Department functions and tasks:
Clinical Nutrition Department is a clinical medical department responsible for nutritional risk screening, nutritional assessment, nutritional diagnosis and nutritional treatment for outpatients and inpatients. Its main functions and tasks are:
1. Complete the medical treatment, teaching and scientific research of clinical nutrition (scientific research related to clinical diseases and nutritional metabolism).
2. Complete nutrition outpatient and inpatient (including critically ill patients) nutritional status assessment and nutritional diagnosis (various diseases).
Evaluation and diagnosis of disease state and/or malnutrition);
3. Establish nutritional treatment methods (parenteral nutrition, enteral nutrition, therapeutic diet and basic diet); Make nutrition treatment plan and list nutrition doctor's advice;
4. The whole process of nutritional therapy: including the preparation of parenteral nutrition, enteral nutrient solution and homogeneous diet; Weighing, preparing therapeutic meals, preparing and making basic meals and transporting them to the bedside of patients in various clinical wards.
5. According to the theory of clinical nutrition, guide clinicians to rationally use nutrition-related drugs (amino acids, fat emulsions, minerals, vitamins and nutritional compound preparations used parenterally and enterally).
Department qualification:
Nutrition department should have places, equipment, facilities and personnel conditions suitable for its functions and tasks.
(1) staffing
1. Nutrition department must be equipped with a sufficient number of medical staff and staff who have received professional training, mastered the basic theory, knowledge and operation technology of clinical nutrition and have the ability to work independently. Doctors, technicians, nurses and managers in the food operation room are compiled according to the technical titles of the hospital, and chefs, nursing staff and other related personnel are compiled according to technical jobs.
2. The director of the nutrition department is the leader of the nutrition department of this unit. The director of the department should have a professional education background in nutrition or medicine, and obtain the certificate of clinical practitioner and the corresponding medical professional and technical positions.
3. The head nurse of the nutrition department should have the qualification of professional and technical positions above the intermediate level, work in the nutrition department for more than 1 year, and have certain management ability.
4. The administrator of the catering operation room should have a cooking foundation and have a college degree or above in management.
5. Nutritionists require medical nutrition majors to graduate or clinical medicine majors to obtain clinical practitioner certificates. The ratio of the number of nutritionists to the number of beds is 1: 100.
6 nutrition technical personnel shall not be less than 2 people.
7. The number of nurses in the nutrition department shall be no less than 2, and they shall be required to graduate from nursing major, obtain practical nurse certificate and complete corresponding treatment.
8. The requirement of the nutrition chef is to graduate from the culinary institute and obtain the corresponding technical grade certificate. The ratio of the number of nutrition chefs to beds is 1: 25-30, and clinical nutrition training should be carried out before taking up their posts.
9. The ratio of the number of nurses (caterers) in nutrition department to beds is 1:35-45, and they should have received clinical nutrition training before taking up their posts.
(two) housing facilities and health requirements, equipment, etc.
Nutrition department should set up a perfect nutrition treatment work area, including nutrition clinic, nutrition metabolism (experiment) room, parenteral nutrition preparation room, enteral nutrition preparation room, dietary operation room, etc.
The location of the nutrition department should be adjacent to the ward, with a building area to complete the corresponding tasks, and the working area should have good ventilation and lighting conditions.
The setting of functional areas of nutrition department should meet the needs of hospital functions and tasks and the actual number of inpatients.
The ratio of the total construction area of the department to the beds is:
Level-III hospitals shall be no less than 1.5m2: 1, in which the catering operation room 1m2: 1 and other working areas shall be 0.5m2: 1.
The level II hospital shall not be less than 1m2: 1, including 0.7m2: 1 in the catering operation room and 0.3m2: 1 in other working areas. The working areas and partitions of each functional area meet the work requirements. Departments and functional areas are clearly identified, which are consistent with the styles and specifications of other departments of medical institutions.
1. nutrition clinic: located in the outpatient area of the hospital, with a special room, equipped with facilities and supplies for outpatient work, including computer and corresponding nutrition software, metabolic car, body composition analyzer, height and weight meter, hand grip, skinfold thickness meter, measuring soft ruler, etc.
