Order of the Ministry of Health 330 on nutrition. Normative legal documents. Indications for the use of enteral nutrition

MINISTRY OF HEALTH
Khabarovsk Territory

In order to implement the Concept of state policy in the field of healthy nutrition of the population of the Khabarovsk Territory, to improve the organization of medical nutrition in medical institutions of the Territory

I declare:

1. .

I order:

1. To the heads of public health authorities 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", to bring it to the attention of specialists of subordinate medical institutions.
1.2. Organize a seminar for medical workers of subordinate institutions to study the above Order by 10.06.2004.
1.3. Ensure the introduction of a new nomenclature of diets, use in medical 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 additives (including soy products , bread from sprouted grain or with lamidan) and ready-made specialized mixtures.
1.4. To staff the vacant positions with dietitians.
1.5. To amend the existing Regulations on the Council for Medical Nutrition, on the organization of the activities of a dietitian, a nurse of a dietary health care 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 Healthcare Professionals of the Ministry of Health of the Khabarovsk Territory doctors and paramedical workers, ensure their referral to specialized courses in the system of postgraduate education.
2. First Deputy Minister of Health of the Khabarovsk Territory Tropnikova V.M. to envisage in the programs of postgraduate training of medical workers the issues of organizing medical nutrition in medical and preventive institutions.
3. To take into consideration the Order of the Ministry of Health of the Russian Federation of 12.02.2004 N 95 "On cancellation of the order of 23.04.1985 N 540 and of 14.06.1989 N 369".
4. Information on the execution of this order shall be submitted by 01.10.2004.
5. Control over the implementation of this order shall be entrusted to the Deputy Minister of Health of the Khabarovsk Territory A.Ya. Derkach.

Act for the destruction of used ampoules of narcotic drugs and psychotropic substances (Appendix 10). (as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

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

2.2. To the heads of healthcare authorities and pharmaceutical organizations in the constituent entities of the Russian Federation:

2.1. To impose personal responsibility on the heads of medical and prophylactic institutions for recording, keeping, 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 of 05.16.2003 N 205)

2.2. Provide medical and prophylactic 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 health authorities and medical and prophylactic institutions should not exceed the monthly requirement. (as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

2.3. To oblige the heads of medical and prophylactic institutions (or their deputies) to ensure the storage of special prescription forms for narcotic drugs only in a safe, the key to which must be in the possession of these managers; and exercise systematic control over the prescription of narcotic drugs and psychotropic substances and the established procedure for their prescription (Appendix 2). Strictly prohibit doctors from issuing as well as prescribing 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 of 05.16.2003 N 205)

2.4. To oblige the attending physicians to prescribe and use narcotic drugs and psychotropic substances, regardless of the dosage form, to draw up records in the medical history and prescription sheet indicating the name of the dosage form of the narcotic drug and psychotropic substance, its amount and dosage. (as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

2.5. To oblige the attending doctors or doctors on duty to hand over used ampoules of narcotic drugs and psychotropic substances on the same day, with the exception of weekends and holidays, to the deputy head for the medical department, 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 corresponding act in the prescribed form (Appendix 10). (as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

3. The Standing Committee on Drug Control, heads of medical and prophylactic institutions, heads of research institutions, when determining the need for narcotic drugs and psychotropic substances, should be guided by the consumption rates of narcotic drugs and psychotropic substances (Tables 2 and 3). (as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

4. The heads of public health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation shall 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 pharmaceutical and medical - preventive institutions. If facts of violation of the procedure for the appointment and admission of persons to work with narcotic drugs and psychotropic substances are revealed, the perpetrators are 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 of 05.16.2003 N 205)

5. The heads of public health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation shall bring this Order to the attention of medical and pharmaceutical workers and exercise constant control over its implementation.

6. Consider the Order of the USSR Ministry of Health of 12/30/82 N 1311 "On measures to eliminate serious shortcomings and further strengthen the fight against drug addiction, improve the accounting, storage, prescribing and use of narcotic drugs and psychotropic substances" (Appendix 2 "Form of a special prescription form for a narcotic drug and psychotropic substance", Appendix 3 "Consumption rates of 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 pharmaceutical departments ", Appendix 9" Rules for the storage and accounting of narcotic drugs in research institutes, laboratories and educational institutions of the health care 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 of narcotic drugs and psychotropic substances in health care institutions "). (as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

7. Control over the implementation of this Order shall be entrusted to the Deputy Minister of Health Vilken A.Ye.

The minister
T.B. DMITRIEVA

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

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

APPENDIX 1. STANDARD REQUIREMENTS FOR TECHNICAL STRENGTHENING AND EQUIPMENT WITH SECURITY AND FIRE ALARMS FOR ROOMS WITH STORAGE OF NARCOTIC DRUGS - Abolished. dated 17.11.2010 N 1008н)

Appendix 2
APPROVED BY
By order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

APPENDIX 2. FORM OF A SPECIAL PRESCRIPTION FORM FOR A 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 of November 17, 2010 N 1008n)

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

dated 09.01.2001 N 2, dated 16.05.2003 N 205)

Table 1

ESTIMATED STANDARDS FOR NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES PER 1000 POPULATION PER YEAR (IN GRAMS)

(as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

N p / p	Name of medicines	Standard for 1000 people
1.	Morphine hydrochloride	0,3
2.	Promedol (trimeperidine)	5,0
3.	Omnopon	0,3
4.	Cocaine	0,02
5.	Dionine (ethylmorphine)	0,1
6.	Estocin hydrochloride	0,3
7.	Codeine	70,3
8.	Opium	833,3
9.	Fentanyl	0,006

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 for the standards, it is necessary to recalculate all dosage forms containing these substances for a purely active drug.

Chairperson
The Standing Committee
drug control
E.A. BABAYAN

table 2

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

(as amended by the Order of the Ministry of Health of the Russian Federation of 05.16.2003 N 205)

