Program center "assistance to education". Regulatory Legal Documents Order 330 on Healthy Diet Nutrition

MINISTRY OF HEALTH
Khabarovsk Territory

In order to implement the Concept of state policy in the field healthy eating of the population of the Khabarovsk Territory, improving the organization of clinical nutrition in the medical and preventive institutions of the Territory

I declare:

1. .

I order:

1. Heads of health management bodies of municipalities, medical and preventive institutions of the region:
1.1. To accept for execution the Order of the Ministry of Health of the Russian Federation of 05.08.2003 N 330 "On measures to improve nutrition in medical institutions of the Russian Federation", bring it to the attention of specialists of subordinate medical institutions.
1.2. Arrange for medical workers subordinate institutions a seminar on the study of the above-mentioned Order before 10.06.2004.
1.3. Ensure the introduction of a new range of diets, use in therapeutic and enteral nutrition with individualization of the chemical composition and calorie content (standard diets, with mechanical and chemical sparing, with an increased amount of protein) decrease or increase in buffet products, biologically active food supplements (including soy products) , bread made from sprouted grains or with lamidan) and ready-made specialized mixtures.
1.4. staff vacant positions nutritionists.
1.5. To amend the existing Regulations on the Council for Clinical Nutrition, on the organization of the activities of a dietitian, a nurse in a dietary medical and preventive institution.
1.6. Submit an application to the Ministry of Health of the Territory on the need to conduct training on the basis of the Institute for Advanced Training of Health Professionals of the Ministry of Health of the Khabarovsk Territory for doctors and paramedical workers, to ensure that they are sent to specialized courses in the system of postgraduate education.
2. First Deputy Minister of Health of the Khabarovsk Territory Tropnikova V.M. to provide for in the programs of postgraduate training of medical workers the issues of organizing therapeutic nutrition in medical institutions.
3. Take note of the Order of the Ministry of Health Russian Federation dated 12.02.2004 N 95 "On the cancellation of the order of 04.23.1985 N 540 and of 06.14.1989 N 369".
4. Information on the execution of this order must be submitted by 01.10.2004.
5. To impose control over the execution of this order on the Deputy Minister of Health of the Khabarovsk Territory A.Ya. Derkach.

White cabbage was excluded from the sparing diet and its content in other standard diets was somewhat reduced. In addition, rye bread, which is contraindicated in a number of inflammatory diseases of the gastrointestinal tract, is excluded from a sparing diet, while the amount of wheat bread, starch, pasta and potatoes is increased.

According to the new standards in clinical nutrition, the number of cereals for making soups, cereals, and side dishes has been increased. There were more vegetables - cucumbers and tomatoes, as well as dairy products, coffee and cocoa.

The composition of the components for the preparation of diet food also includes protein composite dry mixes.

Approaches to the creation of dry composite protein mixtures and their recipes were developed back in the 70s of the last century by Academician A.A. Pokrovsky. These products are made on the basis of whey milk proteins with the inclusion of lecithin, polyunsaturated fatty acids, dietary fiber, vitamins and minerals, maltodextrin (source of carbohydrates).
Dry composite protein mixes include a well-balanced and easily digestible protein, the source of which is not soy, but milk whey proteins. At the same time, they do not contain animal fat, the excess consumption of which leads to the development of atherosclerosis and overweight.
The effectiveness of their inclusion in dietary meals for many cardiovascular diseases, diabetes mellitus, liver diseases, metabolic disorders and other diseases is confirmed by the results of clinical trials that were conducted for two years at the Research Institute of Nutrition of the Russian Academy of Medical Sciences, the Federal State Budgetary Institution "Central Research Institute of Tuberculosis" RAMS and others.
Dry composite protein mixes are produced in accordance with GOST R 53861-2010 “Products of dietary (therapeutic and preventive) nutrition. Mixes protein composite dry. General specifications».
The mixtures are included in State Register and are used as a component for the preparation of dishes for therapeutic and preventive nutrition of children from 3 years of age and adults, and workers employed in work with harmful and especially harmful conditions labor.
Composite protein powder mixtures were introduced into medical and sanatorium nutrition in accordance with the previous standards for six standard diets, which were approved by the Order of the Ministry of Health of Russia in 2003 (Order of the Ministry of Health of Russia dated August 5, 2003 N 330 “On measures to improve clinical nutrition in treatment and prophylactic institutions of the Russian Federation") with changes as of April 26, 2006, introduced by orders of the Ministry of Health and Social Development of Russia No. 2 dated 10.01.2006. and No. 316 dated April 26, 2006

The norms approved by the order were developed by specialists of the Federal State Budgetary Institution Research Institute of Nutrition of the Russian Academy of Medical Sciences with the involvement of practical nutritionists, specialists in clinical nutrition.

When developing average daily food sets of standard diets, the characteristics of their chemical composition and energy value are taken as the basis, and the nature of the disease is taken into account. The development is based on innovative technologies in the field of clinical nutrition. All this, including the introduction of easily digestible components into the diet, allows you to provide the body with the necessary nutrients.

The draft order was publicly discussed on the Unified Information Disclosure Portal on the preparation by federal executive authorities of draft regulatory legal acts and the results of their public discussion. There were no comments or suggestions for the draft order.

www.rosminzdrav.ru

330 order of the Ministry of Health

MEDICINE AND LAW

HERE COULD BE

Rules for the storage, accounting and dispensing of narcotic drugs and special prescription forms in pharmacy warehouses (bases)

1. Narcotic medicinal products, regardless of the dosage form, must be stored in warehouses (bases) authorized by the Standing Committee on Drug Control (PCKN) to work with them. Premises for the storage of narcotic medicinal products must meet the current standard requirements for technical strength (Appendix 1).

Administration note: change to paragraph 1.

2. The room for the storage of narcotic medicinal products upon completion of work must be locked and sealed or sealed, and the keys, seal and seal must be kept by the financially responsible person responsible for the storage of narcotic medicinal products.

3. Responsibility for the organization of proper storage, the safety of narcotic drugs and special prescription forms lies with the head of the pharmacy warehouse (base).

4. Access to the room where narcotic drugs and special prescription forms are stored is allowed only to persons directly working with them, which is issued by order of the head of the warehouse (base) and a special permit from the ATC.

5. Upon receipt of narcotic medicinal products, the head of the warehouse (base) or his deputy is obliged to personally check the compliance of the received quantities with the accompanying documents.

6. Narcotic medicinal products are released from the warehouse (base) only in a sealed form, while each package is labeled with a label indicating the sender, the name of the content and the number of the analysis.

7. Dispensing of narcotic medicines must be carried out in accordance with the requirements signed by the head of the institution or his deputy and certified by the seal of the institution.

All claims and invoices for narcotic medicinal products must be issued separately from claims and invoices for other medicinal products, indicating quantities in words.

Administration note: changes to paragraph 7.

8. The issuance of narcotic medicinal products is carried out under a separate power of attorney, drawn up in the prescribed manner, indicating the name of the drugs received and their quantity in words. The power of attorney is valid for 15 days.

9. Before dispensing narcotic medicinal products, the financially responsible person must personally check the basis of the day of dispensing, the compliance of the dispensed narcotic medicinal product with the accompanying document, the correctness of packaging and sign the copy of the invoice left in the warehouse (base).

Administration note: changes to paragraph 9.

10. Narcotic drugs are dispensed from pharmacy warehouses (bases) only for medical purposes to medical and preventive and pharmaceutical (pharmacy) organizations, as well as research institutions and medical educational institutions with hospital beds.

Administration note: changes to paragraph 10.

11. Narcotic medicinal products, regardless of the dosage form, are accounted for in warehouses (bases) in a numbered and laced book (according to the attached form), affixed with a wax seal and signed by the head of the management body of pharmaceutical organizations of the subject of the Russian Federation.

Administration note: new edition point 11.

12. All documents on the receipt and consumption of narcotic medicinal products in the warehouse (base) must be stored in a closed and sealed safe with the person responsible for their storage, in accordance with the established storage periods.

Administration note: changes to paragraph 12.

13. Storage in pharmacy warehouses (bases) of narcotic drugs that are not permitted for use in medical practice in the Russian Federation is prohibited.

14. Transportation of narcotic medicinal products is carried out in accordance with the current special rules.

Head of Organization Department

Providing medicines and

drug control committee

Name of the pharmacy warehouse (base)

accounting for narcotic drugs in pharmacy warehouses (bases)

Administration note: The book of accounting for narcotic drugs in pharmacy warehouses (bases) is excluded.

Product name ______________________________________________

Unit of measurement __________________________________________________

www.med-pravo.ru

Legislative base of the Russian Federation

Free consultation

federal law

• "Health", N 3, 1998

ORDER of the Ministry of Health of the Russian Federation dated 12.11.97 N 330 "ON MEASURES TO IMPROVE ACCOUNTING, STORAGE, PRESCRIBING AND USE OF NARCOTIC MEDICINES"

In order to streamline the accounting, storage, prescribing and use of narcotic drugs, I order:

1. Put into action:

— Standard requirements for technical strengthening and equipping with means of security and fire alarm systems for premises with the storage of narcotic drugs (Appendix 1).

— The form of a special prescription form for a narcotic drug (Appendix 2).

— Estimated requirements for the need for narcotic drugs for outpatients and inpatients (Appendix 3).

- Rules for the storage and accounting of narcotic drugs in pharmacies (Appendix 4).

- Rules for the storage and accounting of narcotic drugs and special prescription forms in medical and preventive institutions (Appendix 5).

- Regulations on the write-off and destruction of narcotic drugs and special prescriptions not used by cancer patients (Appendix 6).

- Rules for the storage, accounting and dispensing of narcotic drugs and special prescription forms for narcotic drugs in pharmacy warehouses (bases) (Appendix 7).

- Rules for the storage and accounting of narcotic drugs in the control - analytical laboratories(Appendix 8).

– Rules for the storage and accounting of narcotic drugs in research institutes, laboratories and educational institutions(Appendix 9).

— Act for the destruction of used ampoules from narcotic drugs (Appendix 10).

- The form of an extraordinary report submitted to the Ministry of Health of the Russian Federation on the theft and theft of drugs from pharmacies and medical and preventive institutions (Appendix 11).

2.2. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation:

2.1. To impose on the heads of medical and preventive institutions personal responsibility for accounting, safety, dispensing, prescribing and using narcotic drugs and special prescription forms, in accordance with Appendices 1-11 introduced by this Order.

2.2. Provide medical and preventive institutions with special prescription forms for narcotic drugs received from pharmacy warehouses (bases). The stock of special prescription forms for narcotic drugs in the health authorities and medical and preventive institutions should not exceed the monthly requirement.

2.3. To oblige the heads of medical and preventive institutions (or their deputies) to ensure that special prescription forms for narcotic drugs are stored only in a safe, the key to which must be kept by these heads; and exercise systematic control over the prescription of narcotic drugs and the established procedure for prescribing them (Appendix 2). To categorically prohibit doctors from issuing and also writing out prescriptions for narcotic drugs to patients suffering from drug addiction.

2.4. To oblige attending physicians to record the prescription and use of narcotic drugs in the case history indicating the name of the dosage form of the narcotic drug, its quantity and dosage.

2.5. To oblige attending physicians or doctors on duty to hand over used ampoules from narcotic drugs on the same day, except for weekends and public holidays, deputy head of the medical department, and in institutions where he is absent - to the head of the medical institution. The destruction of used ampoules is carried out by a commission chaired by the head with the execution of the relevant act in the prescribed form (Appendix 7).

3. When determining the need for narcotic drugs, the Standing Committee for Drug Control, heads of medical and preventive institutions, heads of scientific research institutions should be guided by the norms for the consumption of narcotic drugs (Appendix 9).

4. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation systematically organize checks on the correctness of the appointment and registration of persons admitted (including temporarily) to work on the receipt, storage, accounting and dispensing of narcotic drugs in pharmacies and medical and preventive institutions . In case of revealing the facts of violation of the order of appointment and admission of persons to work with narcotic drugs, the perpetrators shall be brought to strict liability in accordance with the legislation of the Russian Federation.

5. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation to bring this Order to the attention of medical and pharmaceutical workers, to constantly monitor its implementation.

6. Consider Order of the Ministry of Health of the USSR dated December 30, 1982 N 1311 “On measures to eliminate serious shortcomings and further strengthen the fight against drug addiction, improve accounting, storage, prescribing and use of narcotic drugs” (Appendix 2 “Form of a special prescription form for a narcotic drug”, Appendix 3 “Narcotic drug consumption rates”, Appendix 4 “Form of an extraordinary report submitted to the USSR Ministry of Health on the theft and theft of drugs from pharmacies and medical and preventive institutions”, Appendix 5 “Storage rules and accounting for narcotic drugs in self-supporting pharmacies", Appendix 6 "Rules for the storage and accounting of narcotic drugs and special prescription forms in medical and preventive institutions", Appendix 7 "Rules for the storage, accounting and dispensing of narcotic drugs and special prescriptions blank forms for drugs in pharmacy warehouses", Appendix 8 "Rules for the storage and accounting of drugs in control and analytical laboratories of pharmacy departments", Appendix 9 "Rules for the storage and accounting of drugs in research institutes, laboratories and educational institutions of the healthcare system" , Annex 10 "Regulations on the write-off and destruction of narcotic drugs and special prescriptions not used by cancer patients", Annex 11 "Act on the destruction of used ampoules from narcotic drugs in healthcare institutions").

7. To impose control over the implementation of this Order on the Deputy Minister of Health Vilken A.E.

Appendix 1
APPROVED
Order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330
AGREED
Deputy Minister
internal affairs
Russian Federation
A.N. KULIKOV
March 5, 1993
AGREED
Chairman
Standing Committee
drug control
E.A. BABAYAN
March 4, 1993

1.1. These Requirements provide for technical strengthening measures and define the basic principles for the creation of multi-line security and fire alarm systems to protect premises (special storage facilities) with narcotic drugs included in the lists issued by the Standing Committee on Narcotics Control.