2. The nutrition metabolism (experiment) room consists of four parts: weighing room, precision instrument room, air chamber and operation room, with a building area of not less than 50 m2. The indoor wall is made of aluminum-plastic board, and the ground is wear-resistant, anti-slip and anti-static. Equipped with instruments and equipment corresponding to the test items, including various weighing scales, fluorescence spectrometers, ultraviolet-visible spectrometers, atomic absorption spectrometers, Kjeldahl nitrogen determinators, etc. There should be corresponding exhaust and ventilation equipment when conducting toxicity testing projects. According to the development of the project, corresponding specimen processing and preservation equipment, such as thermostat, drying box, ashing furnace, water bath box, centrifuge, mixer, refrigerator, timely sub-boiling water purifier, etc., will be provided.
3. Parenteral nutrition preparation room: with a building area of not less than 40 m2, it is divided into pretreatment room, dressing changing room, medicine preparation room and preparation room. Among them, the preparation room is a laminar flow purification room, the indoor walls are made of antibacterial coatings or preformed materials, and the ground is wear-resistant, anti-slip, antibacterial and anti-static. Parenteral nutrition preparation room should be equipped with corresponding working equipment, including 100-level purification workbench, operation desk, medicine cart and medicine cabinet, refrigerator, cleaning and disinfection equipment (ultraviolet lamp or air sterilizer, isolation gown).
4. Enteral nutrition preparation room: adjacent to the catering operation room, with a construction area of not less than 60 m2. It is divided into scrubbing room, disinfection room, preparation room, cooking room and distribution area. Among them, the preparation room is a laminar flow purification room, the indoor wall is made of prefabricated materials with antibacterial coating, and the ground is wear-resistant, anti-slip, antibacterial and anti-static. Enteral nutrition preparation room should be equipped with equipment with corresponding working conditions, including homogenizer (colloid mill), masher, purification workbench, microwave oven, induction cooker, refrigerator, console, medicine cabinet, steamer, cleaning and disinfection equipment, measuring instruments and various preparation containers.
5. The building area of the catering operation room is suitable for the sickbed, and it is divided into preparation room, common room, treatment room, staple food production and steaming room, food warehouse, tableware disinfection room, scrubbing room and catering distribution hall. The whole wall is made of white tiles, and the ground is wear-resistant, anti-slip, anti-static and easy to clean, which meets the requirements of fire prevention and has a perfect drainage system. There can be no open ditch in the room, and there is a closed food delivery channel leading to the ward. The catering operation room of Nutrition Department is equipped with basic equipment according to the operation area, including all kinds of cookers and equipment for food processing, production, refrigeration, freezing, storage and transportation, and the treatment room is equipped with weighing instruments such as scales.
6. Other corresponding office buildings and supporting rooms include offices, dressing rooms and shower rooms.
Business scope:
1. Responsible for nutritional risk screening, nutritional assessment, nutritional diagnosis and nutritional treatment for outpatients and inpatients [including parenteral nutrition, enteral nutrition, therapeutic diet (restricted nutritional diet) and basic diet (liquid, semi-liquid, soft rice and ordinary rice)].
2. The nutrition metabolism (experiment) room should complete the detection of evaluation indexes related to nutrition therapy, so as to provide basis for nutrition evaluation, nutrition diagnosis and nutrition therapy. The detection method conforms to the standard operating procedures and quality control standards. Test report specification. Establish inspection results and quality control records.
3. Complete the diagnosis of patients who need parenteral nutrition treatment, formulate nutrition treatment plan (individualized treatment plan needs to be formulated, and the nutrition doctor's advice should be adjusted daily according to the condition) and prepare parenteral nutrition solution. When preparing, the checking system and aseptic operation system should be strictly implemented. Strictly master the operating procedures, drug compatibility and compatibility taboos.
4. Complete the diagnosis of patients who need enteral nutrition treatment, formulate nutrition treatment plan (individualized treatment plan needs to be formulated, and the nutrition doctor's advice should be adjusted daily according to the condition) and prepare enteral nutrition solution. Give priority to natural food, make use of its dietotherapy function, rationally apply enteral nutrition preparations, pay attention to the contraindications of food compatibility, and follow the operating rules when preparing.
5. The dining room is responsible for making reservations, statistics, equipment and production. According to the advice of dieticians, provide therapeutic meals (weighed meals containing various restrictive nutrients) and basic meals (liquid, semi-liquid, soft food and ordinary meals) for hospitalized patients, and transport them to patients' beds.
Business management:
1. Nutrition department is mainly for patients' nutrition treatment, which is set up independently and works for the whole hospital.
2. The nutrition department is managed by the medical department of the medical institution. Hospitals should constantly strengthen the standardized construction and management of nutrition department, implement clinical nutrition work path, and ensure the smooth completion of clinical nutrition work, so as to ensure that patients enjoy scientific and reasonable medical rights and interests.