N p / p	The name of the department of the medical facility	The name of the narcotic drug and psychotropic substance<**>
N p / p	The name of the department of the medical facility	morphine hydrochloride 1% (amp)	omnopon 1% - 1.0 (amp)	omnopon 2% - 1.0 (amp)	promedol 1% - 1.0 (amp)	promedol 2% - 1.0 (amp)	morphine-like total (amp)	fentanyl 0.005 2%<*>(amp)	promedol (gr)	promedol in the table. (pack)	estocin in the table. 0.015 (pack)	ethylmorphine hydrochloride (gr)	codeine and its salts (g)	codeine cough tablets (pack)	cocaine hydrochloride (gr)
1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16
1	Therapeutic	3,0	0,5	2,0	0,5	5,0	11,0	0,4	0,25	1,5	0,6	0,5	0,2	5,0
2	Gastroenterology	3,0		0,5	0,5	5,5	9,5	1,0		0,5				2
3	Cardiological	1,0	0,5	1,5	0,5	5,5	9,0	1,5		1,0		2,0		1,0
4	Pulmonary	1,0	1,0	2,0	1,0	6,0	11,0	0,5				0,06	0,2	4,0
5	Allergic					1,0	1,0							1,0
6	Endocrinological			0,6		1,0	1,6	3,0				0,01		0,1
7	Nephrological	3,0		0,5	0,5	5,5	9,5	1,0		0,5				1,5
8	Hematological	2,5	2,0	12,0	4,0	36,0	56,5	5,0		0,5		0,3		1,5
9	Occupational pathology	1,0	1,0	2,0	0,5	6,0	10,0					0,06	0,2	3,0
10	Surgical	6,0	1,5	8,5	7,0	58,0	81,0	6,0	0,4	1,0	0,2	0,4	0,3	6,0	0,04
11	Traumatological	3,0	1,0	5,0	3,0	21,0	33,0	2,0		0,5		0,5		3,0	0,03
12	Orthopedic			0,2	1,0	4,0	5,2
13	Urological	5,0	0,5	5,0	4,0	31,0	45,0	7,0	0,3			0,07	0,2	3,0
14	Thoracic surgery	2,0		5,0	20,0	150,5	177,0	5,0			0,2			5,0
15	Burn	9,5	3,0	13,0	15,0	115,0	155,5	11,0	0,6	4,0	0,2	0,3	0,5	5,0	0,5
16	Reanimation	9,0	1,0	10,0	20,0	145,0	185,0	100,0
17	Infectious	2,0	3,0	2,0	31,0	5,0	43,0	0,2		1,0		0,3		7,5
18	For pregnant women and women in labor	4,0	0,5	1,0	6,0	4,0	15,5	1,0		1,0		0,25		1,0
19	Pathology of pregnant women					0,5	0,5							0,1
20	Gynecological	3,0	2,5	9,0	2,5	14,0	31,0	4,0		7,0	0,9	0,05		1,5
21	Neurological	0,5		0,5	2,0	1,0	4,0	0,6	0,3			0,45	0,6	1,5	0,03
22	Psychiatric	0,2				0,2	0,4					0,15	0,4	0,1
23	Ophthalmic	0,3	0,5	0,5	0,5	4,0	5,8	1,0	0,3		0,2	0,7		1,5	0,2
24	Otolaryngological	2,0		6,0	0,5	3,5	12,0	0,6	0,3			1,3		2,5	3,0
25	Dermatovenereological					0,1	0,1					0,1		4,0
26	Tuberculous	2,0		1,5	1,0	2,0	6,5		0,1	1,2	0,2	0,35		4,0	0,01
27	Narcological													0,1
28	Pediatric	0,2	0,1		0,3		0,3			1,2		0,05	1,0	1,0
29	Oncological	2,5		15,5	2,0	60,0	80,0	10,0		0,5		0,4		1,7
30	Radio-x-ray	0,5	2,5	12,0	3,0	7,0	26,0	1,0		0,1
31	Reception			0,1		0,25	0,38							0,45
32	In a rural district hospital, including an outpatient appointment	10,0	1,0	6,0	2,0	7,0	26,0	20,0	0,2	0,2		0,2	0,5	6,0	0,1
33	Clinic and outpatient clinic	2,0	0,7	0,3	1,0	2,0	6,0			0,5		0,2		2,0	0,04
34	Dental clinic		0,2	0,3	0,3/ 0,3	- / 0,5	0,35/ 0,85	- / 1,0							0,2
35	Oncology Center	140			55,0	80,0	275,0
36	Tuberculosis dispensary			1,0	0,5	1,0	3,0							3,5
37	For 1000 cases of rendering emergency medical services. help	14,0		7,0		39,0	60,0	2,5		1,5

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

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

Notes:

1) The heads of the healthcare management bodies of the constituent entities of the Russian Federation are allowed, according to the recommendations of the heads of medical and preventive institutions, to increase the calculated 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 prophylactic institutions are allowed to redistribute between the departments the narcotic drugs and psychotropic substances indicated in this table within the general standard of need for the institution for each name. (as amended by the Orders of the Ministry of Health of the Russian Federation of 09.01.2001 N 2, of 16.05.2003 N 205)

3) In the presence of medical indications for the relief of severe pain syndrome 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 the medical indications and the patient's condition. (as amended by the Orders of the Ministry of Health of the Russian Federation of 09.01.2001 N 2, of 16.05.2003 N 205)

Chairperson
The Standing Committee
drug control
E.A. BABAYAN

Table 3

DESIGN STANDARDS
REQUIREMENTS FOR NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES PER ONE BED PER YEAR FOR ONCOLOGICAL DEPARTMENT (CHAMBER) OF PALLIATIVE CARE, MEDICAL - PREVENTIVE INSTITUTION AND HOSPITAL

(as amended by the Orders of the Ministry of Health of the Russian Federation of 09.01.2001 N 2, of 16.05.2003 N 205)

N p / p	Name of the medicinal product	Release form and dosage	Quantity
1	2	3	4
1.	Buprenorphine	Sublingual tablets 0.2 mg	157.5 tab.
		Injection,
		ampoules 0.3 mg in 1 ml	105 ampoules
		ampoules 0.6 mg in 1 ml	52.5 amp in total<*>- 94.5 mg
2.	Dihydrocodeine - retard	Oral tablets
		60 mg	158.7 tab.
		90 mg	105.8 tab.
		120 mg	79.3 tab. in total<*>- 28.56 gr.
3.	Dipidolor (pyritramide)	Solution for injection, ampoules 0.75%, 2 ml	210 amp.
4.	Morphine sulfate (MCT continus or other analogs with a duration of at least 12 hours)	Extended-release tablets for oral administration
		10 mg	120 tab.
		30 mg	40 tab.
		60 mg	20 tab.
		100 mg	12 tab.
		200 mg	16 tab. in total<*>- 6.0 gr.
5.	Morphine hydrochloride	Oral tablets
		10 mg	63 tab.
			63 ampoules in total<*>- 1.26 gr.
6.	Omnopon	Injection,
		ampoules 1%, 1 ml	60 ampoules
		ampoules 2%, 1 ml	30 ampoules in total<*>- 1.2 gr.
7.	Promedol (trimeperidine hydrochloride)	Injection,
		ampoules 1%, 1 ml	40 ampoules
		ampoules 2%, 1 ml	20 ampoules
		Oral tablets
		25 mg	126 tab. in total<*>- 4.95 gr.
8.	Prosidol	Literal pills
		10 mg	765 tab.
		20 mg	382.5 tab.
		25 mg	306 tab.
		Solution for injection, ampoules 10 mg in 1 ml	191.3 amp. in total<*>- 24.86 gr.
9.	Fentanyl - transdermal dosage form	Patch
		25 mcg / hour	7.5 layer
		50 mcg / hour	3.75 reservoir
		75 mcg / hour	2.5 layer
		100 mcg / hour	1.9 reservoir
			For medicinal purposes, the patch is not subject to crushing in total<*>- 750 mcg / hour

<*>In terms of pure active ingredient.

