hospital dietary service management manual.pdf

8/14/2019 HOSPITAL DIETARY SERVICE MANAGEMENT MANUAL.pdf

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HOSPIT L DIET RY SERVI EM N GEMENT M NU L

DEPARTMENT OF HEALTHREPUBLIC OF THE PHILIPPINES


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IjPSPIT L DIET RY SERVI EM N GEMENT M NU L

epartmentof Health

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Second dition


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Department of HealthRepublic of the Philippines

The second edition of the Hospital Dietary Service n gement nu l is a publication of theHealth Finance evelopment Project of theDepartment of Health.This publication was made possible through

support provi e by the U.S. Agency forInternational Development A.LD. , under theterms ofContract No. 49Z Q446 GOQ ZIl4 00 Theopinions expressed herein are those of theauthor s and do not necessarily reflect the viewsof the U S Agencyfor International Development.


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T LE OF ONT NTSAUTHORIZATIONMESSAGEFOREWORDPREFACEACKNOWLEDGMENTSLISTOF FORMSLIST OF ILLUSTRATIONSLISTOF TABLESLISTOF ABBREVIATIONSChapter

L

II.

DIETARY SERVICE INTHE DEPARTMENT OF HEALTHIntroductionHistorical BackgroundHOSPITAL DIETARY SERVICEPhilosophyObjectivesFunctionsStandards

Page No.

255566

III DIETARY HUMAN RESOURCE MANAGEMENT 9Hospital Employment Practices 9Recruitment 9Hiring 20Termination Functions and Management Skill the Nutritionist-Dietitian 23Training and Development Dietary Personnel 25Organization and Staffing Pattern ofthe Different Health Care Levels 28Guidelines in the Staffing Pattern 29Job Descriptions Staff and Personnel 32Nutritionist-Dietitian Nutritionist-Dietitian III Administrative 33Nutritionist-Dietitian II Clinical 5Nutritionist-Dietitian II Teaching-Training 37Nutritionist-Dietitian II Education and Research 38Nutritionist-Dietitian I 39Food Service Supervisor 40Cook II 4Food Service Worker/Utility Worker 42Clerk I Dietary Clerk-Typist 43Dietary Store Aide 44


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Chapter Page NoADMINISTRATION ND MANAGEMENT 45Budgeting 46Cost Control 46Menu Planning 51Purchasing 52Receiving 54Storing 55Issuing 58Food Production 58Meal Service 62Sanitation Safety and Maintenance 66Pest/Vermin Control 71Energy Conservation Effective ommunication Facility and Equipment for theDietary Service Health Care Level 74Requirement for Kitchen Planning 74

V CLINICAL EDUCATIONAL RESEARCHND SPECIALIZED FUNCTIONS OF

THE DIETARY SERVICE 81Clinical and Educational Functions 81Charting and Ward Rounds 81Diet Counselling 85Nutrition Clinic 87Malward or Nutreward 88Research Function 88Research Unit 9Metabolic Balance Studies 95Planning the Metabolic Kitchen Unit 95Specialized Function 97Disaster Feeding 97VI QUALITY ASSURANCE FOR

THE DIETARY SERVICE 99Quality Assurance 99The Importance of Quality Assurancefor Dietary Service Components of the Quality Assurance Program 8Stages in Program Development 11Monitoring and Evaluation 119Process for Writing Indicators 22Data Collection Frames 29Sampling Techniques 29Computing Results 3Quality Assurance Reviewers Data Analysis and Summary


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PPENDICESCode of Ethics for Dietetic ProfessionGeneral onditions on B id di ng of oodstuffSpecifications of ommon oodstuff PurchasedFood Sanitation ChecklistPresidential Decreee 8 6 Sanitaria in Food Serviceommended Classification by Weight of Filipino hildrenEq uip men t Guide for a Con v en tio nal Hos pital Dietetic ServiceNutrition Clinic Forms

DIET RY SERVICE FORi vlSREFERENCES


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Republic of the PhilippinesDepartment of HealthOFFI E OF THE SE RET RY

AN L Z RO OOMPOUNDRIZ L VENUE TA.CRUZMANIlA PHIUPPINESTEL NO 711 6ll 8O

UT ORIZ TION

January 1994

In accordance with the authority vested o the Secretary o Health I hereby declare the policiesregulations and instructions in this ospital ietary Service Management Manual shall govern thorganization management and activities o the Dietary Service in government hospitals unt modifieby order o the Department o Health or by law


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Republic of thePhllipplneeDEPARTMENT O HEALTHOFFICE FOR HE LTH F CILITIESST ND RDS NDREGUL TIONSentszare Cmpd. Sta Cruz ManilaTolNo. 71195 72 axNo 711 95 09

M SS G

January 6 994

The Hospital Operations and Management Service of the Department of Health has beentasked to develop operations manuals specifically for O hospitals that may be of use to otherpublic and private hospitals.

These manuals would serve as standard reference materials for O hospitals to aidadministrators and practitioners in.following standard operating procedures in the management andpractice of the different hospital services or units. Likewise it may also serve as a reference guide forother public and private hospitals

These manuals provide guidelines in the performance of duties and responsibilitiesof hospitalpersonnel as well as outline steps necessary in the effective and efficient operation of each u nit orservice. The procedures in these manuals will assist them in the process necessary to operate aneffective and efficient hospital.

This is an attempt to develop standards and achieve uniformity of procedures in differenthospitals.

JU ~ N G S M.D.Under ecretary on Health

Facilities Standardsand Regulations


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Republic of the PhilippinesDepartment of HealthOFFI E OF THE SE RET RY

SANL Z RO OMPOUNDRIZALAVENUE STA CRUZMANILA PHIUPPINESTEL NO. 711-6 .8

FOREWORDTotal Health care delivery for all is the major thrust the Department Health. Beingprincipal component and an important factor in the attainment health care the Dietary Servichave sought to find new and better ways t improve the nutritional well being its patients.This manual was developed to set the directions needed for the effective management thDietary Service. It is an invaluable reference for Nutritionists/Dietitians and all those involved in thDietary Service. Although not all the guidelines stated in this manual may be suitable for use in atypes of Dietary Service set ups Dietitians could derive useful guidelines and specific directionwhich would aid them in evaluating existing operations and bring about constructive changes animprovements.