The requirements apply to designed, newly built and reconstructed storage facilities for narcotic drugs. The technical strength of premises with drugs, the protection agreements of which have already been concluded, must be brought into line with the requirements of this document within the time limits established in the acts of commission surveys.

The requirements apply to premises for the storage of potent and toxic substances.

1.2. Commission inspections of drug storage facilities are carried out by representatives of health authorities, security units, the State Fire Supervision Service and other interested organizations. The commission, on the basis of current regulations and available documentation, determines the places of concentration of narcotic drugs, selects the best option for protecting the facility using signaling means, taking into account its telephone installation and power supply. During the survey, vulnerabilities in building structures (windows, doors, non-permanent walls, ceilings, floors, ventilation openings, etc.) are identified, the number of security and fire loops, devices, detectors, and sensors necessary to protect drug storage sites is determined.

Based on the results of the inspection of the storage of narcotic drugs, an act of the prescribed form is drawn up, performers and deadlines for the work are determined.

1.3. Preparation and performance of work on equipping the premises with drugs by OPS should be carried out in accordance with:

- with technological maps and instructions for the installation of security alarm systems and devices;

- with VSN 25-09.68-85 "Rules for the production and acceptance of work. Installation of security, fire and security-fire alarm systems”;

- with technical documentation for products;

- with the requirements of PUE, SNiP 2.04.09-84 and SNiP 3.05.06-85.

2.1. Premises with drugs must have walls equivalent in strength to brick walls with a thickness of at least 510 mm, floors and ceilings equivalent in strength to a reinforced concrete slab with a thickness of at least 100 mm.

2.2. Walls, ceilings, floors that do not meet the specified requirements must be reinforced from the inside over the entire area with steel gratings with a rod diameter of at least 10 mm and a mesh size of not more than 150 x 150 mm. Lattices are welded to anchors released from masonry walls or floor slabs with a diameter of at least 12 mm in increments of 500 x 500 mm.

If it is impossible to install anchors, it is allowed to fix embedded parts from a steel strip measuring 100 x 50 x 6 mm to reinforced concrete and concrete surfaces with four dowels.

2.3. Entrance doors of narcotic drug storage facilities must comply with the requirements of GOST 6629-88, GOST 24698-81, GOST 24584-81, GOST 14624-84, be in good order, well fitted to the door frame, full-bodied, at least 40 mm thick, have at least two mortise non-self-locking locks. Doors are upholstered on both sides with sheet iron with a thickness of at least 0.6 mm with a bend of the edges of the sheet on the inner surface of the door or on the end of the leaf with an overlap. The doorway from the inside is additionally protected by lattice metal doors made of steel bar with a diameter of at least 16 mm, with cells of no more than 150 x 150 mm, which are welded at each intersection. The design of the doorway (door frame) is made of steel profile. In existing storage facilities, wooden boxes are allowed, reinforced with steel corners measuring 30 x 40, at least 5 mm thick, fixed to the wall with reinforcing steel pins with a diameter of 10–12 mm and a length of 120–150 mm.

2.4. Window openings of premises with drugs from the inside or between the frames are equipped with metal bars, which are made of steel bars with a diameter of at least 16 mm and the vertical and horizontal distance between the bars is not more than 150 mm. The ends of the lattice rods are embedded into the wall to a depth of at least 80 mm and poured with concrete.

It is allowed to use decorative grilles or blinds, which should not be inferior in strength to the above grilles.

2.5. Drugs must be kept in safes. It is allowed to store drugs in metal cabinets in technically fortified premises. Safes (metal cabinets) must be kept closed. After the end of the working day, they must be sealed or sealed. Keys to safes, seals and ice-cream should be kept by financially responsible persons authorized to do so by orders from health authorities or institutions.

3.1. Drug vaults must be equipped with multi-line security alarm systems with each line connected to separate numbers of centralized monitoring consoles.

3.2. The building structures of the perimeters of the premises are protected as the first line of the alarm system - window and door openings, ventilation ducts, heat inputs and other elements of the premises accessible for penetration from the outside. Doors are blocked on "opening" and "breach". Windows are protected by alarms for "opening" and "destruction" of glass. Non-capital walls, ceilings, places for entering communications - to the "break". Capital walls, ventilation ducts - for "destruction" and "impact".

Blocking of building structures for "opening" (windows, doors) is recommended to be carried out by detectors of the SMK type, for the "destruction" of glass, foil, detectors of the "Window-1" type or similar are used. Non-capital walls (partitions) are protected against a "break" with a PEL wire. To block the main walls and ceiling of the room, it is recommended to use the detector type "Gran-1", which allows you to detect the destruction of building structures made of bricks of at least 150 mm and concrete of at least 120 mm thick. Vulnerable areas of the perimeters of the premises can be protected by opto-electronic detectors such as "Photon-2", "Photon-5", which form a detection zone in the form of a vertical barrier.

3.3. Additional alarm lines protect the internal volumes and areas of the premises, safes (metal cabinets) used to store drugs. For additional security lines, the choice of detectors is determined depending on the nature of the premises and the location of material assets in them. As devices and detectors for these purposes, ultrasonic, optoelectronic, radio wave, capacitive detectors "Echo-2.3", "Photon-1M.4", "Kvant-3", "Volna-2,M", " Fon-1", "Rif-M", "Peak", etc.

To increase the reliability of the alarm operation, it is recommended to use detectors of various operating principles.

3.4. In multi-line protection systems, it is necessary to use receiving and control devices that provide control of alarm loops in the event of a power failure. The use of the receiving control devices and detectors with self-powered power supply or units for switching to power supply from the centralized monitoring console via telephone lines together with on-site devices of the sealing equipment, which do not provide for backup power, is not advisable.

3.5. In addition to independent protection lines, it is recommended to equip safes (metal cabinets) with sensors - traps directly, which are included in the loop of an additional alarm line.

3.6. When the mains supply is switched off, the control panel, sensors and annunciators of one of the signaling lines must be operational. If not in storage telephone lines it is necessary to use HF compaction of free lines of the distribution network, lines of telephones of organizations, apartments of citizens located near the storage, or lines of payphones.

3.7. At large facilities (bases, warehouses) with the storage of narcotic drugs, it is allowed to use the principle of "small centralization" with the installation of small-capacity concentrates at checkpoints with their connection to centralized monitoring panels.

3.8. The workplaces of personnel involved in drug transactions, as well as storage facilities, are equipped with an alarm system, which is intended to transmit alarm signals to the duty units of the internal affairs bodies and take action in the event of a robbery during working hours.

3.9. The fire alarm system must provide round-the-clock operation. Fire detectors are included in common or independent blocking loops connected to common or independent devices with alarm output to centralized monitoring panels or local sound and light signaling devices.

3.10. At facilities (in premises) with the storage of narcotic drugs, it is not allowed to use security alarm equipment that is not included in the List of technical equipment for security, security - fire and fire alarms recommended for use.

4. Compliance with the provisions of these Model Requirements is mandatory upon obtaining permission from the Standing Committee on Narcotics Control to possess narcotic drugs.

Annex 2
APPROVED
Order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

Appendix 3
APPROVED
Order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

CALCULATED STANDARDS FOR THE NEED FOR NARCOTIC MEDICINES
PER 1000 POPULATION PER YEAR (IN GRAM)

Order of the Ministry of Health of Russia dated August 05, 2003 N 330 (as amended on November 24, 2016) “On measures to improve clinical nutrition in medical institutions of the Russian Federation” (together with the “Regulation on the organization of the activities of a dietitian”, “Regulations on the organization of activities Dietary Nurse”, “Regulations on the Council for Medical Nutrition of Medical Institutions”, “Instructions for Organizing Medical Nutrition in Medical Institutions”) (Registered in the Ministry of Justice of Russia on September 12, 2003 N 5073)

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ABOUT IMPROVEMENT MEASURES

THERAPEUTIC NUTRITION IN THERAPEUTIC AND PREVENTIVE

INSTITUTIONS OF THE RUSSIAN FEDERATION

In order to implement the Concept of State Policy in the field of healthy nutrition of the population of the Russian Federation for the period up to 2005, approved by the Decree of the Government of the Russian Federation of 10.08.1998 N 917 "*", to improve the organization of therapeutic nutrition and increase the effectiveness of its use in the complex treatment of patients, I order:

"*" Collection of Legislation of the Russian Federation, 24.08.1998, N 8, art. 4083.

1.1. Regulations on the organization of the activities of a dietitian (Appendix N 1);

1.2. Regulations on the organization of the activities of a dietary nurse (Appendix N 2);

1.3. Regulations on the Council for Clinical Nutrition in Medical Institutions (Appendix No. 3);

1.4. Instructions for the organization of therapeutic nutrition in medical institutions (Appendix N 4);

1.5. Instructions for the organization of enteral nutrition in medical institutions (Appendix N 5).

2. To impose control over the implementation of this Order on the Deputy Minister R.A. Khalfin.

ABOUT THE ORGANIZATION OF THE ACTIVITIES OF A NUTRITIONAL DOCTOR

1. A specialist doctor who has training in clinical nutrition and a certificate in the specialty "dietology" is appointed to the position of a dietitian.

2. A dietitian is responsible for the organization of therapeutic nutrition and its adequate application in all departments of health care institutions.

3. A dietitian supervises dietary nurses, oversees the work of the catering department.

4. A dietitian must:

a) advise the doctors of the departments on the organization of medical nutrition;

b) advise patients on therapeutic and rational nutrition;

c) conduct a random check of case histories according to the prescribed diets and the stages of diet therapy;

d) analyze the effectiveness of therapeutic nutrition;

e) check the quality of products upon their receipt at the warehouse and catering department; control the correct storage of food stock;

f) to control the correctness of the laying of products during the preparation of dishes;

g) prepare documentation on the organization of medical nutrition:

- a seven-day summary menu - summer and winter version;

h) to control the correctness of keeping documentation by the dietary nurse (menu-layout, menu-requirement, etc.);

i) to control the quality of prepared food before issuing it to the departments by taking a sample at each meal;

j) together with the heads of departments, determine the list and number of grocery home transfers for a patient who is being treated in a medical institution;

k) control the timeliness of preventive medical examinations of catering and pantry workers and not allow persons who have not undergone preventive medical examinations, and patients with pustular, intestinal diseases, tonsillitis, to work;

l) systematically organize the improvement of the qualifications of food unit workers on the issues of clinical nutrition;

m) to carry out active sanitary and educational work on rational and therapeutic nutrition for all employees of the medical institution and patients;

o) level up professional qualifications on cycles of improvement in nutrition at least 1 time in 5 years.

ON ORGANIZATION OF MEDICAL ACTIVITIES

1. A specialist with an average medical education, who has special training in clinical nutrition and a certificate in the specialty "dietology".

2. Nurse dietary works under the guidance of a dietitian.

3. The dietary nurse monitors the work of the catering department and the observance of sanitary and hygienic rules by the employees of the catering department.

4. The dietary nurse is obliged to:

a) check the quality of products when they arrive at the warehouse and catering department; control the correct storage of food stock;

b) prepare daily, under the supervision of a dietitian and with the participation of the production manager, a menu-layout (or menu-requirement) in accordance with the card file of dishes and the consolidated menu approved by the Council for Therapeutic Nutrition;

c) exercise control over the correct laying of products during the preparation of dishes and the rejection of finished products, take samples of finished food;

d) control the correctness of the distribution of dishes from the catering unit to the departments in accordance with the "distribution list";

e) to exercise control over: the sanitary condition of the premises of the catering department, distributing, buffet rooms, inventory, utensils, as well as the implementation of personal hygiene rules by the employees of the catering department;

f) organize and personally participate in conducting classes with an average medical staff and employees of the catering department on issues of clinical nutrition;

g) maintain medical records;

h) carry out timely preventive medical examinations of workers in the catering department, distributing and canteen workers and not allow persons who have not passed preventive medical examinations to work; medical checkup, and patients with pustular, intestinal diseases, tonsillitis;

i) level up vocational training at least once every 5 years.

dated 05.08.2003 N 330

ABOUT THE THERAPEUTIC NUTRITION COUNCIL

1. The Council for Clinical Nutrition is an advisory body and is created in a medical institution with a number of beds from 100 and more.

2. The number of members of the Medical Nutrition Council and its personal composition is approved by the Order of the head physician of the institution.

3. The Council for Medical Nutrition includes: the chief physician (or his deputy for medical work) - the chairman; dietician - executive secretary, heads of departments - doctors, anesthesiologist-resuscitator, gastroenterologist, therapist, transfusiologist, surgeon (members of the nutritional support team), deputy chief physician for economic affairs, dietary nurses, production manager (or chef) . If necessary, other specialists of the medical institution may be involved in the work of the Council.

4. Tasks of the Council for Therapeutic Nutrition:

a) improving the organization of medical nutrition in a medical institution;

b) introduction of new technologies for preventive, dietary and enteral nutrition;

d) approval of the nomenclature of diets, mixtures for enteral nutrition, dry protein composite mixtures for therapeutic nutrition, biologically active additives to be introduced in this healthcare institution;

e) approval of seven-day menus, a card file of dishes and a set of mixtures for enteral nutrition;

g) improvement of the ordering system for dietary kits and mixtures for enteral nutrition;

h) development of forms and plans for advanced training of employees in clinical nutrition;

i) control over the organization of therapeutic nutrition and analysis of the effectiveness of diet therapy for various diseases.

5. The Therapeutic Nutrition Council holds meetings as needed, but at least once every three months.

ON THE ORGANIZATION OF THERAPEUTIC FOOD

IN MEDICAL AND PREVENTIVE INSTITUTIONS

The organization of therapeutic nutrition in a medical institution is an integral part of the treatment process and is one of the main therapeutic measures.

In order to optimize medical nutrition, improve the organization and improve its quality management in medical institutions, new nomenclature diets (system of standard diets), differing in the content of essential nutrients and energy value, cooking technology and the average daily set of products.

