement
E – empower the employees
P – promote usage of problem-solving tools
T – train for quality
• Measures on Infection control;

• Management of Disaster and Health Emergency

procedures;
• Development and adoption of Diet. It should be
reviewed annually, revised as necessary and dated in
consultation with the medical staff through its
designated mechanism. A copy of the diet manual
should be placed in each patient care unit;

• Maintenance of functional nutrition clinic;

• Safety measures and practices (control of electrical,

flammable, mechanical, chemical and radiation
hazards);
Standard IV: Facilities and Operations

The NDS should have adequate space, equipment

and supplies to facilitate the efficient, safe,
and sanitary operations and timely provision of
food service to meet the nutritional needs of the
patients.
The facilities must be provided to fulfill the food
service and nutrition and dietetics needs of the
patients and staff.

The layout shall be in accordance with the type,

size, and location of equipment, to make efficient
food preparation, distribution, effective sanitation
and safety.

The food service should be strategically located

and completely equipped.
The following precautions shall be taken in the
handling and preparation of food:

• Protection of food from contamination and spoilage;

• Storage of perishable foods at proper temperature and

maintenance of temperature records;
• Location of adequate and convenient comfort room
and hand washing facilities throughout the service.
Provision of separate male and female comfort rooms.

• Cleaning and sanitizing of all work surfaces, utensils,

and equipment after each period of use;

• Provision of separate cutting boards for meat, poultry,

fish (both cooked and uncooked), raw fruits and
vegetables;
• Replacement of unserviceable wares, utensils
and equipment;

• Control of lighting, ventilation, and humidity, in

order to prevent the condensation of
moisture and the growth of molds;

• Use of efficient equipment and methods for

washing and sanitizing dishes, such as,
installation of a hot water system;
• Use of methods for making, storing, and
dispensing ice that does not allow contamination
to occur. Ice should not be scooped by hand, nor
should food items be stored directly on ice being
stored for dispensing; and

• Restriction of unauthorized individuals in the

food preparation and service to minimize the risk
of contamination and improve operation
efficiency.
Safety shall be ensured by providing at least the
following precautions:

• Walk-in refrigerators that can be opened from the inside;

• Installation of hot and cold water pipes, water heaters,

refrigerator compressor, condensing units, and uncontrolled
heat-producing equipment;
• Labeling of supplies on a first- in first -out
(FIFO) policy;

• Separation and proper storage of all food

and non-food supplies;

• Documentation of the activities of an

active, preventive, and corrective
maintenance, and safety program;
• Procurement of all food supplies from sources
that provide assurance that the food is processed
under regulated quality and sanitation controls;

• Observance of proper waste management and

disposal to prevent the proliferation of insects,
rodents and transmission of diseases. Containers
must be leak proofed and non-absorbent with
tight-fitting covers preferably with impervious
plastic liners to be used.
Standard V: Recording and Documentation

The NDS shall maintain relevant records and

documents for filing as reference materials (see
Appendices for sample forms). All pertinent nutrition
and dietetics information shall be recorded
in the medical chart.
The Registered Nutritionist-Dietitian (RND) shall
write nutrition and dietetics information into the
nutrition forms to be inserted into medical chart
(refer to medical records adviser regarding the
medical chart) as specified, and in the location
determined by those performing the medical
record review function. Such documentation may
include:

• Verification of the diet order of the attending

physician as needed within 24 hours upon
admission;
• Summary of the dietary history and/ or nutrition
assessment, when the past dietary
pattern is known to have a bearing on the patient’s
condition or treatment;

• Assessment of the patient’s nutrient intake and

tolerance of the prescribed diet modification;
• Recommend the diet appropriate for the
disease condition of the patient; and

• Provide a copy of their diet prescription prior

to discharge.

All documents shall be signed over a

stamped name and license number
Administrative Records

1. Meal Census (B, L, S, AMS, PMS)

2. Diet Census (Routine, Therapeutic)
3. Cycle Menu
4. Issuances of Supplies
5. Consumption report
6. Purchase request
7. Daily Market Order
8. Daily Market Purchase
9. Daily Expense
10. Disbursement Voucher
11. Replenishment of Cash advance
12. Liquidation of Cash advance
13. Dealers/Suppliers Performance Report
14. Inventory Report
15. Diet Tags
16. Diet List
17. Annual Accomplishment Reports
18. Meal Request Form
19. Statistical Report for Records Section
20. Stock cards (Receiving)
21. Procurement Program Management Plan (PPMP)
22. Monthly Schedule of NDS Personnel
23. Waste Management Record (Recyclable materials)
24. Daily Monitoring Safety Checklist (Gas pipe,
electricity, water, doors, windows, garbage)
25. Daily Monitoring of Temperature (Room
Temperature, Dry Storage, Chiller and Freezer)
26. Time of Food Delivery
27. Job Order Request Form
28. Customer Satisfaction Survey Form
Clinical Records

1. Nutrition Care Process Form (ADIME)

2. SAM and MAM Data Report Form
3. Patient Conforme
Learning and Development Records
1. Procurement Program Management Plan (PPMP)
2. List of personnel attendance to trainings/seminars and
convention
3. Certificates of trainings
4. Strategic Performance Management System
Standard VI Monitoring and
Evaluation

The quality and appropriateness of

nutritional care provided by the nutrition
and dietetics service
should be monitored, reviewed, and
evaluated regularly. The following
monitoring and quality
control mechanisms shall be
implemented:
The quality and appropriateness of
nutritional care provided by the nutrition
and dietetics should be monitored,
reviewed, and evaluated regularly. The
following monitoring and quality control
mechanisms shall be implemented:
Administrative
1. Nutritional adequacy of all meals served

2. Patient’s diet list should identify all patients who are

admitted.

3. Tray identification through color-coded tag

4. Compliance to submission of reports

5. Ensure the appetizing appearance, palatability

proper serving, temperature, and retention
of the nutritional value of food.

6. Reports of Surveys to determine patient

satisfaction of food service.
Clinical
1. Special and therapeutic diets are identified

2. The nutritional care provided to all patients.

3. Patients receiving therapeutic diets are given diet

counselling according to their medical
conditions as recorded in the medical chart.
4. Critically-ill patients must be prioritized.

5. Nutritionist Dietitians actively participates in

committee activities concerned with health
and Nutrition care.
Learning, Development and Research
1. Human Resource Capability
2. 2. Research Facilities
3. Budget / Funding
4. Institutionalization (Initiatives & Partnership)
5. Soft Skills Development
6. Career Progression/Pathing/Plotting (refer to definition)
7. Affiliation and Practicum