A MARGARITAM GALON MD. MDirector IIIHospital Operations andManagement Service


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PREF ECommunication is vital in all human undertakings but it is especially so inareas concerned with the restoration and maintenance of well being such as healthservices. Because human life is the center of activities in hospitals and othehealth institutions the problems in the communication channels within suchinstitutions must at costs be resolved. One of the most effective means oexpediting communication is undoubtedly to establish policies that cover bothroutine operations andtheirfrequent fluctuations andtom ke such policies availableto those concerned. Thismanual isexpected to serve asa means of educating andinforming the hospital community aboutthe Dietary Service and therefore openavenues of communications among the dietary service staff physicians nursespatients aswell asother hospital staff.Over and above such goals this manual aims to improve the dietary care ohospital patients for the attainment of quality patient care through effective

management and administration And since communication is a principal tootowards thisgoal thismanual was prepared with the objective ofgiving guidance tothe Dietary personnel in improving theirdaily performance.Theguidelines in thismanual should not beregarded as rigid standards. Theiapplication may v ry throughout the country and it is the prerogative of eachDietary Department to either accept or modifythe guidelines according to theispecific needs. However the ideas presented shouldhelp promote the examinationof existing routines with thehopethatconstructive changes and improvements wilbeput intoeffectThe purpose of this manual isto provide a definition of requirements for thevarious health care facilities and services. Whenthedevelopment of a unit isundeconsideration the guidelines assist planners and government health authorities indetermining theneed forsuch a unit and in assessing thepotential impact ofa newunitonexistingandprojected services bothatthelocal andregionallevds. Deficienciesin existing services can be identified and in some cases these can e correctedwithout the need todevelop a new unit Whena unit already exists in a hospital thguidelines will help in identifying problem areas matedtoadministration personnelequipment and physical facilities. They will help determine necessary remediaactions and set priorities for corrective measures on the basis of clinical needsbudget realities and the degree to which a deficiency in physical facilities impedethefunction of theunitEvery health institution therefore is enjoined to avail of this manuafor their reference and guidance

T FELI I NOetary AdviserHospital Operations andManagement Service


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KNOWLEDGMENTSThe Committee on Revision of the Department of Health HospitalDietary Service Management Manual is deeply grateful to all those whohave contributed in the completion of this task and acknowledges withsincere thanks the wholehearted assistance. of the following:

To Dr. Margarita M. Galon Director Hospital Operations andManagement Service for her support and encouragement in thepreparation of this manual;To Dr. Melchor R. Lucas Jr. Medical Officer VII hief of theDivision and all other Advisers of the Support Division Hospitalperations and Management Service for their constructivecriticisms and suggestions;To the Chiefs of Hospital for allowing the Nutritionist Dietitianto attend the Consultative Meetings held during the preparation ofthis manual;To the following persons who have contributed to the preparationof the original ospital ietaryService ManagementManual1986 :Ms. RoseC Cavinoformer Dietetic Management Adviser Bureauof Medical Services Ministry of Health and chairman of theCommittee on manual preparation together with Committeemembers namely Ms. Josefina U. Ramos Dietitian and Ms.Erlinda Cordero Dietitian both ofRizal Medical Center; Ms. ytMadamba Dietitian Iv Dr. Jose N. Rodriguez Memorial Hospital;Ms. Cristina N. Josef Dietitian Eulogio Rodriguez Sr.MemorialHospital; and myself Chief Dietitian Hospital ng Maynila; andToMs. Fenelia Mylene M. Hamo and Ms. Alma Q Sorra HospitalOperations and Management Service for printing the text of thismanual.

Finally no expression of appreciation would adequately suffice inacknowledging the unstinted support of everyone who had contributed inone way or another in the completion of this manual.


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L ST O ORMSStatement of Daily Market PurchasesSupplies Ledger CardDietary Service FormsNO.TITLE

lA.lB.

2.3

4A.4B56.7891

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23

4A4B5

6A6B17

Performance Targets WorksheetCivil Service Commission Performance Appraisal ReportEmployees Schedule for the MonthDietary Order Slip for Bidder ItemsOpen Market Purchase SlipDietary Service Daily Admissions Discharges SheetDaily Delivery Record BookSupplies Requisition an d Issue FormDietary Service Perpetual InventoryRegular Weekly MenuTherapeutic Weekly MenuStandardized RecipesProduction Record Sheet Regular MealsProduction Record Sheet Therapeutic DietsCook s Copy Patient ServiceCook s Copy Cafeteria ServiceDaily Patient Meal CensusDiet ListSpecial Meal Request FormSpecial Meal Record FormDietary Service Admission SheetProblem ListProblem Oriented Progress NotesDiet History Form


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U O ILLUSTR TIONSNO. ILLUSTRATIONS PAGE NO.

I Quality Assurance Related toDepartmental Functions and Activities 1 12. Stages in Developing a Quality Assurance Program

3 Sample Dietary Policy and Proceduresfor Quality Assurance 1124 a . Annual Schedule for Quality Assurance Activitiesin Dietetic Service In-patient 1134 b . Annual Schedule for Quality Assurance Activitiesin Dietetic Service Out-patient Il

5 Sample Data Collection Form 1166. Checklist for Quality Assurance Documentation 1177 Worksheet for Writing Quality Assurance Indicators 1228 Development Indicators fromDepartment Goals and Functions 1239 Checklist for Monitoring and Evaluation Methods 1281 Checklist for Judging Criteria and Method 131


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LIST OF T LES O TABLE PAGE O

Hospital Standard Requirements for Personnel 3Dietary Service Staffing Pattern 3

3 Percentage Allowance for Kitchen Areas


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LIST OF REVI TIONSOFCOHOFIFOFNRIFSWFTEHMTDSHOMS] HM OMFPPDPGHPOMRPRCQ PRAR VSO PT

Administrative OfficerBreast Feedinghi f of HospitalDepartment ofHealthFirst In First OutFood and Nutrition Research InstituteFood Service WarkerFull Time EquivalentHealth Management Training Development ServiceHospital Operations and Management ServicesJoint Commission on Accreditation of HospitalsManagement by ObjectiveMilk FormulaNil Per OremPresidential DecreePhilippine General HospitalProblem Oriented Medical RecordProfessional Regulatory CommissionQuality Assurance ProgramRepublic ActRequisition Issue VoucherSubjective Objective Assessment Plan StatementTuberculosis


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DIET RY SERVI E THEDEP RTMENT OF HE LTHINTRO U TIONAll modes of health care have lately been a m jor concern of thPhilippine government. Recent initiatives aim at more effective means omaintaining good health, its restoration and rehabili tation where it hadeteriorated or has been neglected.Dietetics is a principal component of health care and an import nfactor in the attainment of this ultimate goal. While efficiency is of utmosimportance in attaining this end, the provision for individual needs is oeven greater concern. Dietetics is a sensitive aspect of he lth care, it isbranch of hygienewhich dealswith diet and dieting mong individuals and

groups who are either healthy or ill. The proper application of its principleis crucial to the success of health care delivery and the maintenance of goodhealth.According to the Hospital Licensure Act (RA 4226) of the Bureau oMedical Service 1971), the Dietary Service r nks as one of the six majoservices of the hospital and is an integral part of the total patient care. It iheaded by a professionally qualified Nutritionist-Dietitian who serves as th

dministr tor of the service. In as much as food service involveapproximately 10-14 of the total hospital expenditures, this is a criticaarea, and a hospital which c nnot afford to employ a dietitian is underdistinct handicap.Based on the survey conducted by the committee involved in thpreparation of the Hospital Dietary Service Management Manual, ninetyfive percent (95 ) of the hospital Dietary Service under the Department oHealth (DOH), both in Metro Manila and in the provinces, does not hava formal manual as a guide in the management of the said service. Agreater percentage has informal written policies and procedures th t arehowever, not up-to-date, Results of the survey further indicates th t most-othese Dietary Services are not properly equipped nd ormanaged. In vieof this existing situation, the committeewas prompted to develop this manua


