330 order of the norm of therapeutic nutrition. Organization of medical nutrition. Seven Day Consolidated Menu

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

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

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

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

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

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

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

www.rosminzdrav.ru

330 order of the Ministry of Health

MEDICINE AND LAW

HERE COULD BE

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

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

Administration note: change to paragraph 1.

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

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

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

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

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

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

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

Administration note: changes to paragraph 7.

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

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

Administration note: changes to paragraph 9.

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

Administration note: changes to paragraph 10.

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

Administration note: new wording of paragraph 11.

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

Administration note: changes to paragraph 12.

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

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

Head of Organization Department

Providing medicines and

drug control committee

Name of the pharmacy warehouse (base)

accounting of narcotic drugs in pharmacy warehouses (bases)

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

Product name ______________________________________________

Unit of measurement __________________________________________________

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"Health", N 3, 1998

ORDER of the Ministry of Health of the Russian Federation of November 12, 1997 N 330 "ON MEASURES TO IMPROVE ACCOUNTING, STORAGE, PRESCRIBING AND USE OF NARCOTIC MEDICINES"

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

1. Put into action:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

- with technical documentation for products;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3.6. When the mains supply is switched off, the control panel, sensors and annunciators of one of the signaling lines must be operational. If there are no telephone lines in the storage facilities, it is necessary to use HF sealing of free distribution network lines, telephone lines of organizations, citizens' apartments located near the storage facility, or payphone lines.

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

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

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

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

4. Compliance with the provisions of these Standard requirements is mandatory when obtaining permission from the Standing Committee on Narcotics Control to possess narcotic drugs.

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

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

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

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

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ABOUT IMPROVEMENT MEASURES

THERAPEUTIC NUTRITION IN THERAPEUTIC AND PREVENTIVE

INSTITUTIONS OF THE RUSSIAN FEDERATION

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

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

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

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

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

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

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

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

ABOUT THE ORGANIZATION OF THE ACTIVITIES OF A NUTRITIONAL DOCTOR

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

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

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

4. A dietitian must:

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

b) advise patients on therapeutic and rational nutrition;

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

d) analyze the effectiveness of therapeutic nutrition;

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

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

g) prepare documentation on the organization of medical nutrition:

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

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

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

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

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

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

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

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

ON ORGANIZATION OF MEDICAL ACTIVITIES

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

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

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

4. The dietary nurse is obliged to:

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

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

c) monitor the correct laying of products during cooking and marriage finished products, carry out sampling of prepared food;

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

e) exercise control over: sanitary condition premises of the catering department, distributing, pantry, inventory, utensils, as well as for the fulfillment by employees of the catering department of the rules of personal hygiene;

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

g) maintain medical records;

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

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

dated 05.08.2003 N 330

ABOUT THE THERAPEUTIC NUTRITION COUNCIL

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

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

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

4. Tasks of the Council for Therapeutic Nutrition:

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

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

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

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

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

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

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

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

ON THE ORGANIZATION OF THERAPEUTIC FOOD

IN MEDICAL AND PREVENTIVE INSTITUTIONS

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

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

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

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

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

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

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

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

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

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

The nomenclature of permanent diets in each medical institution is established in accordance with its profile and approved by the Council for Clinical Nutrition. In all medical institutions, at least four meals a day are established, according to indications in separate departments or for certain categories patients (peptic ulcer of the 12 duodenal ulcer, disease of the operated stomach, diabetes mellitus, etc.) use more frequent meals. The diet is approved by the Therapeutic Nutrition Council.

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

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

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

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

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

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

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

to the Instructions for Organizing

CHEMICAL COMPOSITION AND ENERGY

THE VALUE OF STANDARD DIETS USED IN HOSPITALS

MINISTRY OF HEALTH CARE
Khabarovsk Territory

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

I declare:

1. .

I order:

1. Heads of health authorities municipalities, medical and preventive institutions of the region:
1.1. To accept for execution the Order of the Ministry of Health of the Russian Federation of 05.08.2003 N 330 "On measures to improve nutrition in medical institutions of the Russian Federation", bring it to the attention of specialists of subordinate medical institutions.
1.2. Organize a seminar for medical workers of subordinate institutions to study the above Order before 10.06.2004.
1.3. Ensure the introduction of a new range of diets, use in therapeutic and enteral nutrition with individualization of the chemical composition and calorie content (standard diets, with mechanical and chemical sparing, with an increased amount of protein) reduction or increase in buffet products, biologically active food supplements (including soy products) , bread made from sprouted grains or with lamidan) and ready-made specialized mixtures.
1.4. staff vacant positions nutritionists.
1.5. To amend the existing Regulations on the Council for Clinical Nutrition, on the organization of the activities of a dietitian, a nurse in a dietary medical and preventive institution.
1.6. Submit an application to the Ministry of Health of the Territory on the need to conduct training on the basis of the Institute for Advanced Training of Health Professionals of the Ministry of Health of the Khabarovsk Territory for doctors and paramedical workers, to ensure that they are sent to specialized courses in the system of postgraduate education.
2. First Deputy Minister of Health of the Khabarovsk Territory Tropnikova V.M. to provide for in the programs of postgraduate training of medical workers the issues of organizing therapeutic nutrition in medical institutions.
3. To take into account the Order of the Ministry of Health of the Russian Federation of February 12, 2004 N 95 "On the cancellation of the order of April 23, 1985 N 540 and of June 14, 1989 N 369".
4. Information on the execution of this order must be submitted by 01.10.2004.
5. To impose control over the execution of this order on the Deputy Minister of Health of the Khabarovsk Territory A.Ya. Derkach.

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