330 order of the norm of medical nutrition. Organization of medical nutrition. Seven day summary menu

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. 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 making 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, which were carried out for two years at the Research Institute of Nutrition of the Russian Academy of Medical Sciences, Federal State Budgetary Institution 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».
Blends added to State Register and are used as a component for the preparation of medical and preventive nutrition for children from 3 years old and adults, and workers employed in work with harmful and especially harmful conditions labor.
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 medical institutions Russian Federation») With changes as of April 26, 2006, introduced by orders of the Ministry of Health and Social Development of Russia No. 2 dated 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. 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 the body to provide the necessary nutrients.

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

www.rosminzdrav.ru

330 order of the ministry of health

MEDICINE AND LAW

HERE MAY BE

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

1. Narcotic drugs, regardless of the dosage form, should be stored in warehouses (bases) that have permission from the Standing Committee on Drug Control (PCCN) to work with them. Premises for storing narcotic drugs must meet the current standard requirements for technical strength (Appendix 1).

Administration note: amendment of clause 1.

2. The room for storing narcotic drugs at the end of the work should be locked and sealed or sealed, and the keys, seal and seal should be kept by the person in charge of storing narcotic drugs.

H. Responsibility for organizing the correct storage, safety of narcotic drugs and special prescription forms rests 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 formalized by the order of the head of the warehouse (base) and special admission from the ATC authorities.

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

6. Narcotic drugs are dispensed from the warehouse (base) only in a sealed form, with a label indicating the sender, the name of the content and the analysis number attached to each package.

7. The release of narcotic drugs 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 written out separately from claims and invoices for other medicinal products, indicating the quantities in them in words.

Administration note: changes to clause 7.

8. The issuance of narcotic drugs is carried out under a separate power of attorney, drawn up in accordance with the established procedure, indicating the name of the funds received and the number of them 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, correct packaging and sign a copy of the invoice remaining in the warehouse (base).

Administration note: changes to clause 9.

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

Administration note: changes to clause 10.

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

Administration note: new version of clause 11.

12. All documents on the arrival and consumption of narcotic drugs in the warehouse (base) must be kept in a closed and sealed safe by the person responsible for their storage, in accordance with the established storage periods.

Administration note: changes to clause 12.

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

14. Transportation of narcotic drugs is carried out in accordance with current special rules.

Head of Organization Department

Provision of medicines and

drug control committee

Pharmacy warehouse (base) name

accounting of narcotic drugs in pharmacy warehouses (bases)

Note of the administration: The book of accounting of narcotic drugs in pharmacy warehouses (bases) is excluded.

Product name ______________________________________________

Unit of measurement __________________________________________________

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Federal legislation

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"Health", N 3, 1998

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

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

1. Put into operation:

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

- 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 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).

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

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

- Rules for 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 on the destruction of used ampoules of narcotic drugs (Appendix 10).

- 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 accounting, preservation, 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 prophylactic institutions with special prescription forms for narcotic drugs obtained from pharmacy warehouses (bases). The stock of special prescription forms for narcotic drugs in health authorities and medical and prophylactic institutions should not exceed the monthly requirement.

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 the established procedure for their prescription (Appendix 2). Strictly prohibit doctors from issuing, as well as writing out prescriptions for narcotic drugs to patients suffering from drug addiction.

2.4. To oblige the attending physicians to register the appointment and use of narcotic drugs with records in the medical history indicating the name of the drug dosage form, its amount and dosage.

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

3. The Standing Committee on Drug Control, heads of medical and prophylactic institutions, heads of research institutions, when determining the need for narcotic drugs, should be guided by the consumption rates of narcotic drugs (Appendix 9).

4. The heads of public 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 ... If facts of violation of the procedure for prescribing and admitting persons to work with narcotic drugs are revealed, the perpetrators are brought to strict liability in accordance with the legislation of the Russian Federation.

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

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" (Appendix 2 "Form a special prescription form for a narcotic drug ", Appendix 3" Norms of consumption of narcotic drugs ", 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 prophylactic institutions ", Appendix 5" Storage rules and accounting of narcotic drugs in self-supporting pharmacies ", Appendix 6" Rules for the storage and accounting of narcotic drugs and special prescription forms in medical and preventive institutions ", Appendix 7" Rules for the storage, accounting and dispensing of narcotic drugs and special recipes nourishing forms for narcotic drugs in pharmacy warehouses ", Appendix 8" Rules for the storage and accounting of narcotic drugs in control and analytical laboratories of pharmacy departments ", Appendix 9" Rules for the storage and accounting of narcotic drugs in research institutes, laboratories and educational institutions of the health care system " , Appendix 10 “Regulations on the disposal and destruction of narcotic drugs and special prescriptions not used by cancer patients”, Appendix 11 “Act on the destruction of used ampoules of narcotic drugs in health care institutions”).

