Standards › ASF Health Standards v10 › Standard 40
Standard 40
Nutrition and Dietetics
Nutrition and dietetics: qualified nutrition care, individual plans, malnutrition monitoring, texture matched to swallowing, and food safety..
Each criterion is shown in three settings: Humanitarian settings, Transition and fragile, and Standard. In standard settings, every criterion is Must.
Training colours: red means essential, green recommended, yellow optional. Each course shows its level for each setting: humanitarian, transition and fragile, and standard.
40.1Nutrition Care Is Provided by a Qualified Dietitian or Trained ClinicianHumanitarian settings: MustTransition and fragile: MustStandard: Must
Nutrition assessment and planning are carried out by a qualified dietitian, or by a clinician trained in nutrition, as recognised by the professional body. Scope of practice is defined.
Why it matters. Nutrition care needs the right skill. A qualified dietitian, or a clinician trained for the task, assesses and plans the diet, so that the plan is safe and effective.
How the surveyor verifies this criterion
Sample. Review nutrition assessment and plan records for 20 patients, and staff competence records for those who wrote them.
1. Nutrition assessment is carried out by a qualified dietitian or a trained clinician.
Method. Check each assessment for the author and their qualification.
Evidence to show. Nutrition care by qualified staff (NUT-POL-001).
Pass when. Every assessment is by a qualified or trained clinician.
2. The author’s qualification is on the competence register.
Method. Check each author against the register.
Evidence to show. Nutrition staff competence register (NUT-REG-001).
Pass when. Every author is on the register with a current qualification.
3. Dietitian input is recorded where the plan is complex.
Method. Check each complex case for the dietitian review entry.
Evidence to show. Individual nutrition plan record (NUT-FRM-001).
Pass when. Every complex case has dietitian input recorded.
Immediate fail (any one means the criterion is not met). A feeding plan written by an untrained aide with no dietitian input.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Maintains the Nutrition care by qualified staff | Must |
| Secretary (ISCO 3344) | Keeps the Nutrition staff competence register | Must |
| Nurse (ISCO 2221) | Completes the Individual nutrition plan record | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| NUT-REG-001 · Nutrition staff competence register | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| NUT-POL-001 · Nutrition care by qualified staff | Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Nutrition Care by Qualified Clinicians (NUT-01) | Manager; Nurse |
References
- Standards of proficiency: Dietitians (Health and Care Professions Council (UK), 2023 (effective 1 September 2023))
40.2Each Patient Has an Individual Nutrition PlanHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Each patient has a nutrition plan based on a documented assessment of their needs, including any diagnosis, allergy, intolerance, and cultural or religious requirement.
Why it matters. Each patient has different nutritional needs. An individual plan, based on an assessment of their needs, is what keeps them well.
How the surveyor verifies this criterion
Sample. Review nutrition plans for 20 patients, including those with diagnoses, allergies or cultural or religious dietary needs.
1. The plan records diagnosis, allergies, intolerances and cultural or religious needs.
Method. Check each plan for the four items.
Evidence to show. Individual nutrition plan record (NUT-FRM-001).
Pass when. Every plan records all four items.
Immediate fail (any one means the criterion is not met). A diabetic patient given a standard tray with no nutrition plan and no allergy check.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Nurse (ISCO 2221) | Completes the Individual nutrition plan record | Must |
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| NUT-FRM-001 · Individual nutrition plan record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Individual Nutrition Planning (NUT-02) | Manager; Nurse |
References
- WHO (2024). Long-term care for older people: package for universal health coverage. Used for: Long-term care package for older people: individual care plans, nutrition and malnutrition screening, monitoring. Older people, not hospital. https://news.gmj.ge/guideline/long-term-care-for-older-people-package-for-universal-health-coverage/
40.3Malnutrition Is Identified, Monitored and TreatedHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must
Malnutrition and risk of malnutrition are identified with a validated tool. Weight and intake are monitored against documented targets, and treatment is adjusted when targets are not met.
Why it matters. Malnutrition slows recovery, weakens the immune system and can kill. Identifying it with a validated tool, and treating it, prevents harm.
How the surveyor verifies this criterion
Sample. Review malnutrition screening and monitoring records for 20 patients admitted in the last 3 months.
1. Each patient is screened for malnutrition with a validated tool.
Method. Check each record for the named tool and its score.
Evidence to show. Malnutrition identification and monitoring (NUT-SOP-001).
Pass when. Every patient has a validated screen recorded.
Immediate fail (any one means the criterion is not met). A patient losing weight for six weeks with no screen and no monitoring.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Maintains the Malnutrition identification and monitoring | Medium |
| Manager (ISCO 1342) | Checks the criterion at each review | Medium |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| NUT-SOP-001 · Malnutrition identification and monitoring | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Personal Care & Daily Living (LTC-03) | Manager; Nurse |
References
- WHO (2024). Long-term care for older people: package for universal health coverage. Used for: Long-term care package for older people: individual care plans, nutrition and malnutrition screening, monitoring. Older people, not hospital. https://news.gmj.ge/guideline/long-term-care-for-older-people-package-for-universal-health-coverage/
- WHO (2020). Paediatric emergency triage, assessment and treatment: care of critically-ill children. Used for: Paediatric emergency triage, including malnutrition and monitoring in critically ill children. Child emergency care. https://news.gmj.ge/guideline/paediatric-emergency-triage-assessment-and-treatment-care-of-critically-ill-children/
- WHO (2020). Standards for improving the quality of care for small and sick newborns in health facilities. Used for: Standards for small and sick newborns: feeding, weight and screening in facilities. Newborn-specific. https://news.gmj.ge/guideline/standards-for-improving-the-quality-of-care-for-small-and-sick-newborns-in-health-facilities/
40.4Diets and Texture Are Matched to the Swallowing AssessmentHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must
Diet texture and fluid consistency are set from a documented swallowing assessment. The texture is reviewed as the patient’s swallowing changes.