Previously used number system diets (diets N 1 - 15) are combined or included in the system of standard diets, which are prescribed for various diseases depending on the stage, severity of the disease or complications from various organs and systems (table 1).

Along with the main standard diet and its variants in a medical institution, in accordance with their profile, they use:

- surgical diets (0-I; 0-II; 0-III; 0-IV; diet for ulcer bleeding, diet for gastric stenosis), etc.;

- specialized diets: high-protein diet for active tuberculosis (hereinafter - high-protein diet (m));

- unloading diets (tea, sugar, apple, rice-compote, potato, cottage cheese, juice, meat, etc.);

- special diets (potassium, magnesium, tube diet, diets for myocardial infarction, diets for unloading dietary therapy, vegetarian diet, etc.).

Individualization of the chemical composition and caloric content of standard diets is carried out by selecting the medical nutrition dishes available in the card file, increasing or decreasing the number of buffet products (bread, sugar, butter), controlling home delivery of food for patients undergoing treatment in a medical institution, and also by use in therapeutic and enteral nutrition of biologically active food supplements and ready-made specialized mixtures. To correct the diet, 20 - 50% of the protein of ready-made specialized mixtures can be included (table 1a).

Acquisition of dry protein composite mixtures for clinical nutrition is carried out in accordance with the Instructions on the procedure for applying the budget classification of the Russian Federation, approved by Order of the Ministry of Finance of the Russian Federation dated December 21, 2005 N 152n (in accordance with the letter of the Ministry of Justice of the Russian Federation dated January 10, 2006 No. N 01 / 32-ЕЗ The order does not need state registration) under article 340 of the economic classification of expenditures of the budgets of the Russian Federation "Increase in the cost inventories”with the assignment of ready-made specialized mixtures for therapeutic nutrition to the section“ food (payment for food), including food rations for military personnel and persons equated to them.

The nomenclature of permanent diets in each medical institution is established in accordance with its profile and approved by the Council for Clinical Nutrition. In all medical institutions, at least a four-time diet is established; according to indications, in separate departments or for certain categories of patients (duodenal ulcer, disease of the operated stomach, diabetes mellitus, etc.), more frequent meals are used. The diet is approved by the Therapeutic Nutrition Council.

The recommended average daily food sets are the basis for the preparation of standard diets in a medical institution (table 2). When forming standard diets for children and adults receiving sanatorium treatment, more expensive varieties of products are used, taking into account daily nutritional norms in sanatoriums and sanatoriums (tables 3, 4, 5). In the absence of a complete set of products in the catering department, provided for by a consolidated seven-day menu, it is possible to replace one product with another while maintaining the chemical composition and energy value of the used therapeutic diets (Tables 6, 7).

Control of the correctness of the diet therapy carried out should be carried out by checking the compliance of the diets received by patients (in terms of a set of products and dishes, cooking technology, chemical composition and energy value) with the recommended characteristics of standard diets and by checking the uniform use of appropriations by quarters of the year.

General leadership diet in a medical institution is carried out by the chief physician, and in his absence - by the deputy for the medical part.

The dietitian is responsible for the organization of therapeutic nutrition. In cases where there is no position of a dietitian in a medical institution, the dietary nurse is responsible for this work.

The nutritionist is subordinated to dietary nurses and all catering workers who provide therapeutic nutrition in a medical institution in accordance with this Order.

At the catering department of a medical institution, the head of production (chef, senior cook) controls the compliance with the cooking technology and the output of ready-made dietary dishes; food to departments.

All issues related to the organization of clinical nutrition in a medical institution are systematically (at least once a quarter) heard and resolved at meetings of the Medical Nutrition Council.

to the Instructions for Organizing

CHEMICAL COMPOSITION AND ENERGY

THE VALUE OF STANDARD DIETS USED IN HOSPITALS

Ministry of Health of the Russian Federation

About improvement measures
therapeutic nutrition in medical and preventive
institutions of the Russian Federation

dated 07.10.2005 No. 624, dated 10.01.2006 No. 2, dated 04.26.2006 No. 316,
Order of the Ministry of Health of Russia dated June 21, 2013 No. 395n,
Prikaz of the Ministry of Health of Russia dated November 24, 2016 No. 901n)

In order to implement the Concept of State Policy in the field of healthy nutrition of the population of the Russian Federation for the period up to 2005, approved by the Decree of the Government of the Russian Federation of 10.08.1998 N 917, to improve the organization of clinical nutrition and increase the effectiveness of its use in the complex treatment of patients, I order:

1. Approve:

1.1. Regulations on the organization of the activities of a dietitian (Appendix N 1);

1.2. Regulations on the organization of the activities of a dietary nurse (Appendix N 2);

1.3. Regulations on the Council for Clinical Nutrition (Appendix N 3);

1.4. Instructions for the organization of therapeutic nutrition in medical institutions (Appendix N 4);

1.5. Instructions for the organization of enteral nutrition in medical institutions (Appendix N 5);

2. To impose control over the implementation of this order on the Deputy Minister R.A. Khalfin.

Minister
Yu.L. Shevchenko

Comment

On the application of this order, see letter dated April 7, 2004 N 2510 / 2877-04-32 and letter social development Russian Federation of July 11, 2005 N 3237-VS

Appendix No. 1

Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 N 330

POSITION

ABOUT THE ORGANIZATION OF THE ACTIVITIES OF A NUTRITIONAL DOCTOR

1. The position of a dietician is assigned to a specialist doctor who has training in clinical nutrition and a certificate in the specialty "dietology".

2. A dietitian is responsible for the organization of therapeutic nutrition and its adequate application in all departments of health care institutions.

3. A dietitian supervises dietary nurses, oversees the work of the catering department.

4. A dietitian must:

a) advise the doctors of the departments on the organization of medical nutrition;

b) advise patients on therapeutic and rational nutrition;

c) conduct a random check of case histories according to the prescribed diets and the stages of diet therapy;

d) analyze the effectiveness of therapeutic nutrition;

e) check the quality of products upon their receipt at the warehouse and catering department; control the correct storage of food stock;

f) to control the correctness of the laying of products during the preparation of dishes;

g) prepare documentation on the organization of medical nutrition:

Layout cards;

Seven-day menu;

Seven-day summary menu - summer and winter version;

h) to control the correctness of keeping documentation by the dietary nurse (menu-layout, menu-requirement, etc.);

i) to control the quality of prepared food before issuing it to the departments by taking a sample at each meal;

j) together with the heads of departments, determine the list and number of grocery home transfers for a patient who is being treated in a medical institution;

k) control the timeliness of preventive medical examinations of catering and pantry workers and not allow persons who have not undergone preventive medical examinations, and patients with pustular, intestinal diseases, tonsillitis, to work;

l) systematically organize the improvement of the qualifications of food unit workers on the issues of clinical nutrition;

m) to carry out active sanitary and educational work on rational and therapeutic nutrition for all employees of the medical institution and patients;

o) to improve the level of professional qualifications in the cycles of improvement in nutrition at least once every 5 years.

Appendix No. 2

Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 N 330

POSITION

ON ORGANIZATION OF MEDICAL ACTIVITIES

SISTERS DIETARY

1. A specialist with a secondary medical education who has special training in clinical nutrition and a certificate in the specialty "dietology" is appointed to the position of a dietary nurse.

2. A dietary nurse works under the guidance of a dietitian.

3. The dietary nurse monitors the work of the catering department and the observance of sanitary and hygienic rules by the employees of the catering department.

4. The dietary nurse is obliged to:

a) check the quality of products when they arrive at the warehouse and catering department; control the correct storage of food stock;

b) prepare daily, under the supervision of a dietitian and with the participation of the production manager, a menu-layout (or menu-requirement) in accordance with the card file of dishes and the consolidated menu approved by the Council for Therapeutic Nutrition;

c) exercise control over the correct laying of products during the preparation of dishes and the rejection of finished products, take samples of finished food;

d) control the correctness of the distribution of dishes from the catering unit to the departments in accordance with the "distribution list";

e) to exercise control over: the sanitary condition of the premises of the catering department, distributing, buffet rooms, inventory, utensils, as well as the implementation of personal hygiene rules by the employees of the catering department;

f) organize and personally participate in conducting classes with paramedical personnel and catering workers on therapeutic nutrition;

g) maintain medical records;

h) to carry out timely preventive medical examinations of catering, dispensing and buffet workers and not allow people who have not undergone a preventive medical examination, and patients with pustular, intestinal diseases, tonsillitis, to work;

i) improve the level of professional training at least once every 5 years.

Appendix No. 3

Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 N 330

POSITION

ABOUT THE THERAPEUTIC NUTRITION COUNCIL

TREATMENT AND PREVENTIVE INSTITUTIONS

1. The Council for Clinical Nutrition is an advisory body and is created in a medical institution with a number of beds from 100 and more.

2. The number of members of the Medical Nutrition Council and its personal composition is approved by the Order of the head physician of the institution.

3. The Council for Medical Nutrition includes: the chief physician (or his deputy for medical work) - the chairman; nutritionist - executive secretary, heads of departments - doctors, anesthesiologist-resuscitator, gastroenterologist, therapist, transfusiologist, surgeon (members of the nutritional support team), deputy chief physician for economic affairs, dietary nurses, production manager (or chef) . If necessary, other specialists of the medical institution may be involved in the work of the Council.

4. Tasks of the Council for Therapeutic Nutrition:

a) improving the organization of medical nutrition in a medical institution;

b) introduction of new technologies for preventive, dietary and enteral nutrition;

d) approval of the nomenclature of diets, mixtures for enteral nutrition, dry protein composite mixtures for therapeutic nutrition, biologically active additives to be introduced in this healthcare institution;

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

e) approval of seven-day menus, a card file of dishes and a set of mixtures for enteral nutrition;

g) improvement of the ordering system for dietary kits and mixtures for enteral nutrition;

h) development of forms and plans for advanced training of employees in clinical nutrition;

i) control over the organization of therapeutic nutrition and analysis of the effectiveness of diet therapy for various diseases.

5. The Therapeutic Nutrition Council holds meetings as needed, but at least once every three months.

Appendix No. 4

Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 N 330

INSTRUCTIONS

ON THE ORGANIZATION OF THERAPEUTIC FOOD

IN MEDICAL AND PREVENTIVE INSTITUTIONS

(as amended by the Orders of the Ministry of Health and Social Development of Russia
No. 624 of 07.10.2005, No. 2 of 10.01.2006, No. 316 of 26.04.2006,
Order of the Ministry of Health of Russia dated June 21, 2013 N 395n)

The organization of therapeutic nutrition in a medical institution is an integral part of the treatment process and is one of the main therapeutic measures.

In order to optimize therapeutic nutrition, improve the organization and improve its quality management in medical institutions, a new nomenclature of diets (a system of standard diets) is being introduced, differing in the content of basic nutrients and energy value, food preparation technology and the average daily set of products.

Previously used diets of the number system (diets N N 1 - 15) are combined or included in the system of standard diets, which are prescribed for various diseases depending on the stage, severity of the disease or complications from various organs and systems (table 1).

Along with the main standard diet and its variants in a medical institution, in accordance with their profile, they use:

Surgical diets (0-I; 0-II; 0-III; 0-IV; diet for ulcer bleeding, diet for gastric stenosis), etc.;

Specialized diets: high-protein diet for active tuberculosis (hereinafter - high-protein diet (m));

Unloading diets (tea, sugar, apple, rice-compote, potato, cottage cheese, juice, meat, etc.);

Special diets (potassium, magnesium, probe diet, diets for myocardial infarction, diets for unloading dietary therapy, vegetarian diet, etc.).

Individualization of the chemical composition and caloric content of standard diets is carried out by selecting the medical nutrition dishes available in the card file, increasing or decreasing the number of buffet products (bread, sugar, butter), controlling home delivery of food for patients undergoing treatment in a medical institution, and also by use in therapeutic and enteral nutrition of biologically active food supplements and ready-made specialized mixtures. To correct the diet, 20 - 50% of the protein of ready-made specialized mixtures can be included (table 1a).

(As amended by the Order of the Ministry of Health and Social Development of Russia dated 10.01.2006 N 2)

Acquisition of dry protein composite mixtures for clinical nutrition is carried out in accordance with the Instructions on the procedure for applying the budget classification of the Russian Federation, approved by Order of the Ministry of Finance of the Russian Federation dated December 21, 2005 N 152n (in accordance with the letter of the Ministry of Justice of the Russian Federation dated January 10, 2006 No. N 01 / 32-ЕЗ The order does not need state registration) under article 340 of the economic classification of expenditures of the budgets of the Russian Federation "Increase in the cost of inventories" with the assignment of ready-made specialized mixtures for medical nutrition to the section "food (payment for food), including food rations to servicemen and persons equated to them.

(the paragraph was introduced by Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

The nomenclature of permanent diets in each medical institution is established in accordance with its profile and approved by the Council for Clinical Nutrition. In all medical institutions, at least a four-time diet is established; according to indications, in separate departments or for certain categories of patients (duodenal ulcer, disease of the operated stomach, diabetes mellitus, etc.), more frequent meals are used. The diet is approved by the Therapeutic Nutrition Council.

The recommended average daily food sets are the basis for the preparation of standard diets in a medical institution (table 2). When forming standard diets for children and adults receiving sanatorium treatment, more expensive varieties of products are used, taking into account daily nutritional norms in sanatoriums and sanatoriums (tables 3, 4, 5). In the absence of a complete set of products in the catering department, provided for by a consolidated seven-day menu, it is possible to replace one product with another while maintaining the chemical composition and energy value of the used therapeutic diets (Tables 6, 7).

Control of the correctness of the diet therapy carried out should be carried out by checking the compliance of the diets received by patients (in terms of a set of products and dishes, cooking technology, chemical composition and energy value) with the recommended characteristics of standard diets and by checking the uniform use of appropriations by quarters of the year.