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

Annex 1
APPROVED BY
By 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
Chairperson
The Standing Committee
drug control
E.A. BABAYAN
March 4, 1993

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

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

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

1.2. Commission examinations of drug storages are carried out by representatives of health authorities, security units, State Fire Control and other interested organizations. The Commission, on the basis of the current regulations and the available documentation, determines the places of concentration of narcotic drugs, selects the optimal option for protecting the facility with the help of signaling devices, taking into account its telephone installation and power supply. The survey identifies vulnerabilities in building structures (windows, doors, non-capital walls, ceilings, floors, ventilation openings, etc.), determines the number of security and fire loops, devices, detectors, sensors required to protect drug storage sites.

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

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

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

- VSN 25-09.68-85 “Rules for production and acceptance of works. Installation of security, fire and security - fire alarms ";

- 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, at least 510 mm thick, 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 diameter of rods of at least 10 mm and a mesh size of no more than 150 x 150 mm. The gratings are welded to anchors with a diameter of at least 12 mm released from the masonry of the wall or floor slabs with a pitch of 500 x 500 mm.

If it is impossible to mount anchors, it is allowed to shoot embedded parts from a steel strip with a size of 100 x 50 x 6 mm to reinforced concrete and concrete surfaces with four dowels.

2.3. Entrance doors storages of narcotic drugs must comply with the requirements of GOST 6629-88, GOST 24698-81, GOST 24584-81, GOST 14624-84, be serviceable, well fitted to the door frame, full-bodied, at least 40 mm thick, have at least two mortise non-self-locking locks ... Doors are upholstered on both sides with sheet metal 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 edge of the sheet with an overlap. The doorway from the inside is additionally protected by lattice metal doors made of steel bars with a diameter of at least 16 mm, 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 a 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 on the inside or between the frames are equipped with metal bars, which are made of steel rods with a diameter of at least 16 mm and the distance between the rods vertically and horizontally no more than 150 mm. The ends of the grating rods are embedded in the wall to a depth of at least 80 mm and poured with concrete.

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

2.5. Narcotic drugs should be kept in safes. In technically fortified premises, it is allowed to store drugs in metal cabinets. Safes (metal cabinets) must be closed. After the end of the working day, they must be sealed or sealed. The keys to the safes, the seal and the sealant must be kept with them by financially responsible persons authorized to do so by orders of health authorities or institutions.

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

3.2. The first line of alarm protects the building structures of the perimeters of the premises - window and door openings, ventilation ducts, thermal inputs and other elements of the room accessible for penetration from the outside. Doors are locked for "opening" and "break". Windows are protected by alarms for "opening" and "breaking" glass. Non-capital walls, ceilings, communication entry points - on the "break". Capital walls, ventilation ducts- on "destruction" and "impact".

It is recommended to block building structures for "opening" (windows, doors) with detectors of the SMK type; 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 a detector of the Gran-1 type, which allows detecting the destruction of building structures made of bricks of at least 150 mm and concrete with a thickness of at least 120 mm. Vulnerable areas of the perimeters of the premises can be protected by optical - electronic detectors such as "Foton-2", "Foton-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 premises, safes (metal cabinets) used for storing drugs. For additional security lines, the choice of detectors is determined depending on the nature of the premises and locations. material values in them. Ultrasonic, optical-electronic, radio wave, capacitive detectors "Echo-2,3", "Foton-1M, 4", "Kvant-3", "Volna-2, M", " Background-1 "," Rif-M "," Peak ", etc.

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

3.4. In multi-foreign protection systems, control and monitoring devices should be used to monitor alarm loops in the event of a power failure. The use of control and monitoring devices and detectors with autonomous power supply or units for switching to power from the centralized monitoring console via telephone lines in conjunction with object devices of the compaction equipment, which do not provide backup power, is impractical.

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

3.6. When the mains power supply is disconnected, the operability of the control panel, sensors and detectors of one of the alarm lines must be ensured. In the absence of telephone lines in the storages, it is necessary to use HF multiplexing of free lines of the distribution network, telephone lines of organizations, citizens' apartments located near the storage, or payphone lines.

