CMS Revised Hospital CoP Dietary, CAH Dietary, DNV Healthcare and TJC Standards

Event Information
Product Format
Prerecorded Event
Sue Dill Calloway, RN, MSN, JD
90 minutes
Product Description

Learn About the New Changes in Dietary Guidelines for Hospitals and Critical Access Hospitals

The final new changes from CMS regarding the hospital CoPs is complex and confusing. In the final rule, the CMS has made 3 changes to the dietary guidelines for hospitals and rewrote all the dietary guidelines for critical access hospitals.

As per the new rule, the CMS will now permit the Medical Staff and Board to credential and privilege qualified dieticians and qualified nutritional specialist to order the patient’s diet. This includes therapeutic diet, supplemental feeding and enteral nutrition.

In this riveting session, Sue Dill Calloway, RN, MSN, JD will help you learn about the new regulations, and discuss the CMS hospital conditions of participation requirements for dietary and food and nutrition services.

CMS has issued a deficiency report, where the January 2015 memo showed that hospitals received 147 deficiencies in the dietary standards. This webinar will shed light on the common deficiencies received by hospitals from CMS, along with the top problematic ones.

Sue will also cover the Joint Commission provision of care chapter standards related to dietary and the TJC dietary tracer information. The tracer is used to assess and determine the degree of compliance with standards and elements of performance related to nutrition care. This webinar will also provide insights on the DNV Healthcare dietary standards.

Session Highlights:

CMS Food and Dietetic Services CoP Topics

  • 2015 final regulations on credentialing and privileging qualified dieticians and qualified nutritional specialist
    • C&P to order patient diets
    • Can be with or without appointment to the MS
    • State law and hospital policy
    • State scope of practice
    • Must be C&P by MS and board
  • How to obtain current copy of CoP manual
  • Ways to keep up with CMS changes
  • Changes and revisions in tag numbers
  • Organized dietary services
  • Requirement of director and qualified dietary staff
  • Meeting the nutritional needs of patients
  • Policies required
    • Diet manual availability, frequency of meals served, system for diet ordering and tray delivery, accommodation of non-routine occurrence, acceptable hygiene practices, kitchen sanitation etc.
  • Same standards whether or not by contracted services
  • Director who is full time and qualified
    • List of responsibilities to include in job description
    • Approve patient menus and nutritional supplements, patient dietary counseling, collaborating with other staff, maintaining patient data to recommend, prescribe, or modify therapeutic diets etc.
  • Policies and procedures include
    • Safety practices for food handling, emergency food supplies, orientation, work assignments, menu planning, purchasing of foods and supplies etc.
  • Survey procedure questions
  • Diets and menus to meet the needs of patients
  • Therapeutic diet and guidelines
  • Nutritional needs in accordance with recognized dietary practices
  • Current therapeutic diet manual approved by MS and dietician
  • CMS third revised hospital worksheet on infection control
  • Infection control important in dietary

TJC Provision of Care Standards related to Dietary

  • Nutritional Screen
  • Time frame for screens
  • Food and nutrition
  • Person responsible for food and nutrition services
  • Proper sanitation, temperature, etc of food and nutrition
  • What to do if patient refuses food
  • Accommodation of special diets
  • Accommodation of ethnic food and nutrition preferences
  • Storage of food and nutrition
  • Therapeutic diet manual
  • Patient education on nutritional interventions, diets, supplements

Topics Discussed Throughout the Patient Tracer Activity

  • Assessment, care planning
  • Instructions by qualified staff
  • Identification and nutrition risk
  • Nutrition screening criteria
  • Time frames for nutrition assessment and re-evaluation
  • Measuring food consumption
  • Special population needs such as NPO, on vents, in isolation, getting hyperalimentation
  • Procedure to follow if patient refuses meals
  • Discharge education and referrals
  • Communications between dietician and food services

Dietary and food services day to day operation information

  • Director of dietary qualifications
  • Responsibilities of dietary and food services leaders
  • Emergency/disaster plans
  • Hospital diets and menus
  • Food preparation and storage
  • Safe food handling and health of food service staff
  • Contracts for services, food, nutrition support supplies and formulas
  • Sanitation and infection control (pest control, chemicals)
  • Quality improvement activities etc.

DNV Healthcare Standards

CAH Dietary Standards (All new and revised)

Who Should Attend?

  • Dieticians
  • Director of dietary
  • Dietary staff
  • Joint Commission liaison or accreditation director DNV Healthcare
  • CMS or regulatory staff
  • Compliance officer
  • Chief Operating Officer
  • Chief Nursing Officer
  • Nurses and nurse managers
  • Nurse educator
  • Chief Medical Officer
  • Medical staff  and MS department staff
  • Anyone else responsible for complying with the CMS, DNV Healthcare or Joint Commission standards that affect dietary and nutrition services

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About Our Speaker

Sue Dill Calloway - Hospital Coding Expert

Sue Dill Calloway, RN, MSN, JD, is the president of Patient Safety and Healthcare Consulting and Education company with a focus on medical-legal education especially Joint Commission and the CMS hospital CoPs regulatory compliance. She also lectures on legal, risk management and patient safety issues. She was a director for risk management and patient safety for five years for the Doctors Company. She was the...   More Info
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