Thông tư 18/2020/TT-BYT

CIRCULAR

ON HOSPITAL NUTRITION

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

Pursuant to the Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 on functions, duties, powers and organizational structure of the Ministry of Health;  

At the request of the Director General of Medical Services Administration,

The Minister of Health hereby promulgates a Circular on hospital nutrition.

Chapter I

GENERAL PROVISIONS

Article 1. Scope and regulated entities

1. This Circular provides for hospital nutrition, conditions for assurance thereof and responsibility for hospital nutrition.

2. This Circular is applicable to regulatory bodies, organizations and individuals involved in hospital nutrition.

Article 2. Rules for hospital nutrition

1. Hospitals must organize their nutrition operations in connection with their examination and treatment operations.

2. Patients visiting a hospital for outpatient examination and/or treatment shall be screened for nutritional risk factors; and those visiting for inpatient examination and/or treatment shall have their nutritional status screened and assessed.

3. Patients shall be given a diet suitable for their nutritional status and illness.

4. The doctor in charge of a patient and doctors of the nutrition department shall decide the patient’s diet.

5. Nutrition personnel must be professionally qualified for their assigned tasks.

Chapter II

HOSPITAL NUTRITION

Article 3. Nutritional risk factor screening and diet consultancy and indication for outpatients

1. Screen outpatients for nutritional risk factors such as weight loss, loss of appetite, BMI and other risk factors.

2. For patients at nutritional risk or risk of undernutrition or nutrition-related diseases, give them dietary advice and indication suitable for their nutritional status and illness, which shall be recorded in the medical examination book or outpatient medical record.

Article 4. Nutritional status examination, diagnosis and assessment, indication for treatment and monitoring of nutritional status for inpatients

1. Screen patients for nutritional risk factors, examine, diagnose and indicate nutritional treatment within 36 hours starting from the time of admission, which shall be recorded in the medical record.

2. For patients at nutritional risk, assess their nutritional status, diagnose and indicate a diet suitable for their illness, and monitor and reassess their nutritional status throughout the treatment process.

3. For patients without nutritional risk, screen for risk factors every 7 days during which they are hospitalized, which shall be recorded in the medical record.

4. Indicate a daily diet suitable for the nutritional status and illness of each patient, and record the diet code into the treatment sheet according to regulations in Decision No. 2879/QD-BYT dated August 10, 2006 by the Ministry of Health on guidelines for hospital diets.

5. Doctors in charge of patients suffering from severe undernutrition and patients receiving level I care shall consult with doctors of the nutrition department or nutritionists to indicate and formulate a diet suitable for their patients’ nutritional status and illness.

6. Support, monitor and supervise patient’s diet compliance throughout the treatment process.

Article 5. Nutritional advice and communication

1. Hospitals shall formulate advisory and communication documents concerning nutrition and food safety to raise the awareness of patients and their families in hospital.

2. Hospitals shall give advice and raise the awareness about nutrition and food safety for patients and their families.

Chapter III

CONDITIONS FOR ASSURANCE OF NUTRITION OPERATIONS IN HOSPITAL

Article 6. Organizational structure for nutrition

1. Organization of nutrition operations:

Based on the organizational and operational regulations of each hospital, the nutrition department or nutrition unit, which is a part of the clinical block, shall be established in accordance with the following regulations:

a) Hospitals with at least 100 beds must establish a nutrition department. Every 100 beds must have at least 01 nutrition specialist.

b) Hospitals with less than 100 beds must have a nutrition unit or full-time nutritionist if unable to establish a nutrition department.

2. The nutrition department shall comprise:

a) A nutrition advisory unit

b) A nutrition therapy unit

c) A meal processing and provision unit

If there is no meal processing and provision unit, the hospital must sign a contract on meal processing in the hospital with an outside organization or individual, which shall be placed under the professional and food safety supervision of the nutrition department.

Article 7. Nutrition specialists

1. Head of the nutrition department must be a full-time tenured employee and meet the following requirements:

a) Is a general medicine doctor or general practitioner holding a certificate of at least 6 months of training in clinical nutrition.

b) Is a nutritionist holding a bachelor’s degree or higher if no one is qualified for the requirements mentioned in Point a herein.

2. Persons in charge of nutrition therapy must be a general medicine doctor or general practitioner holding a clinical nutrition training certificate or nutritionist.

Article 8. Facilities for nutrition operations

1. Hospitals must provide facilities for nutrition operations as follows:

a) Nutrition department or nutrition unit

b) Meal processing area and eating room must be located away from the morgue, waste retention area, laundry area and isolation area for infectious diseases and fulfill regulatory requirements concerning food safety.

2. Milk preparation areas of pediatrics and neonatology departments must have instructions on milk preparation; hot and cold water; clean water, sinks and hand wash liquid.

Chapter IV

IMPLEMENTING RESPONSIBILITIES

Article 9. Duties of nutrition department or nutrition unit

1. Give advice on hospital nutrition to hospital leaders.

2. Formulate and implement technical procedures for clinical nutrition in hospital.

3. Examine, give advice and provide nutrition therapy suitable for the nutritional status and illness of patients.

4. Develop diets suitable for the nutritional status and illness of inpatients.

5. Cooperate with clinical departments in indicating diets suitable for patients suffering from severe undernutrition and patients receiving level I care.

6. Manage food, process and provide diet meals for patients on their beds. Inspect and supervise food safety in hospital.

7. Inspect and supervise compliance with regulations on nutrition operations in clinical departments and hospital.

8. Take charge of formulating advisory and communication documents concerning nutrition and food safety to raise the awareness of patients, their families and other people in the hospital.