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ospital ietary Service Management Manual

This manual was developed to set the directions needed for the effectivemanagement of the Dietary Service in a general hospital including SecondaryDistrict, Tertiary Provincial, Tertiary Regional and Tertiary Medical Center.All dietetic services need an operational guide or manual containing writteninformation on the efficient and effective management of the units and to,provide ready reference in dealing with future problems. This manual alsoserves as a communication tool within the service and with otherdepartments.Not all of the guidelines stated in this manual will be suitable for use inall types of dietary service set-ups. However, the ideas presented should helpthe Nutritionist- Dietitian to evaluate existing operations with the hopethat constructive changes and improvements will be made.HISTORI L CKGROUND

Dietetics is the combined science and art of planning, preparing, andserving meals to individuals or groups according to the principles of nutritionand management, taking into consideration economic and psychologicalfactors, But dietetics has not always been a science and an art in itself.Despite its early practice as a vital part of patient care, it was not recognizedas a separate discipline. Th us , in t he caring and feeding of t he sick, t henurse was also a dietitian.

Filipino nurses in the early 1900 s underwent rigid training in the variedaspects of dietetics with Ainerican mentors. But soon, dietetics became closelyassociated with food preparation, particularly cooking, that it earned amisconception which took a long time to correct.Shortly after World War II, both nursing and dietetics grewmore complex.Recent knowledge on nutrition and the development of modern methods offood service management soon required that dietetics be considered as anew area of specialization. The limited dietetics training of nurses was no

longer adequate to meet t he increasing d em an ds in t he field. In 1946 theUniversity of the Philippines accepted its first five students for a degree ofBachelor of Science in Home E co no mi cs , m aj or in Food and Nutrition.Nurses. who were in responsible pos it ion s in t he D ie ta ry Service of thehospitals were also given opportunities for specialized training.

In 195 the first nutrition clinic was established by t he I ns ti tut e ofNutrition now Foods and Nutrition Research Institute) with the first Filipinoprofessionally trained in dietetics as the dietitian.In 1952 when the Philippine General Hospital PGH) was reorganized,the Dietary Service became a separate department and other hospitalsfollowed. That same year, the OHestablished under its Bureau of Medical

Services, the Office of the Dietetic Management Adviser. Its principal roleis to set,monitor, evaluate, and recommend dietary service standards, policies,and guidelines for implementation in hospitals and medical centers licensedby the D ep ar tm en t all over t he country. Its o th er advi sory dut ie s i nc lu deconsultative services to hospital heads and dietitians on training needs,programming services for training requirements and consultation needs forkitchen layout and equipment and personnel selection.


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ospital ietary Service Management Manu

By 1955, it became necessary to regulate the practice of dietetics in thPhilippines. Moves were initiated by the newly formed Dietetic Associatioof the Philippines to have a law enacted for this purpose. However, it wanot until 1960 that the Dietetics Lawotherwise known as RA 2674 was passeby. Congress. Briefly, among other things, law requires every government oprivate hospital, with more than seventy-five 75 bu t less than one hundrefifty 150 bed capacity shall employ at least one dieti tian; those with morthan one hundred fifty 150 but less than three hundred (300) bed capacifshall employ at least one dieti tian and two assistant dieti tians; and thoswith more than three hundred (300) bed capacity shall employ two dietitianand no t less than four assistant dietitians.

This Lawwas superseded by Presidential Decree 1286in 1978, specificallSection 27, which states that: All hospitals whether government or privawith twenty five(25)to seventy five 75 bed capacity shall employ a minimumof one Nutritionist-Dietitian; above seventy five (75) to one hundred fift150 bed capacity, a minimum of two Nutritionist-Dietitians; above onhundred fifty 150 to two hundred fifty (250) bed capacity, a minimum othree Nurririonisr-Dieririans; above two hundred fifty (250) bed capacity tfive hundred (500) bed capacity, a minimum of four Nutritionist-Dietitiaand above five hundred (500) to one thousand (1,000) bed capacity,minimum of five Nutritionist-Dietitians. utritionagencies, whethegovernment or private, shall employ at least one (I) Nutritionist-Dietit iafor each province, city, municipali ty, and rural health units. This decrewas a recognition of the expanded role of Nutritionist-Dietitians not only ihospitals but also in community and or public health nutrition, but thessence of regulating the practice of the profession was retained.


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\TIfEHOSPIT L DIET RY SERVI EP LOSOP Y

Each hospital has a guiding philosophy which should be articulatedand ommuni ted to the st ff of the various services Each service inturn must formulate its own philosophy which shall provide the n hofor its goals objectives and program of serviceThe following n serve as a guide in the formul tion of a philosophyfor the Dietary Service:

The Dietary Service is organized to promote optim l nutrition fopatients and hospital personnel regardless of race creed color sociastatus and political belief through the administration of a high qualityfood service:2 Diet is one of the most critical att ributes in hum n growth nddevelopment directly related to good health provides the mosappropriate means of m int ining vitality developing resistance toinfections and organic deterioration the control of m ny diseasprocesses and recovery of health nd function following illness ndiruury:3 Dietary personnel must be prepared guided nd given direction intheir work within the context of prevailing local conditions in ordero attain efficient output; and4 Hospital and Dietary Service goals n be best attained through thecooperation coordination mutual understanding nd dedication oall those concerned with quality patient care

O JE TIVESener l

To maintain or enhance the health of the patients and personnel bproviding them with high quality nd nutritious food through an efficienDietary Service


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ospital ietary ervi e ManagementManual

pe ifi1 To provide or to serve safe, nutritious and attractive food throughcareful planning, wise procurement, and proper preparation ofbalanced and satisfying meals within budgetary limits;2. To implement diet prescriptions in coordination with the physicianand the nurse-in-charge; To provide nutrition consultations and education servicesto patientsaswell as in-service training to both dietary personnel and other relatedfields;4. To undertake investigation, analysis, and research along the field ofNutrition and Dietetics; and5 Topromote and maintain cooperation with other departments in thehospital towards total patient care.

UN TIONSAs a major aspect of total health care and an integral part of the hospital

organization the ietary S er vice is committed to funct ions oadministration, clinical services, education and research as they relate tothe science of food service management and nutrition.