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

Chairperson
The Standing Committee
drug control
E.A. BABAYAN

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

Appendix 4
APPROVED BY
By 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 - Abolished. (as amended by the Order of the Ministry of Health and Social Development of the Russian Federation of November 17, 2010 N 1008n)

APPROVED BY
By order of the Ministry
health care
Russian Federation
dated November 12, 1997 N 330

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 Russian legislation, Federal Law No. 323-FZ of 21.11.2011 “On the Basics of Health Protection of Citizens in the Russian Federation” defines the norms governing the foundations of the organization of medical nutrition.

Table 3. Documents on the implementation of the main directions of the order of the Ministry of Health of Russia dated 5.08.2003 No. 330

Organization of medical nutrition at the federal level

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

Federal Law of November 21, 2011 No. 323-FZ "On the Fundamentals of Health Protection 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 ..

Order of the Ministry of Health and Social Development of Russia dated June 24, 2010 No. 474n "On approval of the Procedure for the provision of medical care to the population in the" dietology "profile. The order is a regulatory document that defines the principles, procedure and system for organizing medical nutrition in the territory of the Russian Federation.

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

Regulatory documents, the names of which are presented in table. 1, currently operate throughout the territory of our country and are mandatory for medical organizations in the organization of medical nutrition.

The organization of therapeutic and prophylactic nutrition for patients in inpatient treatment must be carried out in all medical organizations with round-the-clock beds and day beds with meals, sanatoriums in accordance with Order of the Ministry of Health of Russia dated 5.08.2003 No. 330 "On measures to improve medical nutrition in medical institutions of the Russian Federation."

The documents approved by this order are mandatory for use in organizing the food system, document circulation, accounting for the consumption of food, the appointment of medical 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 medical nutrition in medical institutions. It defines the following norms for the organization of medical nutrition:

Characteristics, chemical composition and energy value of standard diets used in health care facilities (in hospitals, etc.).
The ratio of natural food and specialized food in the patient's daily diet.
Interchangeability of products in the preparation of dietary meals.
Substitution of products for proteins and carbohydrates.
The procedure for discharging food for patients in medical institutions.
The order of control over the quality of finished food in a medical and preventive institution.
Recommendations for the equipment of catering and canteens.
Transportation of prepared food.
Sanitary and hygienic regime of the catering unit and pantries.
List of catering unit documentation for the discharge of foodniya and control over the quality of finished food in medical institutions.

In connection with the release of Order No. 330, the previously used standards by the ratio of the chemical composition of diets, food interchangeability and food substitution cannot be used in medical facilities... For the first time, a federal departmental order introduced a uniform nomenclature of standard diets for all medical institutions.

Instructions on the organization of enteral nutrition in medical institutions are also mandatory. In order to standardize the conduct 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 eating disorders;
observation card of a patient receiving enteral nutrition (insert in the medical card of an inpatient, registration form 003 / U);
method for determining the energy needs of the body;
selection 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 some diseases;
methods of administration of enteral nutritional mixtures.

Federal Departmental Order of the Ministry of Health of the USSR dated 05.05.1983 No. 530 "On approval of instructions for accounting for food products in treatment-and-prophylactic and other health care institutions funded by 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 5.08.2003 No. 330 "On measures to improve medical nutrition in medical institutions of the Russian Federation", a system of accounting and document circulation was approved. It is necessary to maintain documentation in accordance with the requirements of these orders, since it is not only a system for recording patients supplied to meals, but also a system for spending food, monitoring the spending of financial resources.

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

Documentation intended for the statement of food products and accounting, the appropriations issued for them.
Documents reflecting the control over the health of the catering department employees.
Diet service organization documentation (production documentation).

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

"On the basics of protecting the health of citizens in the Russian Federation" Ch. 5 "Organization of health protection" Art. 39 "Health food":

"one. Therapeutic nutrition is nutrition that satisfies 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 main and concomitant diseases, and fulfills preventive and therapeutic tasks. "

Federal Law of November 21, 2011 No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation" Ch. 5 "Organization of health protection" Art. 39 "Medical nutrition": "The norms of medical nutrition are approved by the authorized federal executive body."

Table 1. Normative legal documents that are mandatory for medical organizations in the organization of medical nutrition

Normative legal document	Nutritional norms
Order of the Ministry of Health of Russia dated 5.08.2003 No. 330 "On measures to improve medical nutrition in medical and preventive institutions of the Russian Federation" (registered in the Ministry of Justice of Russia on September 12, 2003 No. 5073) as amended by orders of the Ministry of Health and Social Development of Russia dated October 7, 2005 No. 624 (registered in the Ministry of Justice of Russia on November 1, 2005, No. 7134), dated January 10, 2006, No. 2 (registered in the RF Ministry of Justice on January 24, 2006, No. 7411) and dated April 26, 2006, No. 316 (registered in the Ministry of Justice of Russia on May 26, 2006, No. 7878).	Average daily set of products for one patient in medical institutions. Average daily food packages for children undergoing treatment in sanatorium-resort institutions of various profiles (except for tuberculosis). Average daily set of products for adults undergoing sanatorium treatment. Average daily food packages for children affected by radiation exposure, being treated in sanatorium-resort institutions of various profiles (except for tuberculosis).
Order of the USSR Ministry of Health of 03/10/1986 No. 333 "On improving the organization of medical nutrition in maternity hospitals (departments) and children's hospitals (departments)". The text of the order has not been officially published. The revised nutritional norms for patients have been agreed with the USSR Ministry of Finance (letter from the USSR Ministry of Finance dated 12.09.85 No. 23-2-10 / 11).	The food rate for patients in maternity hospitals (departments) and children's hospitals (departments) per patient per day in grams.
Order of the Ministry of Healthcare of the Russian Federation of 05/06/1995 No. 122 "On measures to improve the operation of hospitals for war veterans." The text of the order has not been officially published.	The average daily set of food products for patients being treated in hospitals (departments of multidisciplinary hospitals) for war veterans.
Orders of the Ministry of Health of the USSR No. 530 dated 05.05.1983 “On Approval of Instructions for the Accounting of Food Products in Medical and Prophylactic and Other Healthcare Institutions Funded by the State Budget of the USSR” (as amended on 05.17.1984, 12.30.1987).	Unified food accounting system in a medical institution.

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

The main reporting forms that are drawn up to provide food for patients admitted to the hospital refer to the documents of the first group.

The main document in this group is a card index of dietary dishes (see details about this document in the article "Specialized card index of dietary dishes", PD No. 1, or on the website www .. documents containing information on 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 main and concomitant diseases. the patient during the day, plan the work of the catering unit, facilitate the implementation of organizational measures, calculate the consumption of products and the allocations allocated for them.