The general management of the diet in a medical institution is carried out by the chief physician, and in his absence - by the deputy for the medical department.

The dietitian is responsible for the organization of therapeutic nutrition. In cases where there is no position of a dietitian in a medical institution, the dietary nurse is responsible for this work.

The nutritionist is subordinated to dietary nurses and all catering workers who provide therapeutic nutrition in a medical institution in accordance with this Order.

At the catering department of a medical institution, control over compliance with the technology of preparation and the output of ready-made dietary dishes is carried out by the head of production (chef, senior cook), control over the quality of ready-made dietary dishes - a dietitian, a dietary nurse, a doctor on duty, allowing the issuance of ready-made food to departments.

All issues related to the organization of clinical nutrition in a medical institution are systematically (at least once a quarter) heard and resolved at meetings of the Medical Nutrition Council.

Table 1

Characteristic,
chemical composition and energy value
standard diets used in healthcare facilities
(in hospitals, etc.)

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

Table 1a

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Ratio natural products nutrition
and specialized food
in the patient's daily diet

(introduced by the Order of the Ministry of Health and Social Development of Russia dated 10.01.2006 N 2,
in red. Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

table 2

to the Instructions for the organization of therapeutic nutrition
in medical institutions

in medical institutions

Lost strength. - Order of the Ministry of Health of Russia dated June 21, 2013 N 395n.

Table 2a

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Average daily set of products per patient
in anti-tuberculosis treatment-and-prophylactic institutions

(introduced by Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

** Koumiss, as a rule, is used in regions where koumiss is traditionally used in food and its production is developed.

Notes:

1. The average daily set of products must be supplemented with specialized food products (dry composite protein mixture) in accordance with tables 1a, 7 to the Instructions for organizing therapeutic nutrition in medical institutions.

2. The average daily set of products may differ from the set of products provided for in this table, depending on the season (winter, spring, summer, autumn).

Table 3

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Average daily set of products
for adults in sanatorium treatment

(As amended by the Order of the Ministry of Health and Social Development of Russia dated October 7, 2005 N 624)

______________________________

* Refined carbohydrates (sugar and confectionery with sucrose) are excluded from the diet of diabetics. They are equivalently replaced by specialized dietary products that do not contain sucrose.

Notes:

1. The average daily set of products may differ from the set of products provided for in this table, depending on the season (winter, spring, summer, autumn).

2. The average daily set of products is supplemented with specialized products for dietary (therapeutic and preventive) nutrition.

Table 4

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Table 5

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Average daily food packages for children,
affected by radiation exposure
being treated in sanatoriums
institutions of various profiles (except for tuberculosis)

Table 6

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Interchangeability of products in the preparation of dietary dishes

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

Notes:

*(1) When using butter for dressing when serving dishes, the amount of replacement and replacement butter of other types is the same.

*(3) Despite the fact that sorbitol is half as sweet as sucrose, its interchangeability rate is 1:1.

*(4) Calculation of the replacement rate is made in accordance with GOST.

*(5) The numerator is the weight of apples when the semi-finished product is defrosted in air, the denominator is the weight of apples when the semi-finished product is defrosted in sugar syrup.

Table 7

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Replacing products for proteins and carbohydrates

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

The procedure for issuing meals

for patients in medical institutions

1. The extract of nutrition is carried out by a dietary nurse under the guidance of a dietitian.

In medical institutions where there is no position of a dietitian, nutrition is issued by a dietitian nurse under the supervision of a doctor responsible for clinical nutrition.

2. When a patient enters a medical institution, medical nutrition is prescribed by the doctor on duty. The prescribed diet is entered into the medical history and at the same time into the consolidated order for all admitted patients, which is sent to the catering department at the set time.

3. Accounting for diets is maintained by ward nurses, who daily report to the head nurse of the department the number of patients and their distribution by diet. On the basis of this information, the senior nurse of the department draws up the form N 1-84 "Portion for the nutrition of patients", which is signed by her, the head of the department and transferred to the catering unit by the dietary nurse.

4. The dietary catering nurse, on the basis of information received from all departments, draws up "Summary information on the presence of patients on meals" in a medical institution, which are verified with the data of the admissions department and signed by her (form N 22-MZ).

5. Based on the "Summary information" dietary nurse with the participation of the head. production (chef) and accountant under the guidance of a dietitian draws up a menu-layout in the form N 44-MZ for the nutrition of patients the next day.

The layout menu is compiled according to a consolidated seven-day menu, taking into account the average daily set of food products, is approved daily by the head physician of the institution and signed by a dietitian, accountant, head. production (chef). In the layout menu, the dietary nurse in the numerator puts down the amount of food for preparing one serving of each dish, in the denominator the accountant (calculator) indicates the amount of food needed to prepare all servings of this dish.

6. Based on the final data of form N 44-MZ, a "Requirement for the issuance of food products from a warehouse (pantry)" is issued in accordance with form N 45-MZ in two copies.

7. The laying of food products in the boiler is carried out in the presence of a dietitian (dietary nurse). Food products are pre-weighed regardless of the fact that they were received by weight from the warehouse (pantry).

8. Issuance of food rations to the departments is carried out in accordance with the form N 23-MZ ("Vallet sheet for the departments of food rations for patients"), which is filled in by the dietary nurse in one copy. When issuing breakfasts, lunches and dinners, branch employees sign for their receipt. The statement is signed by the dietary nurse and head. production (chef).

Buffet products (butter, bread, tea, salt, etc.) are issued to barmaids directly from the warehouse (pantry) at the request of form N 45-MZ.

9. An additional statement and / or return of products is made according to the invoice (requirement) to the warehouse (pantry) in the form N 434. Food stuffs placed in the boiler are not subject to return.

10. Additional meals prescribed in the department for dietary rations are drawn up in two copies, signed by the attending physician, head of the department and approved by the head physician of the medical institution. The first is transferred to the catering unit, the other is stored in the medical history.

11. For each dish prepared in a medical institution, a layout card is drawn up in the form of N 1-85 in two copies: one copy is kept by the accountant, the second - by the dietary nurse (on the back of the card the cooking technology is described).

The procedure for quality control of prepared food in a medical institution

1. The control of prepared food before issuing it to the departments is carried out by the doctor on duty and once a month - by the chief doctor (or his deputy for medical work) of the medical institution, and is also carried out by a dietitian, dietary nurse, head. production (or chef) regardless of the sample produced by the doctor on duty.

2. Checking the finished food at the catering unit before issuing it to the departments is carried out in the following order:

a) directly from the boiler, in accordance with the list of dishes indicated in the layout menu.
The volume of the first courses is set based on the capacity of the pot or boiler and the number of ordered servings and the volume of one serving. The weight of second courses (cereals, puddings, etc.) is determined by weighing the total quantity in a common dish, minus the tare weight and taking into account the number of servings. Portion dishes (cutlets, meatballs, meat, poultry, etc.) are weighed in the amount of 10 servings and the average weight of one serving is set. Weight deviations from the norm should not exceed 3%;

b) by sampling a decorated dish of one of the diets used.

3. The results of the food sample are recorded by the doctor on duty in the journal of prepared food (form N 6-lp).

4. The selection of ready-made meals for laboratory analysis (determination of the chemical composition and energy value, taking into account losses during cold and heat treatment) is carried out by the institutions of the State Sanitary and Epidemiological Supervision of the Ministry of Health of the Russian Federation in a planned manner in the presence of a dietitian or a dietitian nurse.

Technological equipment The catering unit is divided into mechanical, thermal and refrigeration.

1. Mechanical equipment is used for the primary processing of products, it includes:

a) machines for processing cereals, potatoes and vegetables (grinders, potato peelers, vegetable cutters, shredders, mashers, juicers);

b) machines for processing meat and fish (meat grinders, meat mixers, special devices for cleaning fish from scales, cutlet machine, saws for sawing meat carcasses);

c) machines for preparing dough (sifters, dough mixers, a mechanism for laying out and dividing dough);

d) dishwashing machines (or bathtubs for hand wash tableware and bath for washing kitchen utensils);

e) machines for cutting bread, egg cutters;

f) beater for liquid mixtures.

2. Thermal equipment is used for thermal processing of products (boiling, frying, baking, steaming, combined processing).

a) cooking equipment includes cooking pots, sauce pots, steamers, egg and sausage boilers;

b) frying equipment includes electric frying pans, electric crucibles, electric stoves, microwave ovens. Oven ovens (with T - 150 - 200 degrees); drying cabinets (T - 100 - 150 degrees), baking cabinets (T - up to 300 degrees).

3. Non-mechanized equipment:

a) cutting tables, cutting boards, racks, carts, scales, cabinets for storing kitchen utensils and appliances, chests, cutting decks;

b) pots, buckets, baking sheets, frying pans, sieves, vessels, kettles;

c) inventory: knives, forks, spatulas, mortars, molds, strainers, skimmers, etc.

4. Refrigeration equipment represented by refrigerated chambers and refrigerated cabinets.

5. The premises of the pantry at the departments of medical institutions should be provided with:

a) cold and hot running water, regardless of the availability of a hot water supply network; canteens should be equipped with continuous electric boilers;

b) two-section washing bathtubs that are connected to the sewerage; a tank for soaking (disinfection) or boiling dishes;

c) washing disinfectants;

d) nets for drying dishes, appliances and food storage (bread, salt, sugar);

f) a cabinet for storing household equipment;

g) a food warmer or an electric stove for heating food;

h) a table with a hygienic covering for distributing food;

i) a table for dirty dishes;

j) a set of dishes per patient: one deep, small and dessert plates, fork, spoons (table and tea); a mug, and in children's departments with a margin, according to the equipment sheet;

k) cleaning equipment (buckets, rags, brushes, etc.) marked "for pantry".

Responsibility for the right equipment the catering and canteen departments of the medical institution are carried out by the deputy chief physician for the administrative and economic part and the dietitian.

Transportation of prepared food

a) in the absence of a centralized ring delivery food products for their transportation, special transport (covered) is allocated, which is subjected to certification at least once a year in the institutions of the State Sanitary and Epidemiological Supervision. It is strictly forbidden to use this transport for other purposes (transportation of linen, equipment, patients, etc.).

b) for the transportation of prepared food to the pantry departments of the hospital, thermoses, thermos trolleys, food warmer trolleys or tightly closed dishes are used.

Sanitary and hygienic regime of the catering department and pantry

1. In the food blocks of medical institutions, the following must be strictly observed:

Requirements for the arrangement of the catering unit, sanitary maintenance and cooking technology, provided for by the current sanitary rules for enterprises Catering;

Sanitary regulations on the conditions and terms of storage and sale of especially perishable products;

Requirements for mandatory preventive and medical examinations of catering, distributing and buffet workers (forms 1-lp and 2-lp).

It is strictly forbidden in the premises of the catering unit to wash tableware from the departments of the medical institution. Washing of dishes is carried out only in the washing cupboards of the departments in compliance with the disinfection of dishes.

The distribution of ready-made food is carried out no later than 2 hours after its preparation, including the time of delivery of food to the department.

Food is distributed to patients by barmaids and duty nurses of the department. Food distribution should be carried out only in a dressing gown marked "For serving food."

Technical personnel involved in cleaning the wards and other premises of the department are not allowed to distribute. Meals for all patients of the department, with the exception of seriously ill patients, are carried out in a specially allocated room - a dining room. Personal food products of patients (transfers from home) are stored in a closet, bedside table (dry products) and in a special refrigerator (perishable products).

Transfers to patients are accepted only within the range and quantity of products permitted by the doctor.

After each distribution of food, the premises of the pantry and dining room are thoroughly cleaned using disinfectant solutions.

After washing, the cleaning material is poured with 0.5% clarified bleach solution or 1% chloramine solution for 60 minutes, then rinsed in running water and dried (the inventory is used strictly for its intended purpose).

The staff of the catering unit and pantry is obliged to observe the rules of personal hygiene. Before visiting the toilet, the staff must take off their bathrobe, after the visit, they must brush their hands with disinfectants or laundry soap.

Responsible for compliance sanitary requirements when preparing and dispensing ready-made food in the catering department is the head. production (chef), a dietary nurse, a dietitian, and in the department - barmaids and senior nurses.

Letter No. 2510/2877-04-32 of April 7, 2004 of the Ministry of Health of Russia states that the duration of storage of daily samples of prepared food is 48 hours instead of those indicated in the following paragraph "during the day".

Daily samples of prepared food are left daily in the amount of one serving or 100 - 150 g of each dish, placed in a clean boiled for 15 minutes. labeled dishes with a lid, which are stored in a separate refrigerator for a day.

List of documentation of the catering unit for issuing meals and monitoring the quality of prepared food in medical institutions

Form N 1-84

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Portioner

for the nutrition of patients "__" __________ 20__

Head Branch (signature)

Art. honey. branch sister (signature)

Honey. dietary sister of the department (signature)

Form N 22-MZ

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Name of institution __________________________________________________

Summary information on the presence of patients on food

at ___ hours "__" _______ 20__

(Back side)

Individual and additional meals
(as well as the nutrition of mothers who are in a medical institution with babies)

Form N 23-MZ

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Handout list

On vacation to food ration departments

(meal: breakfast, lunch, dinner, etc.)

20__

Dietary nurse ______ Head of production (chef) _____

Form N 1-85

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Name of the medical institution ______________________________________________

I approve: ____________

Head of institution

Layout card N

Name of the dish _________________________________________________________

Indication for use _________________________________________________

Dietitian (dietary nurse)

Production manager (chef)

Accountant

Card turnover

Cooking technology:________________________________________________

Form N 44-MZ

to the Instructions for the organization of therapeutic nutrition
in medical institutions

"I approve"

Chief Physician(signature)

Name of institution _________________________________________________

Layout menu for cooking meals on ________________________

patients on "__" ___________ 20__

Day of the week

Nutritionist (signature)

Diet nurse (signature)

Head of production (chef) (signature)

Accountant (signature)

Form 1-lp

to the Instructions for the organization of therapeutic nutrition
in medical institutions

I. Information about the owner of the medical book.

II. A note on the transition to work in other institutions.

III. The results of the medical examination.

IV. The results of the study on tuberculosis.

V. The results of the study on bacillus carrying.

VI. The results of the study on helminthism.

VII. Marks on the postponed infectious-intestinal diseases.

VIII. Passing the exam on the sanitary-technical minimum.

IX. Vaccination record.

X. Special marks of sanitary supervision about this employee (violation of the rules

personal hygiene, sanitary supervision requirements, etc.).