1 Administrativefunction is aimed at the effective utilization of resourcesin the attainment of the goals set by the service. It includes theestablishment of policies and standards, and the implementation ofprocedures concerned with budget and financial control; developmentof menus; purchasing and receipt of foods; production and service ofsafe, sanitary, nutritious, and palatable food; effective utilization ofpersonnel, layout, and equipment; and maintenance of records andreports.2 Clinical function is aimed at providing and promoting a high quality

nutritional care which includes within its scope, diet prescription,interpretation, implementation of diet orders, and the provision oindividual and group counselling of patients in normal and clinicalnutrition. Specialized services may include prescription of diets innutrition clinics, malnutrition ward malward), disaster feeding,outreach, and home care programs. Education and research functions are aimed at the fulfillment of theDietary Service s commitment to the nutrition education of thepatients as well as hospital personnel and paramedic groups and tothe continued researchand development in food service managementand nutrition. t also includes the training of dietary personnel andpersonnel of other allied fields to improve the quality and efficiency

of food service operation, and the development of a research programto upgrade knowledge in food service management and nutrition.ST N R SPrinciple

Thereshall be an organized Dietetic Service which shall promote optimalnutrition for patients and personnel through the efficient administrationof high quality food service.


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Standard Organization Staffing and anpowerevelopmentThe Dietetic Service shall be organized with clearly stated philosophygoals, and objectives. t shall be directed by a qualified person and staffedby an adequate number of Nutritionist-Dietitians, technical, and clericapersonnel. t shall be integrated with the other units and departments of thehospital in a manner designed to ensure the provision ofoptimal nutritionacare and quality food service. Likewise, it should establish linkages with thnutrition component of field health services.

InterpretationThere shall be clearly stated goals, objectives, and procedures for theDietetic Service developed by the dietetic personnel and consonant with thframework of the hospital. The Dietetic Service should have a written

organizational plan that indicates the routes of intra departmentacommunication. Integrated planning on dietetics with other divisionsdepartments in the hospital shall be encouraged. Job descriptions should badopted for all classifications of personnel. The organizational plan, jobdescription, and the procedure manual should be reviewed periodicallyrevised as necessary, and dated to indicate the time of the last review.

The Dietetic Service must have the required number of qualifiedNutritionist- Dietitians duly registered with the Professional RegulationCommission PRC based on PO 1286 Sec 27 see p. 3 . The service musalso have an adequate number of appropriately qualified personnel basedon the staffing pattern approved by the DOH The Chief NutritionistDietitian shall have the authority and responsibility of ensuring that theestablished policies are carried out; that overall coordination and integratioof the therapeutic and administrative dietetic services are maintained; andthat a review and evaluation of the quality, safety, and appropriateness othe dietetic function is performed.

A qualified Nutritionist-Dietitian shall assure that the provision of highquality nutritional care to patients is maintained.Educational programs offered to dietetic employees should includorientation, on-the-job training, and continuing education programs. Thesprograms must include instructions on personal hygiene, proper inspectionhandling, preparation and serving of food, and proper cleaning and safoperation of equipment.Administrative and supervisory staff should be encouraged to takadvantage of available courses which will acquaint them with modernconcepts on preventive and therapeutic nutrition, and dietary managementA hospital that has a contract with an outside food management companfor dietetic services must require, as a part of the contract, that the companmaintain at least the standards outlined herein for such services. This ialso true to all private hospitals that have contracted the services of foodconcessionaires.


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Standardacilities nd per tions

The Dietetic Service shall have adequate space equipment, and supplies facilitate the efficient, safe and sanitary operationsofall functions assigned to itInterpretation

Facilities must be provided to fulfill the food service and dietetic needsof the patients and staff. The layout of the service, in accordance with thetype, size, and location ofequipment, should make efficient food preparation,distribution, effective sanitation, and safety possible. The food service shouldbe appropriately located and equipped.

The following precautions shall be taken in the handling and preparationof food:

Protection of food from contamination and spoilage;2. Storage of perishable foods at proper temperatures;3 Convenient location of adequate toilet and handwashing facilitiesthroughout the service;4. Thorough cleaning and sanitizing of all work surfaces, utensils, andequipment after each period of use;5. Provision of separatecutting boards for meat, poultry, fish both cookedand uncooked), raw fruits and vegetables;6. Discardingof plasticware and china that is chipped, cracked or has lost itsglaze aswell as disposable containersand utensilsafter one use;7 Control of l igh ti ng, venti lati on, and h um id it y, in orde r to preventthe condensation of moisture and the growth of molds;8. Use of efficient equipment and methods for washing and sanitizingdishes. A good example is the installation of a hot water system;9 Use ofmethods for making, storing, and dispensing ice th t doesnotallow contamination to occur. For example, ice should not be scoopedby hand, nor should food items be stored directly on ice being storedfor dispensing; and1 Restriction of unauthorized individuals in the food preparation andservice areas to m in im iz e the risk of contamination and improveoperational efficiency.Safety shall be ensured by providing at least the following precautions: Walk-in refrigerators th t n be opened from the inside;2. Insulationofhot and coldwaterpipes,waterheaters refrigerator compressors,

condensingunits, and uncontrolled heat-producing equipment;3 Clear labelling of supplies;4. Separate storage of all food and non-food supplies;5. D oc um en ta ti on of the activities of an active, preventive, and correctivemaintenance, nd safety program;6. Procurement ofallfood suppliesfrom sources that provideassurance that thefood is processed under regulated quality and sanitation controls; and


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Proper holding transfer and disposal of garbage to prevent theproliferation of insects and rodents or otherwise permi t thetransmission of disease. Containers must be l ea kp roof and nonabsorbent with tight-fitting covers and it is recommended thatimpervious plastic liners be used.

There shoul d be adequate work space for supervi sory and clericalpersonnel. The officeof the Nutritionist-Dietitian should be properly locatedso that he/she is easily accessiblefor consultation to all who require his/herservice. Current reference materials should also be conveniently located inthe office.Standardolicies n rocedures

There should be written policies and nutritional procedures to governall dietary activities.Interpretation

Written policies and procedures for the Dietetic Service shall be developedto guide all dietetic personnel in the performance of their duties. The chiefof the Dietetics epartment in c oop er at ion wit h the dietetic staffrepresentatives from the nursing and medical staff shall develop policiesand procedures concerning food procurement preparation and service .aswell as nutritional care. These policies and procedures shall be reviewedperiodically revised as necessary and dated to indicate the time of the lastreview.There shall bepolicies and procedures relating to at least the following: Departmentgoals and objectives relationships organization and staffing;2. Responsibility and authorityassigned to the chief dutiesofdietarypersonnel

with job descriptions hours and functions for the variousclassifications;3 Personnel policies including those related to health and groomingsuch as the use of aprons/gowns dietary caps and indoor shoes inthe food preparation and service areas;4. Administrative policies and procedures covering budget patient aridstaff education menu planning specification for purchases of foodand equipment ordering and control of food supplies storagepreparation safety and fire prevention sanitation procedures andwaste disposal. Procedures should also mention in detail how thephysicians orders with regards to treatment and diet will be carried

out to ensure that each pat ie nt receives the ri ght di et served asnutritiously and attractively as possible;5. Provision of standardized recipes for economy and efficiency in foodpreparation;