Seven day summary menu

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

It is recommended to have two menus - autumn-summer and winter-spring, since the assortment of products changes depending on the season, 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 on Health Nutrition.

The number of diets and their set should be individual for each institution and adapted to its profile. When drawing up the menu, it is very important to take into account the high-quality variety of dishes throughout the day and 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 the diets, their energy value, the correct use of natural food norms, the consumption of appropriations 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 appropriate 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 kept in the accounting department, and the second - by the dietary nurse.

Each layout card contains the following data: 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.

Nomenclature of diets

Standard diets 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 foods used as the main therapeutic diets, and 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 food products from the therapeutic diet; they 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 protein composite dry mixtures.

There is another type of diet - individual diets... They are assigned to a specific patient, whose condition requires the exclusion of certain food products from the diet. If he has a decrease in body mass index below the standard indicators, 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 medical institution without fail refer to accounting and reporting documents. At present, in medical institutions, in order to optimize work, automated workflow systems are being introduced, which ensure the introduction of scientifically grounded principles of dietetics.

Information about the presence of patients, for meals, are submitted in the form of Form No. 22 in accordance with Order No. 330 dated 05.08.2003. This form is the basis for the planning and distribution of patients according to diets and meals.

The main legal document on the basis of which food is issued from the warehouse to the food processing unit for cooking and the 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 an accounting employee, who calculates the total amount of all products required to prepare all dishes for their discharge from the warehouse.

Requirement for the issuance of products(Form No. 45-M3, Order No. 330 dated 05.08.2003). This document is drawn up in duplicate. One copy remains after the delivery 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 pantry for a daily supply. The production manager (chef) bears full financial responsibility for them. The next day, he distributes food to the cooks 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.

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

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

Form No. 23-MZ "Handout sheet for dispensing to food ration departments"(food intake: breakfast, lunch, dinner, etc.). This document serves as the basis for issuing ready-made meals to hospital departments.

It is recommended to hang the menu at the entrance to the dining room so that patients can familiarize themselves with it. Those responsible for the organization of nutritional therapy 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 in the past month. The accountant must prepare it by the 10th day of the next month and submit it to the dietitian or the person responsible for the organization of therapeutic nutrition for the analysis of the fulfillment of natural food norms. By the 15th day, the nutritionist or the person responsible for the organization of medical nutrition is obliged to inform the chief physician about the state of compliance with food standards and, if there are any deficiencies, take measures to eliminate them.

Second group documentation. Documents reflecting the control over the health status of the employees of the catering department

The documents reflecting the control over the health status of the employees of the catering department belong to the second group of documents on the organization of medical nutrition.

Each of the employees of the catering unit must have:

"Personal medical record book of the catering unit worker" (form No. 1-лп, order No. 330 dated 05.08.2003).
"Journal of Medical Research". This journal is kept by a dietetic nurse, who is obliged to monitor the timeliness of medical research by all employees of the catering department.
Journal "Health" (form No. 2-lp, order No. 330 dated 05.08.2003). The latter is maintained daily by a dietetic nurse.

Third group documentation. Diet Service Organization Documentation (Manufacturing Documentation)

Diet service organization documentation (production documentation):

Employee time sheet.
Staff work schedules for a month in advance.
A book (or folder) of orders and instructions, where instructions from higher health authorities and guidelines for the organization of therapeutic nutrition should be carefully stored in the appropriate order.
Safety briefing log.
Evaluation log for ready meals (rejection).
The journal of the marriage of products and food raw materials entering the food block.
Journal of C-vitaminization of food.
Folder of chemical analyzes of ready meals.
Perishable food magazine.
Warehouse book, form No. M-17 (order of the Ministry of Health of the USSR No. 530 dated 05/05/1983).
Administrative traversal log.
Sanitary journal.

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

The need for GOSTs

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

Federal Law of December 27, 2002 No. 184-FZ "On Technical Regulation" defined the principles of standardization in the Russian Federation, established 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"). This document states that technical regulations, i.e. federal laws establishing safety requirements, are mandatory to apply 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 “Dietary (therapeutic and prophylactic) food products. Dry protein composite mixtures. General technical conditions ", approved by the order of the Federal Agency for Technical Regulation and Metrology dated September 7, 2010 No. 219-st, determined the basic requirements for specialized products intended for dietary (therapeutic and prophylactic) nutrition of adults and children over three years of age as a protein component for preparing ready-made meals.

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SanPiNs and regulations

A number of documents that determine the requirements for both premises, production processes, and food products are represented by sanitary rules and norms approved by the chief sanitary doctor of the Russian Federation. Here are some of them:

Resolution of the Chief State Sanitary Doctor of the Russian Federation of 05.05.2003 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 January 17, 2005, as amended on June 27, 2008) "Organization of baby food", 2.3.2 "Food raw materials and food products".
Sanitary and epidemiological rules and standards SanPiN2.3.2.1324-03 "Hygienic requirements for the shelf life and storage conditions of food".
Resolution of the Chief State Sanitary Doctor of the Russian Federation of March 5, 2004 No. 9 "On additional measures to prevent diseases caused by micronutrient deficiency."

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

Federal Law of December 27, 2002 No. 184-FZ "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 regulations - 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 by decree of the President of the Russian Federation , or by a decree of the Government of the Russian Federation, or a normative legal act of the federal executive body for technical regulation, and establishes requirements for the objects of technical regulation (products or for products and design processes related to product requirements [including surveys], production , construction, installation, adjustment, operation, storage, transportation, sale and disposal) ".

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

At the level of a constituent entity 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 the therapeutic nutrition system in the region, the health authorities may issue local acts, the main criterion for which is the possibility of expanding the regulatory documents in force in the territory of 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 Basics of Health Protection of Citizens in the Russian Federation" By Order of the Government of the Russian Federation No. 1873-r dated October 25, 2010 "On Approval of the Fundamentals of State Policy of the Russian Federation in the Field of Healthy Nutrition of the Population for the Period until 2020 G." it was recommended that the executive authorities of the constituent entities of the Russian Federation, when formulating and implementing regional programs of socio-economic development, take into account the provisions of the "Fundamentals of State Policy of the Russian Federation in the Field of Healthy Nutrition of the Population for the Period until 2020".

Decree of the President of the Russian Federation dated May 7, 2012 No. 598 "On improving the state policy in the field 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 ".

For the implementation of the specified 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 prophylactic) nutrition, standardize the average daily food sets and a seven-day menu in medical organizations in Moscow, the Department Healthcare of Moscow issued Order No. 1851 dated 23.12.2011 "On improving the organization of dietary (therapeutic and preventive) nutrition", as well as a number of methodological recommendations "Card file of dietary (medical and preventive) nutrition with an optimized composition for children", which regulates the algorithm for organizing dietary (therapeutic and prophylactic) 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 development of the Research Institute of Nutrition of the Russian Academy of Medical Sciences, optimized average daily sets of products are given. Thanks to the measures taken, the unification of the requirements for the organization of dietary (therapeutic and prophylactic) nutrition, the standardization of the average daily food sets and the seven-day menu in medical organizations in Moscow, heads of medical institutions can reasonably and effectively spend financial resources. In addition, it became necessary to introduce in the work of the health department non-departmental control over the expenditure of funds for medical nutrition and the quality of the diet in medical institutions.