9. Provide training and direct activities concerning nutrition and food safety.

10. Conduct scientific research and apply technological and scientific advancements pertaining to nutrition and food safety in treatment, preventive healthcare and health improvement.

Article 10. Duties of other clinical departments to organization of nutrition operations

1. Receive and adopt patients’ diets.

2. Give dietary instructions and supervise patient’s diet compliance according to regulations.

3. Cooperate with the nutrition department or nutrition unit in inspecting and supervising compliance with regulations on nutrition operations and nutritional advice and communication provided for patients and patients’ families in their departments.

Article 11. Responsibilities of hospital directors

1. Promulgate regulations on hospital nutrition.

2. Organize hospital nutrition and take responsibility for all nutrition operations in their hospitals.

3. Establish a hospital nutrition network as professionally required with the participation of clinical departments and units involved in nutrition operations.

4. Ensure facilities, equipment, personnel and funding annually allocated for nutrition operations.

Article 12. Responsibilities of nutrition specialist titles

1. Head of the nutrition department or nutrition unit shall:

a) Organize fulfillment of the nutrition department’s duties provided for in Article 9 herein and take responsibility before the hospital director for organization of hospital nutrition.

b) Manage, inspect, supervise, expedite and direct compliance with professional regulations on nutrition and food safety in their hospital.

c) Inspect and request clinical departments to strictly adopt diets suitable for the nutritional status and illness of patients. Report violations against regulations on hospital nutrition committed by individuals and departments to the hospital director.

d) Request a nutrition service provider to stop its service if it commits a violation against food safety regulations and report to the hospital director for timely handling.

dd) Participate in the drug and treatment council, scientific research council and other relevant councils of the hospital as assigned by the hospital director.

e) Perform other tasks assigned by the hospital director.

2. Nutrition specialists shall:

a) Examine, give advice on and treat nutrition-related diseases using diets suitable for the nutritional status and illness of inpatients and outpatients.

b) Cooperate with in-charge doctors and doctors of the nutrition department in examining and giving advice to patients, giving indications for cases suffering from nutritional diseases or requiring nutrition therapy, or advising in-charge doctors on diet indication.

c) Develop and adopt diets suitable for the nutritional status and illness of patients.

d) Consult with clinical departments to make nutritional interventions upon request.dd) Inspect and supervise nutrition operations and diet adoption according to regulations.

e) Fulfill duties concerning raising the awareness of nutrition and food safety of people in the hospital.

g) Perform other tasks assigned by the department head.

Article 13. Responsibilities of other professional titles for nutrition operations

1. In-charge doctors shall:

a) Indicate diets suitable for the nutritional status and illness of patients under their care. Monitor and inspect diet adoption and food safety related to their patients.

b) Request the nutrition therapy unit of the nutrition department to consult on cases of nutrition-related diseases, undernutrition, comorbidity or severe illness.

c) Consult with doctors of the nutrition department or nutritionists to formulate and indicate diets suitable for patients suffering from severe undernutrition and patients receiving level I care.

d) Provide all necessary information on patients for the nutrition department or nutrition unit to adopt suitable diets.

2. Head nurses of clinical departments shall:

a) Consolidate daily diets indicated by in-charge doctors and transfer data to the nutrition department or nutrition unit for it to prepare meals for patients of their departments.

b) Receive, support and supervise diet compliance of patients of their departments.

c) Give advice and raise the awareness about nutrition for patients of their departments.

3. Nurses shall:

a) Screen patients for nutritional risk factors.

b) Support, monitor, give advice on and supervise patient’s diet compliance and record in medical records according to regulations.

Article 14. Responsibilities of patients and their families

1. Comply with indications for patient’s diet and food safety in hospital.

2. Cooperate with healthcare workers in supporting patient's diet compliance.

Chapter V

IMPLEMENTATION CLAUSE

Article 15. Effect

1. This Circular takes effect from January 01, 2021.

2. Circular No. 08/2011/TT-BYT dated January 26, 2011 by the Ministry of Health providing guidance on hospital nutrition and dietetics is annulled from the date on which this Circular comes into effect.

Article 16. Transitional clauses

1. Nutrition department heads appointed prior to the effective date of this Circular but falling short of the requirements provided for in Clause 1 Article 7 of this Circular may keep their positions and must receive training to meet the requirements before January 01, 2025.

2. Hospital nutrition specialists must complete their nutrition training in accordance with the regulations in Clause 2 Article 7 herein before January 01, 2025.

3. For hospitals with nutrition centers, organization, operation, functions and duties of these centers shall be the same as those of the nutrition department, which are provided for in this Circular.

Article 17. Terms of reference

In case the documents cited in this Circular are amended or superseded, the amended or superseding documents shall apply.

Article 18. Implementing responsibilities

1. Medical Services Administration shall organize implementation of this Circular and inspect and supervise such implementation. Formulate technical documents, training documents and guidelines on hospital nutrition for units.

2. Departments of the Ministry of Health shall direct hospital nutrition intra vires.

3. Departments of Health shall:

a) Implement this Circular in their provinces/cities and inspect and assess such implementation.

b) Assign persons to act as contact points of their nutrition operations. These persons shall hold a bachelor’s degree in general practice or nutrition or higher.

c) Submit year-end or ad hoc reports on results of this Circular’s implementation as requested by competent authorities.

4. Health units of ministries and central authorities shall organize implementation of this Circular in affiliated hospitals and inspect and supervise such implementation.

During the implementation of this Circular, any difficulty arising should be promptly reported to the Ministry of Health (Medical Services Administration) for consideration and resolution./.