6. Proper housekeeping sanitation safety and maintenance in the dietary re

7 Monthly Reports - statistics and cost accounting procedures8. Methods of evaluating the Dietetic Service arid personnel to assess howwgoals and objectives are being met and the quality of service being rendered;9 The proper use of and adherence to the standards for nutritional careas specified in the diet manual/handbook;


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10. Nutritional assessment and .counselling and diet instruction; Disaster Plans the role of the Dietetic Service in the hospital s intemal andextemal disaster plans shall be clearly defined. The Dietetic Service shall beable to meet the nutritional needs of patients and staff during the disasterconsistent withthe capabilities of the hospital and the communityserved;12. DietManual/Handbook A qualified dietitian shall develop or adopt a diet

manual/handbookin cooperation with representatives of the medical staffand withother appropriate dietetic staff. The diet manual/handbook shallserve asa guide in ordering diets and theserved menus should beconsistentwith the requirements in the diet manual/handbook. The diet manual/handbook shall be reviewed annually and revised as necessary bya qualifieddietitian dated to identify the review andany revision made in consultationwith the medical staffthrough itsdesignated mechanism. A copy of thedietmanual/handbook shall be placed in each patient care unit All mastermenus and modified diets shall be approved bya qualified dietitian; and 3 A nutrition clinic that will take care of nutrition referrals at the out-patient department shall be organized adopting the nutrition clinicguidelinesof the O and/or the enclosed guidelines in the manual.

Standard Nutritional spects Patient are

the administration of high quality nutritional care of patients shall beunder the direction of a qualified Nutritionist Dietitian.Interpretation

The nutritional aspects of patient care shall be directed by a qualifiedNutritionist Dietitian whose duties shall include: Supervision of nutritional intake of all patients

a. Planning and evaluating all menus for nutritional adequacy;b. Providing maximum effort to ensure the appetizingappearance palatability proper serving temperature andretention of nutrient values of food;c. Keeping recordsof nutritional intake when necessary;d. Periodic assessment of the patient s nutrient intake and tolerance totheprescribed diet modifications including theeffect ofthe patient sappetite and oo habits on tood intake and anysubstitutions made;e. Conferring with other members of the treatment team aboutdietarymanagement and problems of patients. Initiating orders

for dietary modifications when necessary; .f. Recording dietary progress of patients in their records incollaboration with the nursing service; andg. Developing projects or studies to improve nutritional care.

2. Nutrition Educar.ona. Patient Education includes teaching of normal nutrition as well asspecific diets and involves discussing with patients and/or theirfamilies their food habits diet f lOors associated with their socio-economic background dietary intake andother aspects of nutritionwhich will affect the patient s health after discharge;


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ospital ietary Service Management Manua

b. Education of other members of the therapeutic team;c Education of other Dietary Service personnel;d. Education of community groups through referral to thenutrition clinics;e. Supervision of dietetic affiliates when applicable;f. Collaboration in the preparation or selection of suitable

booklets and instruction sheets for patients, and audio-visualaid for teaching; and .g. Responsible for the p re pa ra tio n or selection of a suitable dietmanual for use as reference by medical and dietary personnelwhen ordering diets.

3. Attendance at appropriate rounds and conferences, and representationon appropriate committees.a. A representative of the dietary staff should attend team

conferences or committee meetings whenever dietaryconsiderations are vital to the diagnostic or therapeuticregimen of the patient or whenever matters pertaining to theefficient delivery of the service are under discussion.

In 1982 the United StatesJoint Commission on Accreditation ofHospitalsOCAH has revised the standards-which took effect on 1 July 1983 Theserevised standards which can be adopted for our hospitals are as follows: rinciple

Dietetic services shall meet the nutritional needs of patients.Standard

The dietetic department/service shall be organized, directed and staffed,and integrated with other units and departments the hospital in a mannerdesigned to ensure the provision of optimal nutritional care and the qualityof food service.Interpretation

The relationship of the dietetic department/service to other units anddepartments of the hospital shall be specified within the overall hospitalorganizational plan or described in writing elsewhere. The scope of thedietetic services provided to in-patients, as appropriate to ambulatory carepatients and patients in a hospital-administered home care program, shallbe defined in writing.Direction

The dietetic department/service shall be directed on a full-time basis byan individual who, by education or specialized training and experience, isknowledgeablein food service management. The director shall be responsibleto the chief executive officer or his designate. The director shall have theauthority and responsibility of ensuring that established policies are carriedout; that overall coordination and integration of the therapeutic andadministrative dietetic services are maintained; and that a review andevaluation of the quality, safety, and appropriateness of the dieteticdepartment service functions are performed.


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StaffingDietetic Services shall be provided by a sufficient number of qualifiedpersonnel under competent supervision. The nutritional aspects ofa patient sneeds shall be supervised by a qualified dietitian duly registered with theProfessional Regulation Commission PRe).

Outside SourcesWhen dietetic services are provided for by an outside food managementcompany, the company shall comply with all applicable requirements of themanual, and the contract shall specify the compliance requirements.

tandardPersonnel shall be prepared for their responsibilities in the provision ofdietetic services through appropriate training and education programs.

InterpretationThe education, training, and experience of the personnel who provides the

dieteticservices shall bedocumented and shallbe related to each individual s level ofparticipation in the provision ofdietetic services A formal training program maybe required as a prerequisite. New personnelshallreceive an orientation ofsufficientduration and substanceprior to providingdieteticservices without directsupervisionand thisorientationshallbedocumented.As appropriateto their level of responsibilitysuch individuals shall receive instructions and should demonstrate competence in: Personal hygiene and infection control;2. Proper inspection, handling, preparation, serving, and storing of food;3 Proper care and safe operation of equipment;4. General food service sanitation and safety;

.5. Proper methods of waste disposal;6. Po rti on control; Writing of modif ied diets using the diet manual handbook;8. Diet in structio n; and9 Recording of pertinent dietetic information in the p ati en t s m ed icalrecord

Personnel providing dietetic service shall participate in relevant in-serviceeducation programs. There shall be a provision for participation of personnelfrom all work shifts. The dir ector of the dietetic department/service or thedirector s qualified designates shall participate in planning and conductingin-service education for dietet ic pers on nel an d, as ap pro pri ate , for otherhospital personnel. In-service education shall include safety and infectioncontrol requirements described elsewhere in this manual. Outside educationalopportunities shall be provided, as feasible, to supervisory dietetic personnel.