In some constituent entities of the Russian Federation, documents have been developed for the implementation of the main directions of the Order of the Ministry of Health of Russia dated 5.08.2003 No. 330 "On measures to improve medical nutrition in medical and preventive institutions of the Russian Federation" in accordance with the Order of providing medical assistance to the population on the profile "dietetics "(See Table 3). The full texts of the documents presented in the table can be found on the website www ..

As an example of the introduction of standardization of the system of therapeutic and prophylactic nutrition, one can present an information letter from the Ministry of Health of the Territorial Fund for Compulsory Medical Insurance of the Saratov Region on September 19, 2010 No. 1103-17 / 3146, No. 4529, addressed to the heads of government bodies and health care institutions. The document is presented in the form of methodological recommendations "Standards for the organization of medical nutrition" for the organization of nutrition by clinical and statistical groups of diseases. Clinical-statistical groups include nosological forms, grouped in a set of clinical, laboratory and instrumental diagnostic signs, which made it possible to identify diseases (poisoning, trauma, physiological state) related to a group of conditions with a common etiology and pathogenesis, clinical manifestations, general approaches to treatment and correction (see the text of the document on the website www .. It is recommended to prescribe therapeutic nutrition to patients, depending on the following factors:

Clinical features of the disease:
- clinical and statistical group of the disease;
- stage (phase) of the disease of a particular patient;
- a certain clinical situation;
- existing complications of the disease.
Physical indicators of the ratio of the patient's weight and body, 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 products per os, the presence of a gastrostomy, enterostomy.

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

The implementation of all stages of standardization is possible with the establishment of standards for the implementation of each specific stage of work. The use of standards allows patients to be guaranteed the safety, effectiveness, compatibility and consistency of the medical services provided to them. In general, the standards should ensure that the medical service meets the required level of quality requirements.

In order to form unified approaches to standardization in dietetics, it is recommended to define unified standardization objects at the level of the constituent entity of the Federation:

technologies for organizing food in medical institutions: types, production processes, food products used for a particular type of food;

technical support for the implementation of dietary nutritional diets;
quality of food;
the qualifications of medical personnel involved in catering;
production, terms of sale, quality of food;
accounting and reporting documentation used in the dietetics system;
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 5.08.2003 No. 330

Regional government bodies of the Russian Federation	Document
Ministry of Health of the Orenburg Region	Order No. 338 of 12/30/2010. Information letter No. 11- l-49/1594 dated 01.12.2008.
Ministry of Health and Social Development of the Chuvash Republic	Information letter No. 03 / 19-7658 dated 27.07.2012.
Ministry of Health of the Republic of Bashkortostan	Order of the Ministry of Health of the Republic of Belarus dated February 28, 2006 No. 122-D "On the organization of medical nutrition in medical institutions." 2. Order of the Ministry of Health of the Republic of Belarus dated 20.12.2010 No. 2813-D "On the recommended average daily food sets for one patient undergoing inpatient treatment in medical institutions of the Republic of Bashkortostan."
Ministry of Health of the Chelyabinsk Region	Order of the Ministry of Health of the Chelyabinsk Region No. 1155 of 23.10.2009 "On the approval of the clinical and organizational guidelines for doctors to provide medical care to the population of the Chelyabinsk Region."

At the healthcare facility level

In medical and prophylactic institutions, the system of organizing therapeutic and prophylactic nutrition should be based on the requirements imposed at the federal level and at the level of the constituent entity of the Federation.

At the same time, when organizing medical nutrition directly in a medical institution, various types of medical 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 administered by a dietitian physician. The technology of implementation is associated with the appointment of a certain diet to the patient in accordance with the approved nomenclature of diets. 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 the preparation of dishes, including dietary products, specialized (mixtures of protein composite dry) and baby food, is the basis for the formation of a medical nutrition system 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 delivered by a nutritional support team. In its absence, this task falls on doctors, as a rule, resuscitators specializing in nutritional support, and on nurses of departments trained in the use of enteral mixtures (as well as other specialists involved in the organization of enteral nutrition). The technology for organizing and carrying out 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 5.08.2003 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 provide the body's energy and plastic needs in a natural way in a number of diseases. Discharge 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 observation card of a patient receiving enteral nutrition (insert in the medical card of an inpatient, registration form No. 003 / U).

The purchase of enteral mixtures is carried out in accordance with article No. 340 of the economic classification of expenses 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 full enteral nutrition, the patient should be removed from nutrition; during partial enteral nutrition, the patient should be removed from those meals that are replaced by enteral mixtures. Information about this must be entered in the patient's medical history and transferred to the catering unit.

Parenteral nutrition is organized and carried out by the nutrition support team, resuscitation doctors, as a rule, in the intensive care and intensive care units (wards). Parenteral nutritional mixtures are drugs and are classified as drug therapy. When carrying out full parenteral nutrition, the patient should be removed from nutrition. This information should be recorded in the patient's medical history.

Enteral and parenteral nutrition refers to artificial types of nutrition that are used only for medical reasons when it is impossible to adequately provide the body's energy and plastic needs in a natural way for a number of diseases and are presented in a number of reference books and recommendations for providing 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 intake 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 of regulatory support for the implementation of federal legislation in the organization of medical nutrition in medical institutions;
standard for the range of services and work in the organization of catering in medical institutions;
quality standard of medical nutrition;
the standard of prescribing therapeutic diets;
the standard of requirements for the organization of medical nutrition in inpatient medical and prophylactic institutions;
standards for the organization of medical nutrition for various clinical and statistical groups of patients;
standard for expert assessment of catering in health care facilities.

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

For the organization of effective and high-quality medical nutrition, which is part of the complex therapy of the patient, it is necessary to organize a Council for Medical Nutrition at the institution. Despite the fact that it is an advisory body, its main tasks are control over the quality of medical nutrition and the introduction of new technologies for medical nutrition. The Council for Medical Nutrition not only approves the nomenclature of diets, specialized dietary food products (mixtures of protein composite dry), mixtures for enteral nutrition, biologically active additives to be introduced in this institution, but also conducts an intradepartmental examination of the usefulness and effectiveness of medical nutrition. The Council also monitors the effectiveness of the introduction of new technologies for therapeutic nutrition.