Form 2-lp

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Magazine "Health"

Form 3-lp

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Journal of C-vitaminization of dishes

Form 6-lp

to the Instructions for the organization of therapeutic nutrition
in medical institutions

Journal of quality control of finished food (defective)

* - when replacing individual dishes in breakfast, lunch or dinner, make an appropriate entry

Annex 5

Approved by Order of the Ministry
healthcare of the Russian Federation
dated 05.08.2003 N 330

INSTRUCTIONS FOR ORGANIZING ENTERAL NUTRITION

IN MEDICAL AND PREVENTIVE INSTITUTIONS

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

Enteral nutrition is a type of nutritional therapy in which nutrients are introduced through a gastric (intestinal) tube when it is impossible to adequately meet the energy and plastic needs of the body in a natural way in a number of diseases.

In medical institutions, the organization of enteral nutrition is carried out by anesthesiologists-resuscitators, gastroenterologists, therapists, surgeons, phthisiatricians, united in a nutritional support team, who have undergone special training in enteral nutrition.

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

The purchase of nutritional mixtures for enteral nutrition is carried out in accordance with the Guidelines on the procedure for applying the budget classification of the Russian Federation, approved by Order of the Ministry of Finance of the Russian Federation of December 21, 2005 N 152n (in accordance with the letter of the Ministry of Justice of the Russian Federation of January 10, 2006 N 01 /32-ЕЗ The order does not need state registration) under article 340 of the economic classification of expenditures of the budgets of the Russian Federation "Increase in the cost of inventories" with the assignment of nutritional mixtures for enteral nutrition to the section "medicines and dressings.
(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

Members of the nutritional support team: conduct classes on enteral nutrition with doctors of a medical institution; carry out advisory assistance to doctors of other specialties and analysis of the clinical and economic efficiency of enteral nutrition of patients.

Indications for the use of enteral nutrition

Protein-energy malnutrition when it is impossible to ensure adequate intake of nutrients:

Neoplasms, especially localized in the head, neck and stomach;

Disorders of the central nervous system: coma, cerebrovascular stroke or Parkinson's disease, as a result of which nutritional status disorders develop;

Radiation and chemotherapy in oncological diseases;

Diseases of the gastrointestinal tract: Crohn's disease, malabsorption syndrome, short bowel syndrome, chronic pancreatitis, ulcerative colitis, diseases of the liver and biliary tract;

Nutrition in the pre- and postoperative periods;

Trauma, burns, acute poisoning;

Complications of the postoperative period (fistulas of the gastrointestinal tract, sepsis, failure of anastomotic sutures);

Infectious diseases;

Mental disorders: psychiatric anorexia, severe depression;

Acute and chronic radiation injuries;

Widespread and generalized forms of tuberculosis with seeding and decay, with significant weight loss, tuberculosis in combination with HIV in III B and further stages; pre- and postoperative periods; local forms of tuberculosis in children early age and during adolescence.

Contraindications to the use of enteral nutrition

Intestinal obstruction;

Acute pancreatitis;

Severe forms of malabsorption.

Assessment of malnutrition

When prescribing enteral nutrition, as well as when choosing the composition of nutrient mixtures and determining the dosage, it is necessary to control the degree of nutritional status disorders. At the first stage, with the help of history taking and clinical examination of patients, risk groups for malnutrition are identified. In patients at risk, a more detailed assessment of the nutritional status is carried out and, if necessary, appropriate treatment is prescribed.

The assessment of the state of nutrition is carried out according to indicators, the totality of which characterizes the nutritional status of the patient and his need for nutrients:

a) anthropometric data:

Growth
- body mass
- body mass index (BMI)
- shoulder circumference
- measurement of the skin-fat fold of the triceps

b) biochemical indicators:

total protein
- albumin
- transferrin

c) immunological indicators:

Total number of lymphocytes

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

Observation Map
patient receiving enteral nutrition

(insert in the medical record of an inpatient, registration form N 003 / U)

Name of the medical institution ________________________

N medical history _____________________________________________________________

FULL NAME. __________________________ Gender _____ Age _____________________

Height ______________________ Body weight at admission _____________ (kg),

at discharge ______________ (kg).

Changes in body weight over the past 6 months ______________________________

Clinical diagnosis:_____________________________________________________

_________________________________________________________________________

BMI - body mass index: weight / height m2

KZhST - skin-fat fold of the triceps.

For enteral nutrition, it is necessary to determine the energy needs of the body. It is necessary to determine the energy consumption using direct or indirect calorimetry methods. If it is impossible to carry out the indicated research methods, the assessment of energy needs can be carried out by calculation using the appropriate equations:

according to the Harris-Benedict equation:

DRE = OEO x FA x FT x TF x DMT,

where DRE - actual energy costs (kcal / day);

OEO - basic energy metabolism;

FA - activity factor; FT - trauma factor;

TF - temperature factor; DMT - underweight.

OEE (men) \u003d 66 + (13.7 x BW) + (5 x R) - (6.8 x B)

OEE (women) \u003d 655 + (9.6 x MT) + (1.8 x R) - (4.5 x B)

where MT - body weight (kg);

P - height (cm);

B - age (years).

For the most accurate determination of energy consumption in severe conditions of patients, it is necessary to use the following amendments to the Harris-Benedict equation:

Energy supply of the main nutrients:

1 g of carbohydrates = 4 kcal

1 g protein = 4 kcal

1 g fat = 9 kcal

The need for nutrients depends on the degree of malnutrition (Table 8) and the nature of the diseases (Table 9).

The choice of the composition of mixtures for enteral nutrition

When choosing a formula for enteral nutrition, you should be guided by the list of enteral formulas below that are approved for use by the Russian Ministry of Health.
(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

The choice of mixtures for adequate enteral nutrition should be based on data from clinical, instrumental and laboratory examination of patients, associated with the nature and severity of the disease and the degree of preservation of the functions of the gastrointestinal tract (GIT).

With normal needs and the preservation of the functions of the gastrointestinal tract, standard nutrient mixtures are prescribed.

With increased protein and energy requirements or fluid restriction, high-calorie nutrient mixtures are prescribed.

Pregnant and breastfeeding women should be given nutritional formulas designed for this group.

In critical and immunodeficiency states, nutritional mixtures with a high content of biologically active protein, enriched with trace elements, glutamine, arginine, omega-3 fatty acids, are prescribed.

Patients with diabetes mellitus type I and II are assigned nutritional mixtures with a reduced content of fats and carbohydrates, containing dietary fiber.

In case of impaired lung function, nutrient mixtures with a high content of fat and a low content of carbohydrates are prescribed.

In case of impaired renal function, nutrient mixtures containing highly biologically valuable protein and amino acids are prescribed.

In case of liver dysfunction, nutrient mixtures with a low content of aromatic amino acids and a high content of branched-chain amino acids are prescribed.

With partially impaired functions of the gastrointestinal tract, nutrient mixtures based on oligopeptides are prescribed.
(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

With a non-functioning intestine (intestinal obstruction, severe forms of malabsorption), the patient must be given parenteral nutrition.

With active tuberculosis of the process, special high-protein mixtures are prescribed, designed for enteral nutrition of patients with tuberculosis.
(the paragraph was introduced by Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

Table 8

to Instructions for the organization of enteral nutrition
in medical institutions

Requirements for basic nutrients (proteins, fats, carbohydrates)
depending on the degree of malnutrition

(As amended by the Order of the Ministry of Health and Social Development of Russia dated April 26, 2006 N 316)

Table 9

To Instructions for the organization of enteral nutrition
in medical institutions

The need for protein in certain diseases

Methods of administering enteral nutritional mixtures

Depending on the duration of the course of enteral nutrition and the preservation of the functional state of various parts of the gastrointestinal tract, the following routes of administration of nutrient mixtures are distinguished:

1. The use of nutrient mixtures in the form of drinks through a tube in small sips;

2. Tube nutrition using nasogastric, nasoduodenal, nasojejunal and dual-channel probes (for aspiration of gastrointestinal contents and intra-intestinal administration of nutrient mixtures, mainly for surgical patients).

3. By imposing a stoma: gastro-, duodeno-, jejuno-, iliostomy. Stomas can be placed surgically or endoscopically.

Control over the effectiveness of enteral nutrition is carried out by the attending physician together with a member of the nutritional support team by monitoring a number of indicators of the patient's condition.

Act for the destruction of used ampoules from narcotic drugs and psychotropic substances (Appendix 10). (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

The form of an extraordinary report submitted to the Ministry of Health of the Russian Federation on the theft and theft of drugs from pharmacies and medical and preventive institutions (Appendix 11).

2.2. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation:

2.1. To impose on the heads of medical and preventive institutions personal responsibility for accounting, safety, dispensing, prescribing and using narcotic drugs and psychotropic substances and special prescription forms, in accordance with Appendices 1-11 introduced by this Order. (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

2.2. Provide medical and preventive institutions with special prescription forms for narcotic drugs and psychotropic substances obtained from pharmacy warehouses (bases). The stock of special prescription forms for narcotic drugs and psychotropic substances in the health authorities and medical and preventive institutions should not exceed the monthly requirement. (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

2.3. Oblige the heads of medical and preventive institutions (or their deputies) to ensure that special prescription forms for narcotic drugs are stored only in a safe, the key to which must be kept by these heads; and exercise systematic control over the prescription of narcotic drugs and psychotropic substances and the established procedure for their prescribing (Appendix 2). To categorically prohibit doctors from issuing and also writing out prescriptions for narcotic drugs and psychotropic substances to patients suffering from drug addiction. (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

2.4. To oblige attending physicians to prescribe and use narcotic drugs and psychotropic substances, regardless of the dosage form, with entries in the medical history and prescription sheet indicating the name of the dosage form of the narcotic drug and psychotropic substance, its quantity and dosage. (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

2.5. To oblige the attending or on-call doctors to hand over used ampoules from narcotic drugs and psychotropic substances on the same day, except for weekends and holidays, to the deputy head of the medical unit, and in institutions where he is absent - to the head of the medical and preventive institution. The destruction of used ampoules should be carried out at least once every 10 days by a commission chaired by the head with the execution of the relevant act in the prescribed form (Appendix 10). (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

3. When determining the need for narcotic drugs and psychotropic substances, the Standing Committee on Drug Control, heads of medical and preventive institutions, heads of research institutions should be guided by the norms for the consumption of narcotic drugs and psychotropic substances (Tables 2 and 3). (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

4. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation systematically organize checks on the correctness of the appointment and registration of persons admitted (including temporarily) to work on the receipt, storage, accounting and dispensing of narcotic drugs and psychotropic substances in pharmacies and medical - preventive institutions. In case of revealing facts of violation of the procedure for appointing and admitting persons to work with narcotic drugs and psychotropic substances, the perpetrators shall be brought to strict liability in accordance with the legislation of the Russian Federation. (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

5. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation to bring this Order to the attention of medical and pharmaceutical workers, to constantly monitor its implementation.

6. To consider as not valid on the territory of the Russian Federation Order of the Ministry of Health of the USSR of December 30, 1982 N 1311 "On measures to eliminate serious shortcomings and further strengthen the fight against drug addiction, improve accounting, storage, prescription and use of narcotic drugs and psychotropic substances" (Appendix 2 "Form of a special prescription form for a narcotic drug and a psychotropic substance", Appendix 3 "Consumption rates for narcotic drugs and psychotropic substances", Appendix 4 "Form of an extraordinary report submitted to the USSR Ministry of Health on theft and theft of drugs from pharmacies and medical and preventive institutions" , Appendix 5 "Rules for the storage and accounting of narcotic drugs and psychotropic substances in self-supporting pharmacies", Appendix 6 "Rules for the storage and accounting of narcotic drugs and psychotropic substances and special prescription forms in medical and preventive institutions", Appendix 7 "Rules for storage, accounting and dispensing drugs drugs and psychotropic substances and special prescription forms for narcotic drugs in pharmacy warehouses", Appendix 8 "Rules for the storage and accounting of narcotic drugs in control and analytical laboratories of pharmacy departments", Appendix 9 "Rules for the storage and accounting of narcotic drugs in research institutes, laboratories and educational institutions of the healthcare system", Appendix 10 "Regulations on the write-off and destruction of narcotic drugs and psychotropic substances and special prescriptions not used by cancer patients", Appendix 11 "Act on the destruction of used ampoules from narcotic drugs and psychotropic substances in healthcare institutions "). (As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

7. To impose control over the implementation of this Order on the Deputy Minister of Health Vilken A.E.

Minister
T.B. DMITRIEV

AGREED
Deputy Minister
internal affairs
Russian Federation
A.N. KULIKOV
March 5, 1993

AGREED
Chairman
Standing Committee
drug control
E.A. BABAYAN
March 4, 1993

APPENDIX 1. TYPICAL REQUIREMENTS FOR TECHNICAL STRENGTHENING AND EQUIPMENT WITH MEANS OF SECURITY AND FIRE ALARM IN PREMISES WITH STORAGE OF NARCOTIC DRUGS - No longer valid. dated 11/17/2010 N 1008n)

Annex 2
APPROVED
Order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

APPENDIX 2. FORM OF SPECIAL PRECISION FORM FOR NARCOTIC DRUG AND PSYCHOTROPIC SUBSTANCE - No longer valid. (As amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated November 17, 2010 N 1008n)

Appendix 3
APPROVED
Order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

dated 01/09/2001 N 2, dated 05/16/2003 N 205)

Table 1

ESTIMATED STANDARDS FOR THE NEED FOR NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES PER 1000 POPULATION PER YEAR (IN GRAM)

(As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

Note. The standards are established by recalculating all dosage forms for a purely active substance, and therefore, when comparing the application with the estimated need according to the standards, all dosage forms containing these substances should be recalculated for a purely active drug.