The extent of the d ie te ti c personnel s participation in continuingeducation shall be documented, and shall be realistically related to the sizeof the staff and the scope and complexity of the dietetic services provided.Education programs for dietetic services personnel shall be based, at least inpart, on the results of dietetic department/service evaluations.


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t nd rd Dietetic services shall be guided by written policies and procedures.

InterpretationThere shall bewritten policies and procedures concerning the scope and

conduct of dietetic services. Administrative policies and proceduresconcerning food procurement, preparation, and service shall be developedby the director of the dietetic department/service. Nutritional care policiesand procedures shall be developed bya qualified Nutritionist-Dietitian whenappropriate consent or approval have been obtained from the medical staffthrough its designated mechanism and from the nursing department/service.The policies and procedures shall be subjected to timely review, revised asnecessary, dated to indicate the time of the last review, and enforced. Thepolicies and procedures shall relate to at least the following: .

The responsibilities and authority of the director of the dieteticdepartment/service and when the director is not a qualified dietitian,of the qualified dietitian;2. Food purchasing, storage, inventory, preparation, and service;3 Diet orders should be recorded in the patient s medical record by anauthorized individual before the diet is served to the patient;4. The proper use of and adherence to the standards for nutritional careas specified in the diet manual handbook;5 Nutritional assessment, counselling, and diet instruction;6. Menus;7 The role, as appropriate, of the dietetic department/service in thepreparation, storage, distribution, and administration of enteric tubefeedings and total parenteral nutrition programs;8. Alterations in diets or diet schedules, including provision of foodservice to persons not receiving regular meal service;9. An identification systemfor patient trays, and methods used to assurethat each patient receives the appropriate diet as ordered;1 Personal hygiene and health of dietetic personnel; Infection control measures to minimize the possibility ocontamination and transfer of infect ion. This shall include theestablishment of a monitoring procedure (to ensure that dieteticpersonnel are free from infections and open skin lesions), and the

establishment of sanitation procedures for the cleaning andmaintenance of equipment and work areas, and the washing andstorage of utensils and dishes); and12 Pertinent safetypractices, including the control ofelectrical,flammablemechanical, and, as appropriate, radiation hazards.

Disaster PlansThe role of the dietetic department/service in the hospital s internaand external disaster plans should be clearly defined. The dieteticdepartment/service should be able to meet the nutritional needs of patientand staff during a disaster, consistent with the capabilities of the hospitaand the community served.


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Diet Manual HandbookA qualified dietitian, in cooperation with other dietetic staff and therepresentatives of the medical staff, should develop or adopt a diet manualhandbook and the standards for nutritional care specified therein should bein accordance with those of the Recommended Dietary Allowances of theFood and Nutrition Research Institute FNRI). The nutritional deficiencies

of any diet not in compliance with the recommended dietary allowancesshould be specified. The diet manual handbook should serve as a guide inordering diets, and the menus served should be c on si st en t wit h therequirements specified. The diet manual handbook should be reviewedannually and revised as necessary by a qualified dietitian, dated to indicatethe time of the last review and any revisions made, and approved by themedical staff through its designated mechanism. A copy of the diet manualha ndb oo k should be placed in each patient care unit. All master menusand modified diets should be approved by a qualified dietitian. tandard V

The dietetic department/service shall be designed and e qu ip pe d tofacilitate the safe, sanitary, and timely provision of food service to meet thenutritional needs of patients.Interpretation

Sufficient space and equipment shall be provided for the dieteticdepartment/service to store food separatelyfrom nonfood supplies; to prepareand di stri but e food, i nc lu di ng modified diets; and to clean and sanitizeutensils and dishes apart from food preparation areas. When storage facilitiesare limited, paper products may be stored with food supplies. Sufficientspace shall be provided for supportive personnel to perform their duties.Current reference materials shall be made available to dietetic personnel andmust be conveniently located in the dietary department/service.fuod and non-food supplies shall be stored under sanitary, safe and secureconditions. The dietetic department/service facilities and equipmentshould complywith federal state and local sanitation and safetylaws and regulations. .The following precautions should be taken in the handl ing andpreparation of food:

Food is protected from contamination and spoilage;2. Food is stored at proper temperatures uti lizing appropriatethermometers, and maintaining temperature records;3 Lighting, ventilation, and humidity are controlled in order to preventthe condensation of moisture and the growth of molds;4. Methods that minimize the opportunity for contamination are usedfor making, storing, and dispensing ice. For example, ice should notbe scooped by hand, nor should food items or scoops be stored directlyon ice that is being stored for dispensing;5. Separate cutting boards are provided for meat, poultry, fish and raw fruitsand vegetables ooke foods should not be cut on the sameboards used forraw food preparation. Separate cutting boards may not be required whenthere are boards in use that are non-absorbent and capable of being cleanedand sanitized adequately and when the cleaning and sanitizing proceduresare performed properlybetween usage for different food categories;


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6. All working surfaces particularly food contact surfaces utensils andequipment are thoroughlycleansed and s nitize between periodsof use;7 Adequate toilet handwashing and hand drying facilities areconveniently located throughout the department;8. Dish-washing and utensil-washing equipment and techniques that assure

s nitize serviceware and prevent recontamination including monitoring ofproper temperature maintenanceduring cleaning cycles areused;

9 Plastic ware china and glassware that has lost its glaze or is chippedor cracked is discarded;10 Disposable containers and utensils are discarded after usage; and Movement of unauthorized individuals through food preparation andservice areas is controlled in order to decreasethe risk of contamination

and improve operational efficiency.Safety shall be ensured by providing at least the following precautions: All walk-in refrigerators and freezers on the premises whether they

are in use or not can be opened from the inside;2. There is insulation of or protection from hot and cold water pipeswater heaters refrigerator compressors condensing units and heatproducing equipment;3 Food and non-food supplies are clearly labeled;4. A review is conducted on the hospital preventive and correctivemaintenance and safety programs as these relate to the dieteticdepartment/service and actions are taken based on the findings othe review The review and actions taken shall be documented; and5. All food is procured from sources that process the food under regulatedquality and sanitation controls. This does not preclude the use o

local produce.The holding transfer and disposal ofgarbage shall be done in a mannerthat will prevent the proliferation of insects rodents and vermin and wil

not otherwise permit the transmission of diseases. Cont ai ne rs must beleakproof and non-absorbent with tight-fitting covers and it is recommendedthat impervious liners be used.tandard

Dietetic servicesshall be provided to patients in accordance with a writtenorder of the responsible practitioner. All appropriate dietetic informationshall be recorded in the patient s medical record.Interpretation

The qualified diet it ia n or a ut hori ze d designate shall e nt er dieteticinformation into the medical record as specified and in the lo ca tio ndetermined by those performing the medical record review function. Thesedeterminationsshall be made by the medical record committee if and whenone exists. The qualified dietitian or authorized designate is responsible fordocumenting appropriate nutritional information in the medical recordon the requestof the appropriate medical staffmember. Such documentatiomay include:


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1. Conf ir ma ti on of the diet order by the responsible practitioner within24 hours ofadmission for those patients receiving oral alimentation,and within 24 hours for all subsequent orders for a diet modification;2. Summary of the dietary history and or nutrition assessment, whenthe past dietary pattern is known to have a bearing on the patient scondition or treatment; Timely and periodic assessment of the patient s nutrient intake andtolerance to the prescribed diet modification, including the effect ofthe pat ie nt s appe tit e and food habits on food intake and anysubstitution made;4. Description of the diet instructions given to the patient or family andassessment of their diet knowledge; and5. Description or copy of the diet information forwarded to anotherinstitution upon patient discharge. fnutritional care follow-up revertsto the practitioner s office or a health care agency, this should benoted in the patient s record.

tandard VThe quality and appropriateness of nutritional care provided by theDietetic Service should be reviewed and evaluated regularlyInterpretation

The director of the dietetic department/service, in consultation with aqualified dietitian when the director is not a qualified dietitian), shall beresponsible for ensuring that a reviewand evaluation of the appropriatenessand effectiveness of nutritional care is accomplished in a timely manner.The reviewand evaluation program should also include the nutritional careprovided to in-patients and, when applicable, to ambulatory care patientsand patients in a hospital-administered home care program. The reviewand evaluation shall be performed at leastannually and shall involve the useof the medical record and the pre-established criteria. The review andevaluation shall include data gathered from the medical, nursing, and dieteticstaff and should be performed within the overall hospital quality assuranceprogram. The quality and appropriateness of dietetic services provided tothe hospital by outside sources shall be included in the review and evaluationon the same regular basis.

The following quality control mechanisms shall be implemented:I All menus are evaluated for nutritional adequacy;2. There is a means of identifying patients who are receiving oral intake;3 Tray identification is monitored;4. Not more than 5 hours elapse between the serving of the eveningmeal and the next substantial meal for patients who are on oral intakeand do not have specific dietary requirements;5. As appropriate, the nutrient intake of patients is assessed and recorded;6. Asappropriate, patients with special dietary needs receive instructionsrelative to their diets, and an indication of the patient s or family s)understanding of these instructions is recorded in the medical record;


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As appropriate patients who are discharged from the hospital onmodified diets should receive written instructions n individualizedcounselling prior to their discharge;8. Qualified dietitians participate in committee activities concerned withnutritional care; A m ximum effort is made to ensure the


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DIET RY UM NRESOUR E M N GEMENTHOSPIT L EMPLOYMENT PR TI ESR RUITM NT

Opportunities for government employment shall be open to all qualifiedindividuals and positive efforts shall be exerted to attract the best qualifiedapplicant to enter the service.Employees shallbe selected on the basisoffitness, determinedbythe appointingauthority, to perform the duties and assume the responsibilities of the positions,whether in the competitive or in noncompetitive service as well as on the basisofmerit as provided for in the Civil Service lawn rulesQualifications and an appropriate examination shall be required fromthe applicant for appointment to p os iti on s in the comp eti tive service inaccordance with the Civil Service Rules and as e mb od ied in PO 1286 nlythe registered Nutritionist-Dietitian who successfully passed the NutritionistDieti tian s Board Ex am in at io ns ; given on ce a year by the PRC, shall beconsidered for appointment to the classified/professional positions in theDietary Service, and are therefore legally authorized to practice dietetics ingovernment or private hospitals, with a bed capacity of 25 or more.No written examinations shall be required for positions such as cooksand food service workers. Some points to consider in the recruitment forthese positions include age, experience, basic education and knowledge,aptitude, capacity, skills, character, physical fitness, and potential for growth

and development. In recruitment, there s ho ul d be a wide selection andcareful placement of ap pl ican ts for the present job. T he p rocedu re in therecruitment process includes:I Surveying the source of labor supply personal contact, newspaperadvertisements, employment agencies, schools, etc.);2. Filling-up of an application f or m by the applicant; Giving a seriesof tests to gauge the aptitude and ability of the applicant;4. Checking the applicant s work experience, school records, and personalreferences;


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5 Interviewing the applicant to evaluatethe factors not revealed bytests.and to determine their ability in relation to the job opening;6. Selecting the person most qualified for the particular opening; and7 Undergoing a physical and medical checkup

IRINWhen the applicant has passed the requirements and is chosen for theposition, his/her application papers are finally processed by the PersonnelDepartment.

Medical ExaminationAll employees must undergo a complete medical checkup annually and mustsecure a health certificate issued bythe respective government health office.Chest X-ray blood test, stool culture, and throat culture must be donefor each employee every year. In cases where an employee has a positivefinding, he/she will be allowed to rest for a period time deductible from

his/her sick-vacation leave credits, as the case may be.Number Working HoursThe normal number working hours is 40 per week excluding mealhours . Each employee must render a total eight hours of work a day.Shift schedules should be rotated in order to be fair to all employees. Insomecases, employees are scheduled on a broken shift duty when there is alack personnel. As much as possible, such schedules should be avoided.The Nutritionist-Dietitian-in-charge prepares the monthly time scheduleat least 15 days in advance to enable the employees to know their tour duty ahead time. See DSFormNo.2, Employees Schedulefor the Month .He/she also has the authority to make changes in the schedule whenevernecessary.

Leave AbsenceThe following are the leave privileges enjoyed by employees: Vacation Leave -granted to employees and allowed for personal reasons.The.grant a vacation leave is contingent upon the necessities theservice.2. SickLeave - taken by an employee for reasons his/her own sicknessor that any member his/her immediate family.3 Maternity Leave - granted to married women employees in case

pregnancy or by reasons confinement, abortion, or miscarriage, inaddition to the vacation and sick leave to which they may be entitled.Personnel Entitled to a Leave Absence

After six months full-time employment, each employee is entitled toa 15-day vacation leave and a 15-day sick leave for each calendar year service with full pay exclusive Saturdays, Sundays and holidays. Anyabsence within the first six months shall bewithout pay. The total vacationand sick leave that can be accumulated to the credit any employee shall,in no case exceed ten months.


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In case of pregnancy married women employees are entitled to amaternity leave of not more than 60 days in addit ion to the vacation andsick leave allowable under the following conditions:I Married women employees who have rendered two or more years ocoritinuous service under regular and permanent appointment areentitled to 60 days maternity leavewith full pay;2. Those who have rendered less than two years of continuous serviceunder regular and permanent appointment are entitled to 60 daysmaternity leave with half pay; Those who have rendered two or more years of continuous servicunder provisional/temporary appointment are entitled to 60 daysmaternity leave with half pay;4. Those who are under provision/temporary appointment and haverendered less than two years of continuous service are entitled to anumber of days of maternity leavewith pay based on the ratio of 30days of maternity leave to two years of continuous service; and5. Thosewho have passed the CivilService examination given before the date

of application for maternity leave but the results of such examination werereleased afterthe dateof application areentitled to maternity leave grantedtoregular employees asof the date when said examination were given

Granting of Leave of AbsenceGranting of vacation leave depends upon the needs or demands of theservice and the discretion of the Nutritionist Dietitian in charge.Sick leave shall be granted only on account of sickness on the part othe employee concerned or of any member of his immediate family. Amedical certificate from a government physician must be presented by theemployee before returning to work if the sick leave is five days or more.