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

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

List of works	Implementation activities
Preparation of regulatory documents for catering	Preparation of an order for the organization of dietary meals. Organization of the work of the Council for Medical Nutrition.
Carrying out work on the purchase of food	Carrying out works on the purchase of natural food products. Carrying out work on the purchase of specialized food products (mixtures of protein composite dry).
Carrying out work on the provision and renovation of the catering unit and pantry equipment	Carrying out work to provide equipment: technological mechanical; technological thermal; non-mechanized; technological refrigeration; for catering.

Application of specialized products

The patient's nutrition is the basis for restoring protein losses that occur during illness, adapting to changing metabolic conditions, and also remains a fairly effective therapeutic agent and in some cases has a decisive influence on the course and outcome of the disease.

On February 3, 2005, the Ministry of Health and Social Development of Russia approved guidelines for the organization of medical nutrition in medical institutions. Currently, the so-called specialized food products have entered the composition of dietary products. Mixtures containing the main macro- and micronutrients in optimal proportions or in the amount required to correct the main components of food can be used as specialized products of medical nutrition in medical institutions.

Specialized health food products are specially formulated foods for the nutrition of sick people with the aim of enriching diets or replacing conventional foods that are medically restricted or prohibited.

At present, in most medical institutions of the Russian Federation, the technology of protein correction of therapeutic diets has been introduced in order to increase the nutritional and biological value of diets. Nutritionists often have one of the most difficult questions in the process of practical implementation of protein correction of therapeutic diets: what specialized food products can be used to be included in dietary meals during protein correction? The answer to this question is quite simple: the selected products must comply with the requirements of GOST R 53861-2010, and there must be appropriate certification and quality documents for it.

A separate issue in the organization of medical nutrition is the availability in the hospital of specialized medical food products intended for the nutrition of patients with hereditary metabolic disorders (for example, with phenylketonuria or lactase deficiency). In the composition of such products, either the number of substances intolerable by the body is limited, or they are not there at all. So, with phenylketonuria, the amino acid phenylalanine is completely excluded from the diet, which is perceived by the body as a poison due to a defect in the enzyme system. That is why there are specialized health food products for children suffering from phenylketonuria, galactosemia, celiac disease.

Order of the Ministry of Health and Social Development of Russia dated 09.01.2007 No. 1 "On approval of the list of medical devices and specialized products of medical nutrition ..." the List of specialized health food products for disabled children was approved. This list includes specialized health food products:

without phenylalanine for disabled children suffering from phenylketonuria, according to age standards;
free of lactose and galactose for disabled children suffering from galactosemia, according to age standards;
gluten free for disabled children with celiac disease, according to age standards.

Currently, within the framework of the Unified Sanitary Rules of the EurAsEC Customs Union, specialized food products are defined as subject to mandatory state registration, including baby food, food for pregnant and lactating women, dietary (therapeutic and prophylactic) food, food for athletes. Among the documents of the customs union that regulate the issues of specialized nutrition, it is necessary to highlight the Decision of the Customs Union Commission dated May 28, 2010 No. 299 "On the application of sanitary measures in the customs union", which defines a list of specialized products for medical nutrition for children.

The use of specialized food products opens up great opportunities for organizing therapeutic and prophylactic nutrition. With the help of rationally constructed diets, an increase in the general stability of the body is ensured, the use of the properties of food components, their protective effect on the structure and function of the most affected organs, compensation for excessively consumed food and biologically active substances in connection with diseases.

Federal Law of 21.11.2011 No. 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation" Ch. 5 "Organization of health protection" Art. 39 "Health food":

"3. Specialized products of medical nutrition are food products with an established chemical composition, energy value and physical properties, proven therapeutic effect, which have a specific effect on the restoration of disturbed or lost body functions as a result of disease, prevention of these disorders, as well as on increasing the adaptive capabilities of the body. "

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

With changes and additions from:

On 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-VS

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 Until 2005, approved by Decree of the Government of the Russian Federation dated 10.08.1998 N 917 *, to improve the organization of medical nutrition and to increase the effectiveness of its application in the complex treatment of patients, I order:

1.1. Regulations on the organization of the activity of a dietitian (Appendix No. 1);

1.2. Regulations on the organization of the activities of a dietetic nurse (Appendix No. 2);

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

1.4. Instructions for the organization of medical nutrition in medical institutions (Appendix No. 4);

1.5. Instructions for the organization of enteral nutrition in medical institutions (Appendix No. 5);

2. Control over the implementation of this order shall be entrusted to the Deputy Minister RA Khalfin.

Order 330 on nutritional therapy

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ABOUT IMPROVEMENT MEASURES
MEDICAL NUTRITION IN MEDICAL 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 Until 2005, approved by the Decree of the Government of the Russian Federation dated 10.08.1998 No. 917 *, to improve the organization of medical nutrition and increase the effectiveness of its application in the complex treatment of patients, I order:

———————————
* Collected Legislation of the Russian Federation, 08.24.1998, No. 8, Art. 4083.

a. Regulations on the organization of the activity of a dietitian (Appendix No. 1);
b. Regulations on the organization of the activities of a dietetic nurse (Appendix No. 2);
c. Regulations on the Council for Medical Nutrition in Medical and Prophylactic Institutions (Appendix No. 3);
d. Instruction on the organization of medical nutrition in medical institutions (Appendix No. 4);
e. Instructions for the organization of enteral nutrition in medical institutions (Appendix No. 5).

2. Control over the implementation of this Order shall be entrusted to the Deputy Minister R.A. Khalfina.

The minister
Yu.L. Shevchenko

Appendix No. 1
Approved by
By order of the Ministry
health care
Russian Federation
dated 05.08.2003 No. 330

POSITION
ABOUT THE ORGANIZATION OF ACTIVITIES OF THE DIET STUDENT

The position of a dietitian is a specialist doctor who is trained in nutritional therapy and a certificate in dietetics.

The nutritionist is responsible for the organization of nutritional therapy and its adequate use in all departments of health care institutions.

Nutritionist supervises dietary nurses, supervises the work of the catering department.

The dietitian is obliged to:

advise department doctors on the organization of medical nutrition;

to advise patients on the issues of therapeutic and rational nutrition;

conduct a random check of medical records according to the compliance of the prescribed diets and the stages of diet therapy;

analyze the effectiveness of medical nutrition;

monitor the correctness of the bookmark of products when preparing dishes;

prepare documentation for the organization of medical nutrition:
- layout cards;
- seven-day menu;
- seven-day consolidated menu - summer and winter options;

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

to monitor the quality of finished food before issuing it to the departments by taking a sample at each meal;

together with the heads of departments, determine the list and number of food parcels at home for a patient being treated in a medical and preventive institution;

control the timeliness of preventive medical examinations of workers in the catering and canteens and prevent persons who have not undergone preventive medical examinations and patients with pustular, intestinal diseases, angina from working;

to organize systematically the improvement of the level of qualification of the catering department workers on the issues of medical nutrition;

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

to raise the level of professional qualifications in the cycles of improvement in dietetics at least once every 5 years.