3. The director of the Nutrition Department is fully responsible for the medical management and quality control of the department, and the head nurse and the food operation room administrator assist the director to do the corresponding management work.
Quality control:
Clinical nutrition department should establish and improve various rules and regulations, job responsibilities and related technical specifications and operating procedures, and strictly abide by them to ensure the quality of medical services. Nutrition department should strengthen quality control and management, and designate special personnel to be responsible for medical quality and safety management.
Hospitals should strengthen the management and evaluation of medical quality in clinical nutrition department and various functional departments (medical treatment, nursing, hospital infection, safety, etc.). ) should perform daily supervision functions.
1. Establish the working system of departments and functional areas. Mainly includes:
(1) Ward rounds and consultation system The Nutrition Department implements a three-level ward rounds system for inpatients, and abides by the relevant regulations of the health administrative department and medical institutions on consultation. Write nutrition medical records and related medical documents. Establish a succession system.
② The working system of each functional area includes the working system of nutrition clinic, parenteral nutrition preparation room, enteral nutrition preparation room, nutrition metabolism (experiment) room and diet operation room of nutrition department.
(3) The system of reservation, distribution and delivery of inpatient meals and the system of pre-meal inspection (the type and quality of inpatient meals should be checked and confirmed by nutritionists before being sent to the ward).
2. Establish a complete hospital dietary doctor's advice execution system. The dietary orders of hospitalized patients should be issued by the responsible doctor and executed by the doctor's nurse. The diet order is consistent with the diagnosis of the disease. Hospital meals are prepared by the food operation room according to the doctor's advice and sent to the patient's bed to keep warm in winter.
3. Other related systems:
① Financial management system: including perfect account management, registration, inventory, audit and warehouse management system. Establish a cost accounting system.
② Health management system: employee health files, food raw material files, tableware disinfection system, food sample retention system, health inspection system, etc.
③ Hospital infection management system: including tableware disinfection bacteria culture system and workplace air bacteria culture system. The emphasis is on aseptic operation system and prevention of cross infection.
4. Establish a maintenance system for instruments and equipment, with special personnel in charge, keep the instruments and equipment in normal use at any time, establish use and maintenance files, and conduct quality control on a regular basis.
5. Establish employee training and assessment system to ensure that medical staff and staff have corresponding technical operation ability and conduct regular assessment.
6. Establish the work flow and operation specifications of each post.
safety management
1. Medical safety system: strictly implement the work system of ward round, outpatient service and consultation, standardize the writing of medical documents, and allow medical practitioners and nurses to work within the scope of practice. Accept the examination of the hospital medical management department.
2. Food safety system: including environmental sanitation, personal hygiene and food hygiene system. Establish an emergency plan for food poisoning. Accept the supervision of the health supervision department.
3. Nutrition department should establish hospital infection management system, strengthen hospital infection management, strictly implement the hygienic standard and aseptic operation of parenteral and enteral nutrient solution preparation, establish hospital infection management files, and accept the inspection of hospital infection management department.
4. The overall layout of nutrition discipline should make medical area, food operation room and living area relatively independent, so as to reduce the interference between them and control hospital infection. There should be a reasonable medical flow between the medical area and the food operation room, including people flow and logistics, and hospitals with conditions can set up different access channels. The work area should control the entry of non-undergraduate personnel, especially non-medical personnel. There are adequate hand washing facilities and disinfection equipment.
5. Establish a management system for drugs and medical materials. The management and use of drugs and medical consumables are standardized and recorded.
6. Chemical reagents and dangerous goods management system: subject to inspection by the hospital security department.
7. Fire prevention and theft prevention management: focus on strengthening fire prevention work and accept the inspection of the hospital security department.
8. Strengthen the construction of medical ethics and code of conduct for the staff of medical institutions, and accept the inspection of the medical ethics construction department of the hospital.
management by supervision
1. The health administrative department entrusts the clinical nutrition quality control center (currently established in Tianjin, Shanghai, Zhejiang, Shenyang, Shandong and other places. ) or other relevant organizations to evaluate, inspect and guide the quality of the clinical nutrition department of medical institutions.
2. Medical institutions shall cooperate with the administrative department of health and its entrusted clinical nutrition quality control center or other organizations to inspect and guide the clinical nutrition department, and shall not refuse, obstruct or provide false materials.