Chairman
Standing Committee
drug control
E.A. BABAYAN

table 2

ESTIMATED REQUIREMENTS FOR NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES PER BED PER YEAR

(As amended by the Order of the Ministry of Health of the Russian Federation dated May 16, 2003 N 205)

<*>The consumption rate of fentanyl 0.005% per patient operated under general anesthesia is within 18 ampoules.

<**>The standards for prosidol for medical practice in surgical, traumatological, oncological, dental, gynecological, medical and preventive institutions are approved by analogy with the calculated standards for promedol.

Notes:

1) The heads of the health authorities of the constituent entities of the Russian Federation are allowed, on the proposals of the heads of medical and preventive institutions, to increase the calculation standards given in this table, but not more than 1.5 times. (as amended by the Order of the Ministry of Health of the Russian Federation of 09.01.2001 N 2)

2) The heads of medical and preventive institutions are allowed to redistribute between the departments the narcotic drugs and psychotropic substances indicated in this table within the limits of the general requirement standard for the institution for each item. (As amended by the Orders of the Ministry of Health of the Russian Federation dated 01/09/2001 N 2, dated 05/16/2003 N 205)

3) If there are medical indications for the relief of severe pain in the departments of medical and preventive institutions indicated in this table, it is allowed to use non-invasive forms of narcotic drugs and psychotropic substances in quantities corresponding to medical indications and the patient's condition. (As amended by the Orders of the Ministry of Health of the Russian Federation dated 01/09/2001 N 2, dated 05/16/2003 N 205)

Chairman
Standing Committee
drug control
E.A. BABAYAN

Table 3

CALCULATION STANDARDS
REQUIREMENTS FOR NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES PER BED PER YEAR FOR THE ONCOLOGICAL DEPARTMENT (WARD) OF PALLIATIVE CARE OF THE MEDICAL AND PREVENTIVE INSTITUTION AND HOSPITAL

(As amended by the Orders of the Ministry of Health of the Russian Federation dated 01/09/2001 N 2, dated 05/16/2003 N 205)

<*>In terms of pure active substance.

Note. For each of the paragraphs of this Annex, it is allowed to exceed the amount of a specific dosage form of the medicinal product within the specified total amount in terms of pure active substance.

Chairman
Standing Committee
drug control
E.A. BABAYAN

Table 4 - Repealed. (as amended by the Order of the Ministry of Health of the Russian Federation of 09.01.2001 N 2)

Appendix 4
APPROVED
Order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

APPENDIX 4. RULES OF STORAGE AND ACCOUNTING OF NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES IN PHARMACIES - No longer valid. (As amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated November 17, 2010 N 1008n)

APPROVED
Order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

Order of the Ministry of Health of the Russian Federation of August 5, 2003 N 330
"On measures to improve clinical nutrition in medical institutions of the Russian Federation"

With changes and additions from:

For the application of this order, see the letter of the Ministry of Health of the Russian Federation of April 7, 2004 N 2510 / 2877-04-32 and the letter of the Ministry of Health and Social Development of the Russian Federation of July 11, 2005 N 3237-BC

In order to implement the Concept of State Policy in the field of healthy nutrition of the population of the Russian Federation for the period up to 2005, approved by Decree of the Government of the Russian Federation of 08.10.1998 N 917 *, improve the organization of clinical nutrition and increase the effectiveness of its use in the complex treatment of patients, I order:

1.1. Regulations on the organization of the activities of a dietitian (Appendix N 1);

1.2. Regulations on the organization of the activities of a dietary nurse (Appendix N 2);

1.3. Regulations on the Council for Clinical Nutrition in Medical Institutions (Appendix No. 3);

1.4. Instructions for the organization of therapeutic nutrition in medical institutions (Appendix N 4);

1.5. Instructions for the organization of enteral nutrition in medical institutions (Appendix N 5);

2. To impose control over the implementation of this order on the Deputy Minister R.A. Khalfin.

Order 330 on Clinical Nutrition

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ABOUT IMPROVEMENT MEASURES
THERAPEUTIC NUTRITION IN THERAPEUTIC AND PREVENTIVE
INSTITUTIONS OF THE RUSSIAN FEDERATION

(as amended by the Orders of the Ministry of Health and Social Development of the Russian Federation
dated 07.10.2005 No. 624, dated 10.01.2006 No. 2, dated 26.04.2006 No. 316)

In order to implement the Concept of State Policy in the field of healthy nutrition of the population of the Russian Federation for the period up to 2005, approved by the Decree of the Government of the Russian Federation dated 10.08.1998 No. 917 *, improve the organization of clinical nutrition and increase the effectiveness of its use in the complex treatment of patients, I order:

———————————
* Collection of legislation of the Russian Federation, 08/24/1998, No. 8, art. 4083.

a. Regulations on the organization of the activities of a dietitian (Appendix No. 1);
b. Regulations on the organization of the activities of a dietary nurse (Appendix No. 2);
c. Regulations on the Council for Clinical Nutrition in Medical Institutions (Appendix No. 3);
d. Instructions for organizing therapeutic nutrition in medical institutions (Appendix No. 4);
e. Instructions for the organization of enteral nutrition in medical institutions (Appendix No. 5).

2. To impose control over the implementation of this Order on the Deputy Minister R.A. Khalfin.

Minister
Yu.L. Shevchenko

Application No. 1
Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 No. 330

POSITION
ABOUT THE ORGANIZATION OF THE ACTIVITIES OF A NUTRITIONAL DOCTOR

Application No. 2
Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 No. 330

POSITION
ON ORGANIZATION OF MEDICAL ACTIVITIES
SISTERS DIETARY

Application No. 3
Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 No. 330

POSITION
ABOUT THE THERAPEUTIC NUTRITION COUNCIL
TREATMENT AND PREVENTIVE INSTITUTIONS

(As amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2006 No. 316)

1. improvement of the organization of medical nutrition in a medical institution;
2. introduction of new technologies for preventive, dietary and enteral nutrition;
3. approval of the nomenclature of diets, mixtures for enteral nutrition, dry protein composite mixtures for therapeutic nutrition, biologically active additives to be introduced in this healthcare institution; (As amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2006 No. 316)
4. approval of seven-day menus, a card file of dishes and a set of mixtures for enteral nutrition;
5. improvement of the ordering system for dietary kits and mixtures for enteral nutrition;
6. development of forms and plans for advanced training of employees in clinical nutrition;
7. control over the organization of therapeutic nutrition and analysis of the effectiveness of diet therapy for various diseases.
8. The Therapeutic Nutrition Council meets as needed, but at least once every three months.

Application No. 4
Approved
Order of the Ministry
health care
Russian Federation
dated 05.08.2003 N 330

INSTRUCTIONS
ON THE ORGANIZATION OF THERAPEUTIC FOOD
IN MEDICAL AND PREVENTIVE INSTITUTIONS

in red. Orders of the Ministry of Health and Social Development of the Russian Federation
No. 624 of 07.10.2005, No. 2 of 10.01.2006, No. 316 of 26.04.2006)

The organization of therapeutic nutrition in a medical institution is an integral part of the treatment process and is one of the main therapeutic measures.

In order to optimize therapeutic nutrition, improve the organization and improve its quality management in medical institutions, a new nomenclature of diets (a system of standard diets) is being introduced, differing in the content of basic nutrients and energy value, food preparation technology and the average daily set of products.

The previously used diets of the number system (diets No. 1-15) are combined or included in the system of standard diets, which are prescribed for various diseases depending on the stage, severity of the disease or complications from various organs and systems (Table 1).

Along with the main standard diet and its variants in a medical institution, in accordance with their profile, they use:

• surgical diets (0-I; 0-II; 0-III; 0-IV; diet for ulcer bleeding, diet for gastric stenosis), etc.;
• specialized diets: high-protein diet for active tuberculosis (hereinafter - high-protein diet (m));
  (the paragraph was introduced by the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2006 No. 316)
• unloading diets (tea, sugar, apple, rice-compote, potato, cottage cheese, juice, meat, etc.);
• special diets (potassium, magnesium, probe diet, diets for myocardial infarction, diets for unloading dietary therapy, vegetarian diet, etc.).

Individualization of the chemical composition and caloric content of standard diets is carried out by selecting the medical nutrition dishes available in the card file, increasing or decreasing the number of buffet products (bread, sugar, butter), controlling home delivery of food for patients undergoing treatment in a medical institution, and also by use in therapeutic and enteral nutrition of biologically active food supplements and ready-made specialized mixtures. To correct the diet, 20-50% of the protein of ready-made specialized mixtures can be included (table 1a).
(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated 10.01.2006 No. 2)

Note:
Order of the Ministry of Finance of the Russian Federation dated December 21, 2005 No. 152n became invalid from January 1, 2007 in connection with the publication of the Order of the Ministry of Finance of the Russian Federation dated December 8, 2006 No. 168n. The current Instructions on the procedure for applying the budget classification of the Russian Federation were approved by Order of the Ministry of Finance of the Russian Federation dated December 25, 2008 No. 145n.

Acquisition of dry composite protein mixtures for clinical nutrition is carried out in accordance with the Instructions on the procedure for applying the budget classification of the Russian Federation, approved by Order of the Ministry of Finance of the Russian Federation dated December 21, 2005 No. 152n (in accordance with the letter of the Ministry of Justice of the Russian Federation dated January 10, 2006 No. N 01 / 32-ЕЗ The order does not need state registration) under article 340 of the economic classification of expenditures of the budgets of the Russian Federation "Increase in the cost of inventories" with the assignment of ready-made specialized mixtures for medical nutrition to the section "food (payment for food), including food rations to servicemen and persons equated to them.
(the paragraph was introduced by the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2006 No. 316)

The nomenclature of permanent diets in each medical institution is established in accordance with its profile and approved by the Council for Clinical Nutrition. In all medical institutions, at least a four-time diet is established; according to indications, in separate departments or for certain categories of patients (duodenal ulcer, disease of the operated stomach, diabetes mellitus, etc.), more frequent meals are used. The diet is approved by the Therapeutic Nutrition Council.

The recommended average daily food sets are the basis for the preparation of standard diets in a medical institution (table 2). When forming standard diets for children and adults receiving sanatorium treatment, more expensive varieties of products are used, taking into account daily nutritional norms in sanatoriums and sanatoriums (tables 3, 4, 5). In the absence of a complete set of products in the catering department, provided for by a consolidated seven-day menu, it is possible to replace one product with another while maintaining the chemical composition and energy value of the used therapeutic diets (Tables 6, 7).

Control of the correctness of the diet therapy carried out should be carried out by checking the compliance of the diets received by patients (in terms of a set of products and dishes, cooking technology, chemical composition and energy value) with the recommended characteristics of standard diets and by checking the uniform use of appropriations by quarters of the year.

The general management of the diet in a medical and preventive institution is carried out by the chief physician, and in his absence, the deputy for the medical unit.

The dietitian is responsible for the organization of therapeutic nutrition. In cases where there is no position of a dietitian in a medical institution, the dietary nurse is responsible for this work.

The nutritionist is subordinated to dietary nurses and all catering workers who provide therapeutic nutrition in a medical institution in accordance with this Order.

At the catering department of a medical institution, the head of production (chef, senior cook) controls the compliance with the cooking technology and the output of ready-made dietary dishes; food to departments.

All issues related to the organization of clinical nutrition in a medical institution are systematically (at least once a quarter) heard and resolved at meetings of the Medical Nutrition Council.

Table 1
to the Instructions for Organizing
preventive institutions

Characteristics, chemical composition and energy value of standard diets,
used in healthcare facilities (hospitals, etc.)

www.santegra.spb.ru

The order of the Ministry of Health of Russia approved the norms of clinical nutrition

White cabbage was excluded from the sparing diet and its content in other standard diets was somewhat reduced. In addition, rye bread, which is contraindicated in a number of inflammatory diseases of the gastrointestinal tract, is excluded from a sparing diet, while the amount of wheat bread, starch, pasta and potatoes is increased.

According to the new standards in clinical nutrition, the number of cereals for making soups, cereals, and side dishes has been increased. There were more vegetables - cucumbers and tomatoes, as well as dairy products, coffee and cocoa.

The composition of the components for the preparation of diet food also includes protein composite dry mixes.

Approaches to the creation of dry composite protein mixtures and their recipes were developed back in the 70s of the last century by Academician A.A. Pokrovsky. These products are made on the basis of whey milk proteins with the inclusion of lecithin, polyunsaturated fatty acids, dietary fiber, vitamins and minerals, maltodextrin (source of carbohydrates).
Dry composite protein mixes include a well-balanced and easily digestible protein, the source of which is not soy, but milk whey proteins. At the same time, they do not contain animal fat, the excess consumption of which leads to the development of atherosclerosis and overweight.
The effectiveness of their inclusion in dietary meals for many cardiovascular diseases, diabetes mellitus, liver diseases, metabolic disorders and other diseases is confirmed by the results of clinical trials that were conducted for two years at the Research Institute of Nutrition of the Russian Academy of Medical Sciences, the Federal State Budgetary Institution "Central Research Institute of Tuberculosis" RAMS and others.
Dry composite protein mixes are produced in accordance with GOST R 53861-2010 “Products of dietary (therapeutic and preventive) nutrition. Mixes protein composite dry. General technical conditions".
Mixtures are included in the State Register and are used as a component for the preparation of therapeutic and preventive nutrition for children from 3 years of age and adults, and workers employed in jobs with harmful and especially harmful working conditions.
Composite protein powder mixtures were introduced into medical and sanatorium nutrition in accordance with the previous standards for six standard diets, which were approved by the Order of the Ministry of Health of Russia in 2003 (Order of the Ministry of Health of Russia dated August 5, 2003 N 330 “On measures to improve clinical nutrition in treatment and prophylactic institutions of the Russian Federation") with changes as of April 26, 2006, introduced by orders of the Ministry of Health and Social Development of Russia No. 2 dated 10.01.2006. and No. 316 dated April 26, 2006

The norms approved by the order were developed by specialists of the Federal State Budgetary Institution Research Institute of Nutrition of the Russian Academy of Medical Sciences with the involvement of practical nutritionists, specialists in clinical nutrition.