Appendix No. 2
Approved by
By order of the Ministry
health care
Russian Federation
dated 05.08.2003 No. 330

POSITION
ABOUT ORGANIZATION OF MEDICAL ACTIVITIES
DIETARY SISTERS

The position of a dietetic nurse is a specialist with secondary medical education, who has special training in therapeutic nutrition and a certificate in the specialty "dietetics".

A dietary nurse works under the guidance of a dietitian.

The dietetic nurse monitors the work of the food unit and the observance of sanitary and hygienic rules by the food workers.

A dietary nurse is obliged:

check the quality of products when they arrive at the warehouse and catering unit; control the correct storage of food supplies;

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

monitor the correctness of the bookmark of products during cooking and waste the finished product, take a sample of the finished food;

control the correct delivery of dishes from the catering unit to the departments in accordance with the "distribution sheet";

exercise control over: the sanitary condition of the premises of the catering unit, dispensers, pantries, inventory, dishes, as well as the fulfillment of the rules of personal hygiene by the employees of the catering unit;

organize and personally participate in conducting classes with nurses and catering workers on the issues of medical nutrition;

keep medical records;

carry out timely preventive medical examinations of employees of the catering department, dispensers and pantries and prevent persons who have not undergone a preventive medical examination and patients with pustular, intestinal diseases, angina from working;

to raise the level of professional training at least once every 5 years.

Appendix No. 3
Approved by
By order of the Ministry
health care
Russian Federation
dated 05.08.2003 No. 330

POSITION
ABOUT NUTRITIONAL HEALING ADVICE
MEDICAL AND PREVENTIVE INSTITUTIONS

(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation of 26.04.2006 No. 316)

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

The number of members of the Council for Medical Nutrition and its personal composition is approved by the order of the chief physician of the institution.

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

Tasks of the Nutritional Health Council:

improvement of the organization of medical nutrition in a medical and prophylactic institution;
introduction of new technologies for preventive, dietary and enteral nutrition;
approval of the nomenclature of diets, mixtures for enteral nutrition, protein composite dry 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 of 26.04.2006 No. 316)
approval of seven-day menus, a card index of meals and a set of mixtures for enteral nutrition;
improvement of the ordering system for dietary kits and mixtures for enteral nutrition;
development of forms and plans for professional development of employees in therapeutic nutrition;
control over the organization of medical nutrition and analysis of the effectiveness of diet therapy for various diseases.
The Nutritional Health Council meets as needed, but at least once every three months.

Appendix No. 4
Approved by
By order of the Ministry
health care
Russian Federation
dated 05.08.2003 N 330

INSTRUCTIONS
ON ORGANIZATION OF MEDICAL NUTRITION
IN MEDICAL AND PREVENTIVE INSTITUTIONS

as amended by 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)

The organization of medical nutrition in a medical and prophylactic 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, cooking technology and the average daily set of products.

Previously used diets of the numbered 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 basic standard diet and its variants in a health care facility, in accordance with their profile, the following are used:

surgical diets (0-I; 0-II; 0-III; 0-IV; diet for ulcerative bleeding, diet for stomach stenosis), etc.;
specialized diets: a high-protein diet with active tuberculosis (hereinafter referred to as a high-protein diet (s));
(the paragraph was introduced by the Order of the Ministry of Health and Social Development of the Russian Federation of April 26, 2006 No. 316)
unloading diets (tea, sugar, apple, rice-compote, potato, curd, juice, meat, etc.);
special diets (potassium, magnesium, probe diets, diets for myocardial infarction, diets for unloading and dietary therapy, vegetarian diet, etc.).

The individualization of the chemical composition and calorie content of standard diets is carried out by selecting the medical nutrition dishes available in the card index, increasing or decreasing the number of buffet products (bread, sugar, butter), controlling food parcels at home for patients undergoing treatment in a medical institution, as well as by use of biologically active food supplements and ready-made specialized mixtures in medical and enteral nutrition. To correct the diet, 20-50% 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 of January 10, 2006 No. 2)

Note:
The order of the Ministry of Finance of the Russian Federation of December 21, 2005 No. 152n became invalid on January 1, 2007 in connection with the publication of the Order of the Ministry of Finance of the Russian Federation of 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 of December 25, 2008 No. 145n.

The purchase of dry protein composite mixtures for therapeutic 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 of December 21, 2005 No. 152n (in accordance with the letter of the Ministry of Justice of the Russian Federation of January 10, 2006 No. N 01/32-ЕЗ The order does not need state registration) according to article 340 of the economic classification of expenses of the budgets of the Russian Federation "Increase in the cost of inventories" with the referral of ready-made specialized mixtures for therapeutic 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 of April 26, 2006 No. 316)

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

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

The control of the correctness of the diet therapy should be carried out by checking the compliance of the diets received by the patients (in terms of the range 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 - by the deputy for the medical part.

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

Subordinate to the dietitian are dietary nurses and all catering workers who provide medical nutrition in a medical and preventive institution in accordance with this Order.

At the catering unit of the medical and prophylactic institution, control over the compliance with the cooking technology and the output of ready-made dietary meals is carried out by the production manager (chef, chief cook), control over the quality of ready-made dietary meals is a dietitian doctor, a dietary nurse, a doctor on duty, authorizing the issuance of ready-made food in the compartments.

All issues related to the organization of medical nutrition in a medical and prophylactic institution are systematically (at least 1 time per quarter) heard and resolved at meetings of the Council for Medical Nutrition.

Table 1
to the Instructions for organizing
prevention facilities

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

www.santegra.spb.ru

By order of the Ministry of Health of Russia, the norms of medical nutrition are approved

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

According to the new standards in medical nutrition, the number of cereals for the preparation of soups, cereals, side dishes has been increased. There are more vegetables - cucumbers and tomatoes, as well as fermented milk products, coffee and cocoa.

The composition of the components for the preparation of dietary meals also includes protein composite dry mixes.

Approaches to the creation of dry protein composite mixtures and their formulation were developed back in the 70s of the last century by Academician A.A. Pokrovsky. These products are made on the basis of milk whey proteins with the inclusion of lecithin, polyunsaturated fatty acids, dietary fiber, vitamins and minerals, maltodextrin (a source of carbohydrates).
Dry protein composite mixtures 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 excessive 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 carried out for two years at the Research Institute of Nutrition of the Russian Academy of Medical Sciences, the Central Research Institute of Tuberculosis "RAMS, etc.
Dry protein composite mixtures are produced in accordance with GOST R 53861-2010 “Dietary (therapeutic and prophylactic) food products. Dry protein composite mixtures. General technical conditions ".
The mixtures are included in the State Register and are used as a component for the preparation of medical and preventive nutrition for children from 3 years of age and adults, and workers employed in jobs with harmful and especially harmful working conditions.
Dry protein composite 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 medical nutrition in treatment-and-prophylactic institutions of the Russian Federation ") with amendments as of April 26, 2006, introduced by orders of the Ministry of Health and Social Development of Russia No. 2 of January 10, 2006. and No. 316 dated 26.04.2006.