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

3.8. Workplaces of personnel engaged in drug operations, as well as storage facilities, are equipped with alarms, which are designed to transmit alarm signals to the duty units of the internal affairs bodies and to take measures 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 general or independent blocking loops connected to general or independent devices with alarm signals output to centralized monitoring panels or local sound and light signaling devices.

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

4. Compliance with the provisions of these Typical requirements is mandatory upon obtaining permission from the Standing Committee on Drug Control for the possession of narcotic drugs.

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

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

CALCULATION STANDARDS FOR NARCOTIC DRUG NEEDS
PER 1000 POPULATION PER YEAR (IN GRAMS)

Order of the Ministry of Health of Russia dated 05.08.2003 N 330 (as amended on 24.11.2016) "On measures to improve medical nutrition in medical institutions of the Russian Federation" (together with the "Regulations on the organization of the activity of a nutritionist dietetic nurse "," Regulations on the Council for Medical Nutrition of Medical and Prophylactic Institutions "," Instructions for the Organization of Medical Nutrition in Medical Institutions ") (Registered in the Ministry of Justice of Russia 09/12/2003 N 5073)

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ABOUT IMPROVEMENT MEASURES

MEDICAL NUTRITION IN MEDICAL 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 Decree of the Government of the Russian Federation of 10.08.1998 N 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, N 8, Art. 4083.

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 R.А. Khalfina.

ABOUT THE ORGANIZATION OF ACTIVITIES OF THE DIET STUDENT

1. The position of a dietitian is a specialist doctor who is trained in therapeutic nutrition and a certificate in dietetics.

2. A dietitian is responsible for the organization of nutritional therapy and its adequate use in all departments of health care institutions.

3. The dietitian supervises the dietary nurses, supervises the work of the catering unit.

4. The dietitian must:

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

b) advise patients on therapeutic and rational nutrition;

c) conduct a random check of medical records for the compliance of the prescribed diets and the stages of diet therapy;

d) analyze the effectiveness of therapeutic nutrition;

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

f) exercise control over the correctness of the laying of products when preparing dishes;

g) prepare documentation for the organization of medical nutrition:

- seven-day consolidated menu - summer and winter options;

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

i) exercise control over the quality of finished 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 food parcels at home for a patient being treated in a medical and preventive institution;

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

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

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

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

ABOUT ORGANIZATION OF MEDICAL ACTIVITIES

1. A specialist with an average medical education with special training in therapeutic nutrition and a certificate in dietetics.

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

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

4. A dietetic nurse is obliged to:

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

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

c) monitor the correctness of the bookmark of products during cooking and rejection finished products, take a sample of finished food;

d) control the correct delivery 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 unit, distribution rooms, pantries, inventory, dishes, as well as the implementation of the rules of personal hygiene by the employees of the catering unit;

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

g) keep medical records;

h) to carry out timely preventive medical examinations of employees of the catering department, dispensers and pantries and not to allow persons who have not undergone a preventive medical examination and patients with pustular, intestinal diseases, sore throat to work;

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

dated 05.08.2003 N 330

ABOUT THE ADVICE ON HEALING NUTRITION

1. 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.

2. 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.

3. 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 nutritional 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.

4. Tasks of the Nutritional Health Council:

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

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

d) 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;

e) approval of seven-day menus, a card index 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 professional development of employees in therapeutic nutrition;

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

5. The Nutritional Medicine Council meets as needed, but at least once every three months.

ON ORGANIZATION OF MEDICAL NUTRITION

IN MEDICAL AND PREVENTIVE INSTITUTIONS

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

Along with the basic standard diet and its variants in the 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 (t));

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

- special diets (potassium, magnesium, probe diet, 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 home food parcels 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% of the protein of ready-made specialized mixtures can be included (Table 1a).

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 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 b 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 attribution of ready-made specialized mixtures for therapeutic nutrition to the section "food (payment for food), including food rations for military personnel and persons equated to them."

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

The recommended average daily food sets are the basis for the compilation 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 patients (in terms of the 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 - 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 prophylactic institution in accordance with this Order.

At the catering unit of a medical and prophylactic institution, control over the observance of the cooking technology and the output of ready-made dietary meals is carried out by the head of production (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.

to the Instructions for organizing

CHEMICAL COMPOSITION AND ENERGY

THE VALUE OF STANDARD DIETS USED IN HEALTHCARE

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 region

I declare:

1. .

I order:

1. Heads of health authorities municipalities, treatment-and-prophylactic 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. Equip vacancies 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 for 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 the organization of medical nutrition in medical and prophylactic 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.

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