When developing average daily food sets of standard diets, the characteristics of their chemical composition and energy value are taken as the basis, and the nature of the disease is taken into account. The development is based on innovative technologies in the field of clinical nutrition. All this, including the introduction of easily digestible components into the diet, allows you to provide the body with the necessary nutrients.

The draft order was publicly discussed on the Unified Information Disclosure Portal on the preparation by federal executive authorities of draft regulatory legal acts and the results of their public discussion. There were no comments or suggestions for the draft order.

www.rosminzdrav.ru

Organization of medical nutrition



The process of organizing medical nutrition in medical institutions of our country must be considered from the standpoint of the current federal legislation. For the first time in the Russian legislation, the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” defines the rules governing the basics of the organization of clinical nutrition.

Organization of medical nutrition at the federal level

The organization of medical nutrition at the federal level takes place in accordance with the requirements of the following regulations:

Federal Law No. 323-FZ dated November 21, 2011 “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”. In accordance with Art. 76 of the Constitution of the Russian Federation, the law has direct effect on the territory of the entire country. In the field of health protection, this law introduces the most general, fundamental norms that require more detailed explanation in departmental orders, methodological recommendations and information letters (see the text of the document on the website www.praktik-dietolog.ru in the "Legal Framework" section).

Order of the Ministry of Health and Social Development of Russia dated June 24, 2010 No. 474n “On Approval of the Procedure for Providing Medical Assistance to the Population in the Dietetics Profile”. The order is a regulatory document that defines the principles, procedure and system for organizing medical nutrition in the Russian Federation.

The norms of therapeutic nutrition are the basis for the formation of nutritional rations in diet therapy and at the same time the organization, planning and financing of the entire system of therapeutic nutrition in the institution.

Regulatory documents, the names of which are presented in Table. 1, are currently valid throughout our country and are mandatory for medical organizations when organizing medical nutrition.

The organization of therapeutic and preventive nutrition of patients undergoing inpatient treatment must be carried out in all medical organizations that have round-the-clock beds and day-stay beds with food, sanatoriums in accordance with Order of the Ministry of Health of Russia dated August 5, 2003 No. 330 “On measures to improve clinical nutrition in medical institutions of the Russian Federation”.

The documents approved by this order are mandatory for use in organizing the nutrition system, document flow, accounting for food consumption, prescribing therapeutic nutrition to various categories of patients in accordance with diseases and complications of diseases. One of these documents is an instruction on the organization of therapeutic nutrition in medical institutions. It defines the following standards for the organization of therapeutic nutrition:

• Characteristics, chemical composition and energy value of standard diets used in healthcare facilities (hospitals, etc.).
• The ratio of natural food products and specialized food products in the patient's daily diet.
• Interchangeability of products in the preparation of dietary dishes.
• Replacement of products for proteins and carbohydrates.
• The procedure for extracting food for patients in medical institutions.
• The procedure for monitoring the quality of prepared food in a medical institution.
• Recommendations for the equipment of the catering unit and pantry.
• Transportation of prepared food.
• Sanitary and hygienic regime of the catering unit and pantry.
• The list of documentation of the catering department for the discharge of foodresearch and control over the quality of prepared food in medical institutions.

In connection with the issuance of Order No. 330, the previously used standards according to the ratio of the chemical composition of diets, the interchangeability of food products and the replacement of products not to be used in medical facilities. For the first time, a federal departmental order introduced a single nomenclature of standard diets for all medical institutions.

Instructions for the organization of enteral nutrition in medical institutions are also mandatory. In order to standardize the delivery of enteral nutrition, this document defines the following requirements:

• indications for the use of enteral nutrition;
• contraindications to the use of enteral nutrition;
• assessment of malnutrition;
• observation card of a patient receiving enteral nutrition (insert in the medical record of an inpatient, registration form 003/U);
• methodology for determining the energy needs of the body;
• the choice of the composition of mixtures for enteral nutrition;
• requirements for basic nutrients (proteins, fats, carbohydrates) depending on the degree of malnutrition;
• the need for protein in certain diseases;
• ways of introducing enteral nutritional mixtures.

Federal Departmental Order of the Ministry of Health of the USSR dated May 5, 1983 No. 530 “On approval of instructions for accounting for food products in medical and preventive and other health care institutions that are on the state budget of the USSR”(as amended on 05/17/1984, 12/30/1987) and the Order of the Ministry of Health of Russia dated 08/05/2003 No. 330 "On measures to improve therapeutic nutrition in medical institutions of the Russian Federation" approved the accounting and document management system. It is necessary to maintain documentation in accordance with the requirements of these orders, since it is not only a system for recording patients put on food, but also a system for spending food, controlling the spending of financial resources.

All documents on the organization of medical nutrition can be divided into three groups:

• Documentation intended for the issuance of food products and accounting, appropriations issued for them.
• Documents reflecting the control over the health status of catering employees.
• Documentation on the organization of a dietary service (production documentation).

Federal Law No. 323-FZ dated November 21, 2011

"On the basics of protecting the health of citizens in the Russian Federation", Ch. 5 "Organization of health care" Art. 39 "Healing nutrition":

"one. Therapeutic nutrition is nutrition that ensures the satisfaction of the physiological needs of the human body in nutrients and energy, taking into account the mechanisms of the development of the disease, the characteristics of the course of the underlying and concomitant diseases, and performing preventive and therapeutic tasks.

Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, Ch. 5 "Organization of health care" Art. 39 "Healthy nutrition": "Norms of medical nutrition are approved by the authorized federal executive body."

Table 1. Regulatory documents that are mandatory for implementation by medical organizations in the organization of medical nutrition

Documentation of the first group. Documentation intended for the issuance of food products and accounting, appropriations issued for them.

The main reporting forms, which are compiled to provide food for patients admitted to the hospital, belong to the documents of the first group.

The main document in this group is a card file of dietary dishes (see details about this document in the article "Specialized card file of dietary dishes", PD No. 1, or on the website www.praktik-dietolog.ru in the section "To the taste of the patient"). Without a file cabinet, it is impossible to correctly compose a seven-day menu, a menu layout, i.e. documents that provide information on meeting the physiological needs of the human body for nutrients and energy, taking into account the mechanisms of the development of the disease, the characteristics of the course of the underlying and concomitant diseases. The card file is of particular importance in the proper organization of clinical nutrition. If it is available, it is possible to calculate what the patient actually receives during the day, plan the work of the catering department, facilitate organizational measures, calculate the consumption of products and the allocations allocated for them.

Seven Day Consolidated Menu

Based on the card index, a seven-day summary menu is compiled. Using the seven-day menu in the work, it is possible to plan the volume of food purchases, organize the work of the catering staff, and develop standards in the preparation of various dishes.

It is recommended to have two menus - autumn-summer and winter-spring, as the assortment of products changes depending on the time of year, in addition, some products have a different percentage of waste after cold processing (cleaning). Of course, it is allowed to have one seven-day consolidated menu, but then it is necessary to make adjustments to it according to the seasons.

Before drawing up a seven-day menu, it is necessary to develop a nomenclature of diets and approve standard and special diets at the Council for Clinical Nutrition.

The number of diets and their set should be individual for each institution and adapted to its profile. When compiling the menu, it is very important to take into account the qualitative variety of dishes during the day and the week as a whole. It is desirable that one dish in its modifications be used as much as possible for various diets.

When compiling the menu, the main attention is paid to the chemical composition of diets, their energy value, the correct use of natural food norms, the consumption of appropriations allocated for food, the possibility of replacing products in accordance with the replacement tables for protein and fat. When compiling the menu, national characteristics are also taken into account by including relevant dishes.

Layout card

For each dish made at the catering unit, a layout card must be drawn up in two copies (form No. 1-85), one of which is stored in the accounting department, and the second - with the dietary nurse.

Each layout card contains data: the name of the dish, a list of diets for which this dish is recommended to be used; a list of products needed to prepare this dish; bookmark rates (gross); Net weight; the chemical composition of the dish and the net energy value of the dish, taking into account losses during the heat treatment of the finished dish; its estimated cost; cooking technology.

Diet nomenclature

Standard diets- these are diets with a physiological content of proteins, fats and carbohydrates and enriched with vitamin and mineral complexes. Standard diets differ in the content of essential nutrients and energy value, the average daily set of products used as the main therapeutic diets, as well as the cooking technologies used.

Special diets are assigned to a specific clinical and statistical group of patients, the condition of which requires the exclusion of certain foods from the therapeutic diet, are formed on the basis of standard diets in accordance with the nosological form of the disease, the phase of the disease. Protein correction of the diet is carried out with dry protein composite mixtures.

There is another type of diet - individual diets. They are assigned to a specific patient whose condition requires the exclusion of certain foods from the diet. If he has a decrease in body mass index below the standard values, then the diet is formed individually in accordance with the nosological form of the disease, the phase of the disease, the need for additional nutrition.

Accounting and reporting documentation

A number of documents that must be kept in a mandatory manner in a medical institution refer to accounting and reporting documents. In medical institutions, in order to optimize work, automated document management systems are being introduced that ensure the implementation of evidence-based principles of nutrition.

Information about the presence of patients who are on meals, are submitted in the form of form No. 22 in accordance with order No. 330 of 05.08.2003. This form is the basis for planning and distributing patients according to diets and meals.

The main legal document, on the basis of which food products are issued from the warehouse to the kitchen for cooking and appropriations for food are spent, is layout menu(form No. 44-MZ, order No. 330 dated 05.08.2003). The last digit in the layout menu is entered by the accounting officer, who calculates the total number of all products needed to prepare all the dishes for their release from the warehouse.

Requirement for the issuance of products(form No. 45-M3, order No. 330 dated 05.08.2003). This document is made in two copies. One copy remains after the issuance of products from the storekeeper, according to the second copy, the production manager (chef) receives food from the storekeeper for cooking the next day. Products are stored in the daily supply pantry. The production manager (chef) bears full financial responsibility for them. The next day, he distributes food to the chefs according to the dishes they prepare. The second copy is handed over to the counting department for settlements, and is subsequently kept by the production manager.

Buffet Requirement(tea, bread, butter, sugar, etc.) is issued separately according to the same form No. 45-MZ. Buffet products from the warehouse go directly to the departments, bypassing the catering unit.

If the number of patients changes compared to the menu layout data (or menu requirements) by more than three people, the dietary nurse prepares "Information on the movement of patients". In accordance with this document, it draws up in the form No. 434-fur (with an increase in the number of patients) "Demand for the warehouse" to receive additional products based on the main version of the standard diet. If the number of patients decreases compared to the previous day, then the products not used for cooking are returned to the warehouse in the same form with the indication “Return” (except for the products already put into the boiler when preparing breakfast).

Form No. 23-MZ "Distribution list for vacation to food ration departments"(meal: breakfast, lunch, dinner, etc.). This document serves as the basis for issuing ready-made meals to hospital departments.

The menu is recommended to be posted at the entrance to the dining room so that patients can familiarize themselves with it. Responsible for the organization of clinical nutrition in the hospital should inform patients about the replacement of certain dishes. In the absence of the necessary products, this replacement must be carried out taking into account their nutritional value.

Cumulative statement reflects the actual consumption of all products for the past month. The accountant must prepare it by the 10th day of the next month and submit it to a dietitian or a person responsible for organizing clinical nutrition for analysis of the fulfillment of natural food norms. By the 15th day, a nutritionist or a person responsible for organizing therapeutic nutrition is obliged to inform the chief physician about the state of fulfillment of food standards and, if there are deficiencies, take measures to eliminate them.

Documentation of the second group. Documents reflecting the control over the health status of catering employees

Documents reflecting the control over the health status of catering employees belong to the second group of documents on the organization of therapeutic nutrition.

Each food service worker must have:

• "Personal medical book of a catering worker" (form No. 1-lp, order No. 330 of 08/05/2003).
• "Journal of Records of Medical Research". This journal is maintained by a dietary nurse, who is obliged to monitor the timeliness of medical research by all employees of the catering department.
• Journal "Health" (form No. 2-lp, by order No. 330 of 08/05/2003). The latter is administered daily by a dietary nurse.

Documentation of the third group. Documentation for the organization of a dietary service (production documentation)

Documentation for the organization of a dietary service (production documentation):

• Employee time sheet.
• Staff schedules for the month ahead.
• A book (or folder) of orders and orders, where instructions from higher health authorities and guidelines for the organization of clinical nutrition should be carefully stored in the appropriate order.
• Journal of safety briefing.
• Ready meals assessment journal (defective).
• Journal of rejection of products and food raw materials supplied to the catering department.
• Journal of C-vitaminization of food.
• Folder of chemical analyzes of ready meals.
• Journal of Perishable Products.
• Warehouse accounting book, form No. M-17 (Order of the Ministry of Health of the USSR No. 530 dated 05.05.1983).
• Log of administrative rounds.
• Sanitary magazine.

With the availability and proper maintenance of all documentation on the organization of the dietary service, it is possible to clearly organize the organization of therapeutic nutrition in the institution at all stages.

The need for GOSTs

At the federal level, a number of legal documents have been introduced to ensure the quality of food products and the safety of their use in public catering, including medical and preventive, in medical institutions (see Table 2).

Federal Law No. 184-FZ of December 27, 2002 "On Technical Regulation" the principles of standardization in the Russian Federation are defined, the rules for the application of technical regulations and national standards of the Russian Federation (GOST R 1.0-2004 "Standardization in the Russian Federation. Basic provisions") are established. This document states that technical regulations, i.e. federal laws that establish safety requirements, are mandatory for application to all products.