Appendix Basic Skills Requirements of Clinical Nutrition Department Staff
First of all, doctor
1. After strict professional theoretical and technical training and passed the examination.
2. Master the basic theories and skills of nutrition and clinical nutrition, and have certain judgment and analysis ability on organism metabolism and organ function: types of nutrients, physical and chemical properties, physiological functions, clinical manifestations of deficiency and excess; Food source and nutritional value of food; Nutrition requirement standard of population; Nutritional components, dietotherapy and medicated diet of common foods; Pathogenesis, clinical manifestations and nutritional metabolism characteristics of various common and critical diseases; Hospital dietary indications; Types, components, dosage forms and nutritional components of enteral and parenteral preparations; The concept, types, characteristics and diagnosis of malnutrition; Contents of nutritional risk screening, nutritional assessment, nutritional diagnosis and nutritional treatment.
3. Master the diagnosis and treatment techniques commonly used in clinical nutrition: anthropometric methods include height, weight, skin fold thickness, girth, etc. Calculation of nutrition evaluation method; Basic methods for calculating human nutrient requirements, food nutrient content and food conversion; Determination of biochemical metabolic indexes of nutrition; Medical history collection and medical document writing; Compilation of hospital diet recipes; The use of nutritional therapy software, etc.
Second, nurses.
1. After strict professional theoretical and technical training and passed the examination.
2. Master the relevant knowledge and theories of nutrition and clinical nutrition: the types of nutrients, physiological functions and clinical manifestations of deficiency and excess; Hospital dietary indications; Types of enteral and parenteral preparations.
3. Master the professional technology of clinical nutritional therapy: the preparation method of parenteral and enteral nutrient solution; Aseptic operation specification; Prevention and control of nosocomial infection in nutrition department, clinical nursing and monitoring of nutritional treatment.
Third, the chef.
1. Received professional theoretical and technical training and passed the examination.
2. Master the professional theory of clinical nutritional dietotherapy: nutrient types, physical and chemical properties, food sources and nutritional value of food; Nutrition requirement standard of population; Nutritional components of common foods, dietotherapy function, preparation of medicated diet, types of dietotherapy, indications of hospital diet.
3. Master the professional skills of clinical nutrition and dietotherapy: making hospital meals; Food sample retention; Fire prevention operation.
Fourth, caregivers.
1. Received professional theoretical and technical training and passed the examination.
2. Master the professional theory of clinical nutritional diet therapy: nutrient types, physical and chemical properties and physiological functions; Food source and nutritional value of food; Nutrition requirement standard of population; Nutritional components, dietotherapy and medicated diet of common foods; Dietary principles of common diseases; Hospital dietary indications.
3. Master the professional skills of clinical nutrition and dietotherapy: making hospital meals; Prevention and control of nosocomial infection in nutrition department, tableware disinfection.
(Dietitian Professional Committee of Chinese Medical Doctor Association)
Working system of nutrition department
First, from the economic situation of most patients, plan and prepare meals that meet the treatment principles and health requirements. ?
Two, in addition to special needs to limit some nutrients, should be based on the supply situation, the deployment of nutritious meals, regularly calculate the nutritional value. If nutrition and calories are insufficient, it must be solved in time to promote the patient's physical recovery. ?
Third, make the types of hospital meals, such as ordinary meals, semi-liquid meals, liquid meals and various therapeutic meals, and clearly define the principles and contents of various meals so that medical staff can understand them. ?
Fourth, actively cooperate with the clinic, carry out clinical nutrition research, observe the curative effect at any time, and constantly sum up experience. ?
5. The following points should be considered when making recipes for various meals: nutritional value, therapeutic principles, food standards, sample adjustment, seasonal foods and patients' eating habits.
Six, in the procurement, storage and production of food, to do a good job in economic accounting, pay attention to saving; Balance payments and clear accounts. ?
Seven, do a good job of nutrition knowledge propaganda, so that patients understand the relationship between nutrition and health, the clinical significance of diet therapy. Educate chefs and catering staff on nutrition and hygiene knowledge. ?
Eight, all kinds of meals should be distributed according to the prescribed time. Before meals, the nutritionist should check the taste and make sure that it meets the treatment principles and hygiene requirements before sending it out. ?
Nine, the patient canteen hygiene management, including environmental hygiene, food hygiene, staff hygiene requirements, according to the staff canteen management system five, six, seven. ?
X. Preparation, distribution, catering and storage of food. , should be based on hospital conditions, formulate specific requirements, and strictly implement the cleaning and disinfection system of food and tableware.