T RMIN TIONTermination of employment could be a voluntary resignation on thepart of the employee. In this case resignation papers must be filled out andsubmitted by the employee one month before the date of his resignationtakes effect. Clearance from any obligation should be checked prior to thetermination of employment.Employment may be terminated due to failure to perform assigned dutiesincompetency dishonesty laziness and insubordination Unpleasanpersonality undesirable traits stubbornness and habitual absenteeism arealso grounds for dismissal.

The termination procedure is as follows:I The employee is notified about his termination;2. The employee isgiven a chance to express himself/herselfwith regardsto his her termination; A final interview is given and the reasons for his termination arereviewed; and4. In some cases the employee may be recommended for a lower position

Depa rtme nt of Health

\DH1 8 45 H79d 2


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Employee DisciplineThe following are declared to be grounds for disciplinary action inaccordance with the provision o the Civil Service laws and rules PD No.

807 dated 6 October 1975 :1 Dishonesty2. Oppression3 Misconduct4. Neglect o duty5 Disgraceful and immoral conduct6. Beingnotoriously undesirable which is of common knowledge7 Discourtesy in the course o official duties8. Inefficiency and incompetence in the performance o official duties9 Receiving for personal use a fee gift or othervaluable things in thecourse ofofficial duties or connection therewith when such fee giftorothervaluablethings are given byanyperson in thehopeor expectation of receiving a favoror better treatment than that accorded to otherpersons or committing actspunishable underthe anti-graft laws10. Conviction o a crime involving moral turpitude Improper or unauthorized solicitation of contributions from subordinateemployees and byteachers or school officials from school children12. Violationo existingCivil Service laws and rules and reasonable officeregulation13. Falsification o official documents 4 Frequent unauthorized absences or tardiness in reponing forduty loafing orfrequent unauthorized absences from dutyduring regular office hours 5 Habitual drunkenness 6 Gambling prohibited by law 7 Refusal to perform official duty or to render overtime service 8 Disgraceful immoral or dishonestconduct prior to enteringthe service 9 Physical or mental incapacity or disability dueto immoral or vicious habits20. Lending money at unreasonable interest rates2 Borrowing money by superior officers from subordinates or lendingby subordinates to superior officers22. Willful failure to pay debts or willful failure to pay taxes due to thegovernment23. Contracting loans of money or other property from persons withwhom the office o the employee concerned has a business relation24. Pursuit o private business vocation or profession without thepermission required by these rules or existing regulations25. Insubordination26. Engaging directly or indirectly in partisan political activities27 Conduct prejudiced against the best interest of the service28. Lobbying for personal interests or gain in the legislative halls andofficeswithout authority


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9 Promoting the saleof tickets in behalf ofprivate enterprises that arnot intended for charitableor publicwelfarepurposes and even in thlatter cases there is no prior authority30. Nepotism as definedin section 49 ofthis decree

Thecodeofethics should beobserved bytheprofessional st ff SeeAppendixCode ofEthics)EmployeeEvaluation

The New Performance Appraisal System, which is basically orientetowards performance resultsandwhichis expectedto effectlinkagebetweeManagement by Objective MBO) and performance evaluation, has beeprescribedfor adoption inthe career service effective1 January 1979.There shallbe two rating periods during the year, one from January toJune and the other, from July to December.The supeIVisor should rate the employee s perform nce at the end of everrating period The rating that isgiven to the employee should e discussed withbimlher. Points of disagreement about the rating should be settled at this stage sthat satisfactory supeIVisor-subordinate relationship maye maintained.The superior shall rate the employeeusing the Performance AppraisaReport Form. nly one form is adopted for rating both supervisory annon-supervisory personnel. See DS Form No. lA, Performance TargetWorksheet andDS FormNo. lB, Civil Service Performance Appraisal ReportFive adjective ratings which are given corresponding point scores arprovided in the system. They are: Outstanding, Very -SatisfactorySatisfactory, Fair, and Unsatisfactory.

Importance ofthe Ratingsnemployee needs a rating ofsatisfactory orhigher tobeeligible furpromotios well asfurgrade increase. n employee with an Outstanding rating shall brecommended foranincentive award Theefficiency rating shalleoneofthebasiindetennining theretention ofanemployee inc seofa reduction intheworkfurcenemployee\\


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standardizes recipes and supervises their use; supervisesselection and training of nonprofessional food servicepersonnel; assists in the maintenance of records fordepartment planning and financial management; andevaluates work procedures employees utilizationphysical layout and equipment.

Therapeutic Nutritionist Dietitian - Onewho plansanddirects thepreparation andservice ofmodified dietsprescribed bythephysician4. Teaching Nutritionist-Dietitian - One who plans organizesandteaches courses or conducts educationalprograms relatedto normal and therapeutic nutrition.

Management SkillsThe managementskills needed for the Chiefand/or AdministrativeNutritionist-Dietitian are as follows:

l Organizational Skillsa Plansandorganizesthe servicebasedonthe objectives;b. Establishes priorities and allocate resources; andc. Encourages and participates i n r esearch

2 Financial Skillsa Interprets f inancial s tatements;b. Preparesbudgets;c Plans the utilization of resources in department;d. Forecasts manpower requirements; ande Continually updatesmanagerial and technical knowledge

Educational Skillsa Creates conducts and evaluates orientations and inservice training programs

4. Communication Skillsa Motivates and leads employees;b. Maintains close i ison with the hospital administration;c. Maintains records; andd. Publishes results ofthe department s research

5 Political-NegotiationSkillsa Understands politicalprocesses inthe work place; andb. Uses lobbying to achieve o bjectives

6. TechnicalFood Service Management Skillsa Designs menus and evaluates acceptance;b. Standardizesrecipes;c Develops specifications for procurement offood andequipment;d. Establishes and maintains standards of

Production and serviceSanitationSafety


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e Plans kitchen layout designs; and Determines equipment requirements

7 Personnel Management Skillsa Appoints appraises and dismisses the staff;b. Develops job descriptions and specifications;c. Educates and trains the staff; andd. Directs the staffC. Skillsneeded for Therapeutic or Clinical Nutritionist- Dietitiansand/or Teaching Nutritionist-Dietitians

1 Communication Skillsa Knows and understands the needs of the targetaudience; and

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