Currently, there are technical regulations for milk and dairy products, juices and other food products.

National standards, or as they are also called, GOST R, are one of the most important components of the reform of technical regulation in the Russian Federation. They are divided into two types: standards for methods of analysis and standards that establish requirements for any type of product. The newly introduced GOST system, created to replace obsolete standards, has defined specific standards for entire product groups, including specialized ones. So, National standard of the Russian Federation GOST R 53861-2010 “Products of dietary (therapeutic and preventive) nutrition. Mixes protein composite dry. General technical conditions", approved by order of the Federal Agency for Technical Regulation and Metrology No. 219-st dated September 7, 2010, defined the basic requirements for specialized products intended for dietary (therapeutic and preventive) nutrition of adults and children over three years old as a protein component for preparing ready-made meals.

Want more information on dietetics?
Subscribe to the information and practical journal "Practical Dietology"!

SanPiNs and resolutions

A number of documents that define the requirements for both premises, production processes, and food products are represented by sanitary rules and regulations approved by the Chief Sanitary Doctor of the Russian Federation. Here are some of them:

• Decree of the Chief State Sanitary Doctor of the Russian Federation dated May 5, 2003 No. 91 "On measures to prevent diseases caused by iron deficiency in the diet of the population."
• Sanitary and epidemiological rules and regulations SanPiN 2.3.2.1940-05 (approved by the chief state sanitary doctor on 01/17/2005, as amended on 06/27/2008) "Organization of baby food", 2.3.2 "Food raw materials and food products".
• Sanitary and epidemiological rules and regulations SanPiN2.3.2.1324-03 "Hygienic requirements for shelf life and storage conditions of food products."
• Decree of the Chief State Sanitary Doctor of the Russian Federation dated March 5, 2004 No. 9 “On additional measures to prevent diseases caused by micronutrient deficiency”.

The implementation of these documents in the organization of therapeutic and preventive nutrition is also mandatory.

Federal Law No. 184-FZ dated December 27, 2002 “On Technical Regulation” (adopted by the State Duma on December 15, 2002, approved by the Federation Council on December 18, 2002), Ch. 1 "General provisions" art. 2. "Basic concepts":

"Technical regulation - a document that is adopted by an international treaty of the Russian Federation, subject to ratification in the manner prescribed by the legislation of the Russian Federation, or in accordance with an international treaty of the Russian Federation, ratified in the manner prescribed by the legislation of the Russian Federation, or federal law, or a decree of the President of the Russian Federation , or a decree of the Government of the Russian Federation, or a regulatory legal act of the federal executive body for technical regulation, and establishes mandatory requirements for the application and execution of requirements for objects of technical regulation (products or products and design processes related to product requirements [including surveys], production , construction, installation, adjustment, operation, storage, transportation, sale and disposal)”.

Table 2. Regulatory documents regulating the quality of food products and the safety of their use in public catering

At the level of the subject of the Federation

The documents discussed in the previous sections of the article are mandatory for execution at the level of the subject of the Federation. However, when planning the organization of a therapeutic nutrition system in a region, health authorities may issue local acts, the main criterion for which is the possibility of expanding the regulatory documents in force in the Russian Federation.

In accordance with Art. 39 of the Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” Order of the Government of the Russian Federation of October 25, 2010 No. 1873-r “On Approval of the Fundamentals of the State Policy of the Russian Federation in the field of healthy nutrition of the population for the period up to 2020 G." it is recommended that the executive authorities of the constituent entities of the Russian Federation take into account the provisions of the Fundamentals of the State Policy of the Russian Federation in the field of healthy nutrition of the population for the period up to 2020 when forming and implementing regional programs for socio-economic development.

Decree of the President of the Russian Federation No. 598 dated May 7, 2012 “On Improving the State Policy in the Sphere of Health Care” instructed the Government of the Russian Federation, together with the executive authorities of the constituent entities of the Russian Federation, to approve by July 1, 2012 an action plan for the implementation of the “Fundamentals of the State Policy of the Russian Federation in the field of healthy nutrition population for the period up to 2020”.

To comply with the said regulatory legal acts established by the Government of the Russian Federation, as well as orders established by the Ministry of Health and Social Development of Russia, and in order to unify the requirements for the organization of dietary (therapeutic and preventive) nutrition, standardize average daily food sets and the seven-day menu in medical organizations in Moscow, the Department health care of Moscow issued Order No. 1851 dated December 23, 2011 “On improving the organization of dietary (therapeutic and preventive) nutrition”, as well as a number of methodological recommendations “Card index of dishes of dietary (therapeutic and preventive) nutrition of an optimized composition for children”, regulating the algorithm for organizing dietary (therapeutic and preventive) nutrition in medical organizations of the city.

This order uses the norms of physical needs developed by Rospotrebnadzor (G. G. Onishchenko), the norms of protein correction of ready-made meals, calculated in accordance with the order of the Ministry of Health and Social Development of Russia No. 330. In accordance with the developments of the Federal State Budgetary Institution "Research Institute of Nutrition" of the Russian Academy of Medical Sciences, optimized average daily food sets are given. Thanks to the measures taken, the unification of requirements for the organization of dietary (therapeutic and preventive) nutrition, the standardization of average daily food sets and the seven-day menu in medical organizations in Moscow, heads of medical institutions can reasonably and efficiently spend financial resources. In addition, it became necessary to introduce non-departmental control over the expenditure of funds for medical nutrition and the quality of diet in medical institutions into the work of the Department of Health.

In some constituent entities of the Russian Federation, documents have been developed to implement the main directions of the Order of the Ministry of Health of Russia dated August 05, 2003 No. 330 “On measures to improve therapeutic nutrition in medical institutions of the Russian Federation” in accordance with the Procedure for providing medical care to the population in the profile “dietology” approved by the Ministry of Health and Social Development of Russia » (see Table 3). The full texts of the documents presented in the table can be found on the site www. praktik-dietolog.ru in the "Legislative framework" section.

As an example of the introduction of standardization of the therapeutic and preventive nutrition system, we can present the information letter of the Ministry of Health of the Territorial Fund of Compulsory Medical Insurance of the Saratov Region dated September 19, 2010 No. 1103-17 / 3146, No. 4529, addressed to the heads of government bodies and healthcare institutions. The document is presented in the form of guidelines "Standards for the organization of clinical nutrition" for catering for clinical and statistical groups of diseases. Clinical-statistical groups include nosological forms grouped into a set of clinical, laboratory and instrumental diagnostic features that made it possible to identify diseases (poisoning, trauma, physiological state) belonging to a group of conditions with a common etiology and pathogenesis, clinical manifestations, general approaches to treatment and corrections (see the text of the document on the website www.praktik-dietolog.ru in the "Legislative Framework" section). It is recommended to prescribe therapeutic nutrition to patients depending on the following factors:

1. Clinical features of the disease:
   • clinical and statistical group of the disease;
   • stage (phase) of the disease of a particular patient;
   • certain clinical situation;
   • existing complications of the disease.
2. Physical indicators of the ratio of the weight and body of the patient, the severity of protein-energy deficiency:
   • the degree of violation of the nutritional status;
   • body mass index.
   • Individual characteristics of the organism;
     • food intolerance;
     • the presence of contraindications to the use of a number of food products in the diet;
     • the possibility of taking food per os, the presence of gastrostomy, enterostomy.

     The process of standardization in dietetics refers to such actions as setting rules and characteristics for the purpose of their repeated use, aimed at achieving orderliness in the work of the catering departments of medical institutions, preparing dietary dishes, prescribing and choosing the type of therapeutic diet and the quality of therapeutic nutrition provided to the patient.

     The implementation of all stages of standardization is possible when the standards for the implementation of each specific stage of work are established. The use of standards makes it possible to guarantee patients the safety, efficiency, compatibility and consistency of their medical services. In general, standards should ensure that the medical service meets the required level of quality requirements.

     In order to form unified approaches to standardization in dietology, it is recommended to define common objects of standardization at the level of the subject of the Federation:

     catering technologies in medical institutions: types, production processes, food products used in one or another type of nutrition;

   • technical support for the implementation of therapeutic diets;
   • food quality;
   • qualification of medical personnel involved in catering;
   • production, sales conditions, food quality;
   • accounting and reporting documentation used in the system of dietetics;
   • economic aspects of standardization, food procurement system, personalized accounting.

   Table 3 . Documents on the implementation of the main directions of the order of the Ministry of Health of Russia dated August 5, 2003 No. 330

   At the level of a medical institution

   In medical institutions, the system of organizing medical and preventive nutrition should be based on the requirements set at the federal level and at the level of the subject of the Federation.

   At the same time, when organizing therapeutic nutrition directly in a medical institution, various types of therapeutic nutrition (dietary, enteral and parenteral) are used, which differ from each other in the presence of medical indications for use, organizational technologies, organization of the production process and execution technique.

   Diet meals are organized and carried out by a dietitian. The execution technology is associated with the appointment of a certain diet to the patient in accordance with the approved diet nomenclature. Organization of the work of the catering unit, the formation of food therapeutic diets (diets) for various clinical and statistical groups of patients on the basis of standard diets and special and individual diets developed on their basis using food products in cooking, including dietary products, specialized (mixtures of protein composite dry) and baby food, is the basis for the formation of a system of therapeutic nutrition in a medical institution. Protein correction of ready-made dietary meals is carried out in accordance with the requirements of the order of the Ministry of Health of the Russian Federation No. 330 and GOST R 53861-2010.

   Enteral nutrition is organized and administered by the nutritional support team. In its absence, this task falls on physicians, usually resuscitators, who specialize in nutritional support, and on departmental nurses trained in the use of enteral mixtures (as well as other specialists involved in the process of organizing enteral nutrition). The technology for organizing and conducting enteral nutrition is regulated in Appendix No. 5 of the instructions for organizing enteral nutrition in medical institutions (approved by order of the Ministry of Health of Russia dated August 5, 2003 No. 330) (as amended on April 26, 2006). For enteral nutrition, enteral mixtures are used, which completely replace one or more meals, are used only for medical reasons when it is impossible to adequately meet the energy and plastic needs of the body in a natural way in a number of diseases. The extract of enteral mixtures from the food warehouse is carried out on the basis of Form No. 22-MZ "Information on individual and additional nutrition" after a preliminary calculation of the patient's need for the main ingredients, filling out the Card of observation of the patient receiving enteral nutrition (insert in the medical record of the inpatient, registration form No. 003/U).

   The purchase of enteral mixtures is carried out according to article No. 340 of the economic classification of expenditures of the budgets of the Russian Federation "Increase in the cost of inventories" with the assignment of nutritional mixtures for enteral nutrition to the section "Medicines and dressings". When carrying out complete enteral nutrition, the patient should be removed from the diet; when conducting partial enteral nutrition, the patient should be removed from those meals that are replaced by enteral mixtures. Information about this should be recorded in the patient's medical history and transferred to the catering department.

   Parenteral nutrition is organized and carried out by a nutritional support team, resuscitators, as a rule, in intensive care units (wards) and intensive care units. Mixtures for parenteral nutrition are drugs and belong to drug therapy. When carrying out total parenteral nutrition, the patient should be taken off the diet. Information about this should be recorded in the patient's medical history.

   Enteral and parenteral nutrition are artificial types of nutrition that are used only for medical reasons when it is impossible to adequately meet the energy and plastic needs of the body naturally in a number of diseases and are presented in a number of reference manuals and recommendations for nutritional support in intensive care and resuscitation. These sections are not within the competence of a dietitian, they expand the possibilities of introducing nutrients into the patient's body using alternative methods (through the vascular bed) or specially created artificial balanced nutritional mixtures, the entry of which into the human body is possible without the phase of gastric digestion.

   When standardizing medical nutrition, it is necessary to introduce a number of organizational standards into the work of medical institutions:

   • standard for regulatory support for the implementation of federal legislation in the organization of medical nutrition in medical institutions;
   • standard for the range of services and works in the organization of catering in medical institutions;
   • quality standard for clinical nutrition;
   • standard for prescribing therapeutic diets;
   • standard of requirements for the organization of medical nutrition in stationary medical institutions;
   • standards for the organization of clinical nutrition for various clinical and statistical groups of patients;
   • standard for expert evaluation of catering in medical institutions.

   When organizing medical nutrition in an institution, it is necessary to determine the sequence of implementation of the main activities and distribute responsibility among the participants in this process. The head of the medical institution has the most difficult role. The whole subsequent process of forming high-quality approaches to the organization of clinical nutrition depends on his actions. The list of works carried out by the head of the health facility to provide food for a medical institution (organization) is presented in Table. 4. The functioning of the entire therapeutic nutrition system in a medical institution depends on how these works and services are performed.

   In order to organize effective and high-quality therapeutic nutrition, which is part of the complex therapy of the patient, it is necessary to organize a Council for therapeutic nutrition in the institution. Despite the fact that it is an advisory body, its main tasks are to control the quality of therapeutic nutrition and the introduction of new therapeutic nutrition technologies. The Therapeutic Nutrition Council not only approves the nomenclature of diets, specialized dietary products (composite protein mixtures), mixtures for enteral nutrition, dietary supplements to be introduced in this institution, but also conducts an internal examination of the usefulness and effectiveness of therapeutic nutrition. The Council also monitors the effectiveness of the introduction of new technologies for therapeutic nutrition.

   In addition, the process of differentiated prescribing of therapeutic diets should be approved by the Medical Nutrition Council, since the most important role in the effectiveness and quality of therapeutic nutrition is played by the continuity between the food unit and departments, the dietitian, attending physicians and specialists involved in the treatment of patients. The practical implementation of unified regulatory requirements for the organization of clinical nutrition will ensure the planning and formation of financing from the standpoint of the rational use of financial resources.

   Table 4. Works carried out by the head of the health facility to provide food to the medical institution (organization)