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 therapeutic nutrition.

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

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

www.rosminzdrav.ru

Organization of medical nutrition

Organization of medical nutrition at the federal level

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

Characteristics, chemical composition and energy value of standard diets used in health care facilities (in hospitals, etc.).
The ratio of natural food and specialized food in the patient's daily diet.
Interchangeability of products in the preparation of dietary meals.
Substitution of products for proteins and carbohydrates.
The procedure for discharging food for patients in medical institutions.
The order of control over the quality of finished food in a medical and preventive institution.
Recommendations for the equipment of catering and canteens.
Transportation of prepared food.
Sanitary and hygienic regime of the catering unit and pantries.
List of catering unit documentation for the discharge of foodniya and control over the quality of finished food in medical institutions.

indications for the use of enteral nutrition;
contraindications to the use of enteral nutrition;
assessment of eating disorders;
observation card of a patient receiving enteral nutrition (insert in the medical card of an inpatient, registration form 003 / U);
method for determining the energy needs of the body;
selection 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 some diseases;
methods of administration of enteral nutritional mixtures.

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

Documentation intended for the statement of food products and accounting, the appropriations issued for them.
Documents reflecting the control over the health of the catering department employees.
Diet service organization documentation (production documentation).

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

"On the basics of protecting the health of citizens in the Russian Federation" Ch. 5 "Organization of health protection" Art. 39 "Health food":

Table 1. Normative legal documents that are mandatory for medical organizations in the organization of medical nutrition

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

The main reporting forms that are drawn up to provide food for patients admitted to the hospital refer to the documents of the first group.

The main document in this group is a card index of dietary dishes (see the details of this document in the article "Specialized card index of dietary meals", PD No. 1, or on the website www.praktik-dietolog.ru in the section "To the taste of the patient"). Without a card index, it is impossible to correctly draw up a seven-day menu, a layout menu, that is, documents that provide information on satisfying 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 main and concomitant diseases. The card file is of particular importance in the correct organization of medical nutrition. If it is available, it is possible to calculate what the patient actually gets during the day, plan the work of the catering unit, facilitate the implementation of organizational measures, calculate the consumption of products and the appropriations allocated for them.

Seven day summary menu

It is recommended to have two menus - autumn-summer and winter-spring, since the assortment of products changes depending on the season, in addition, the percentage of waste is different for some products after cold treatment (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 on Health Nutrition.

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 kept in the accounting department, and the second - by the dietary nurse.

Nomenclature of diets

Standard diets 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 foods used as the main therapeutic diets, and the cooking technologies used.

Accounting and reporting documentation

Second group documentation. Documents reflecting the control over the health status of the employees of the catering department

The documents reflecting the control over the health status of the employees of the catering department belong to the second group of documents on the organization of medical nutrition.

Each of the employees of the catering unit must have:

"Personal medical record book of the catering unit worker" (form No. 1-лп, order No. 330 dated 05.08.2003).
"Journal of Medical Research". This journal is kept by a dietetic nurse, who is obliged to monitor the timeliness of medical research by all employees of the catering department.
Journal "Health" (form No. 2-lp, order No. 330 dated 05.08.2003). The latter is maintained daily by a dietetic nurse.

Third group documentation. Diet Service Organization Documentation (Manufacturing Documentation)

Diet service organization documentation (production documentation):

Employee time sheet.
Staff work schedules for a month in advance.
A book (or folder) of orders and instructions, where instructions from higher health authorities and guidelines for the organization of therapeutic nutrition should be carefully stored in the appropriate order.
Safety briefing log.
Evaluation log for ready meals (rejection).
The journal of the marriage of products and food raw materials entering the food block.
Journal of C-vitaminization of food.
Folder of chemical analyzes of ready meals.
Perishable food magazine.
Warehouse book, form No. M-17 (order of the Ministry of Health of the USSR No. 530 dated 05/05/1983).
Administrative traversal log.
Sanitary journal.

The need for GOSTs

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

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SanPiNs and regulations

Resolution of the Chief State Sanitary Doctor of the Russian Federation of 05.05.2003 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 January 17, 2005, as amended on June 27, 2008) "Organization of baby food", 2.3.2 "Food raw materials and food products".
Sanitary and epidemiological rules and standards SanPiN2.3.2.1324-03 "Hygienic requirements for the shelf life and storage conditions of food".
Resolution of the Chief State Sanitary Doctor of the Russian Federation of March 5, 2004 No. 9 "On additional measures to prevent diseases caused by micronutrient deficiency."

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

"Technical regulations - 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 by decree of the President of the Russian Federation , or by a decree of the Government of the Russian Federation, or a normative legal act of the federal executive body for technical regulation, and establishes the mandatory requirements for the application and execution of the objects of technical regulation (products or for products and design processes related to product requirements [including surveys], production , construction, installation, adjustment, operation, storage, transportation, sale and disposal) ".

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

At the level of a constituent entity of the Federation

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

Clinical features of the disease:
- clinical and statistical group of the disease;
- stage (phase) of the disease of a particular patient;
- a certain clinical situation;
- existing complications of the disease.
Physical indicators of the ratio of the patient's weight and body, 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 products per os, the presence of a gastrostomy, enterostomy.
  The process of standardization in dietetics means such actions as setting the rules and characteristics for the purpose of their repeated use, aimed at achieving orderliness in the work of the catering units of medical and preventive institutions, preparing dietary meals, prescribing and choosing the type of therapeutic diet and the quality of the medical food provided to the patient.
  
  The implementation of all stages of standardization is possible with the establishment of standards for the implementation of each specific stage of work. The use of standards allows patients to be guaranteed the safety, effectiveness, compatibility and consistency of the medical services provided to them. In general, the standards should ensure that the medical service meets the required level of quality requirements.
  
  In order to form unified approaches to standardization in dietetics, it is recommended to define unified standardization objects at the level of the constituent entity of the Federation:
  
  technologies for organizing food in medical institutions: types, production processes, food products used for a particular type of food;
- technical support for the implementation of dietary nutritional diets;
- quality of food;
- the qualifications of medical personnel involved in catering;
- production, terms of sale, quality of food;
- accounting and reporting documentation used in the dietetics system;
- economic aspects of standardization, food procurement system, personalized accounting.
- standard of regulatory support for the implementation of federal legislation in the organization of medical nutrition in medical institutions;
- standard for the range of services and work in the organization of catering in medical institutions;
- quality standard of medical nutrition;
- the standard of prescribing therapeutic diets;
- the standard of requirements for the organization of medical nutrition in inpatient medical and prophylactic institutions;
- standards for the organization of medical nutrition for various clinical and statistical groups of patients;
- standard for expert assessment of catering in health care facilities.