Why it matters. A patient with swallowing difficulty who is given the wrong texture can choke or breathe food into the lungs. The diet must be matched to a documented swallowing assessment.
How the surveyor verifies this criterion
Sample. Review swallowing assessments and texture orders for 15 patients with a swallowing concern.
1. A documented swallowing assessment is on file before the texture is set.
Method. Check each texture order for an assessment dated before it.
Evidence to show. Swallowing assessment and texture record (NUT-FRM-002).
Pass when. Every texture order follows an assessment.
2. Diet texture and fluid consistency match the assessment.
Method. Check each order against the assessment result.
Evidence to show. Diet texture from swallowing assessment (NUT-SOP-002).
Pass when. Every order matches its assessment.
3. The texture is reviewed as swallowing changes.
Method. Check each record for the review and any change made.
Evidence to show. Swallowing assessment and texture record (NUT-FRM-002).
Pass when. Every change in swallowing is followed by a texture review.
Immediate fail (any one means the criterion is not met). A patient with a swallowing problem given thin fluids with no assessment.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Nurse (ISCO 2221) | Completes the Swallowing assessment and texture record | Medium |
| Manager (ISCO 1342) | Maintains the Diet texture from swallowing assessment | Medium |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| NUT-SOP-002 · Diet texture from swallowing assessment | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| NUT-FRM-002 · Swallowing assessment and texture record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Diet Texture and Swallowing Safety (NUT-04) | Manager; Nurse |
References
- What is the IDDSI Framework (International Dysphagia Diet Standardisation Initiative, 2016 (framework finalised November 2015))
40.5Food Service Is Safe and HygienicHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Food is prepared, stored and served under documented food safety rules. Staff who handle food are trained, and temperatures and hygiene are checked on a recorded schedule.
Why it matters. Food that is not stored, prepared and served safely causes outbreaks of illness, and vulnerable patients are the most at risk. Documented food safety rules are the basis of safe food.
How the surveyor verifies this criterion
Sample. Review food safety records, temperature logs and staff training for the last 3 months.
1. Food is prepared, stored and served under documented food safety rules.
Method. Check the rules against the practice records sampled.
Evidence to show. Food safety and hygiene (NUT-POL-002).
Pass when. Every sampled practice follows the documented rules.
2. Temperatures and hygiene are checked and recorded on each shift.
Method. Check each shift for the temperature and hygiene entries.
Evidence to show. Food temperature and hygiene check register (NUT-REG-002).
Pass when. Every shift has temperature and hygiene checks recorded.
Immediate fail (any one means the criterion is not met). Food kept at room temperature for hours and served without hygiene checks.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Maintains the Food safety and hygiene | Must |
| Secretary (ISCO 3344) | Keeps the Food temperature and hygiene check register | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| NUT-REG-002 · Food temperature and hygiene check register | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| NUT-POL-002 · Food safety and hygiene | Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Food Safety & Hygiene Fundamentals (FOOD-01) | Manager; Nurse |
References
- Five keys to safer food manual (World Health Organization, 2006)
Who is responsible for Standard 40
Each criterion names the positions responsible for it. Every position links to its own terms of reference.
| Criterion | Responsible | Supports |
|---|---|---|
| 40.1 Nutrition Care Is Provided by a Qualified Dietitian or Trained Clinician | Dietitian / nutritionist General practitioner (GP) |
Dietary aide (patient meals) |
| 40.2 Each Patient Has an Individual Nutrition Plan | Dietitian / nutritionist Head nurse / ward manager |
General practitioner (GP) |
| 40.3 Malnutrition Is Identified, Monitored and Treated | Dietitian / nutritionist Head nurse / ward manager |
General practitioner (GP) |
| 40.4 Diets and Texture Are Matched to the Swallowing Assessment | Speech and language therapist Dietitian / nutritionist |
Head nurse / ward manager |
| 40.5 Food Service Is Safe and Hygienic | Catering manager Dietary aide (patient meals) |
Infection prevention and control (IPC) lead |
Role details: reporting, supervision and training
Training shown is the general recommendation. Role-specific training is set in the next improvement round.
| Role | Reports to | Supervises | Recommended training |
|---|---|---|---|
| Infection prevention and control (IPC) lead | Quality manager | IPC nurse | Facility induction; safeguarding adults (general recommendation) |
| General practitioner (GP) | Medical director | None | Facility induction; safeguarding adults (general recommendation) |
| Head nurse / ward manager | Director of nursing | Nurse specialist, Registered nurse, Nursing associate, Health care assistant / nursing aide | Facility induction; safeguarding adults (general recommendation) |
| Speech and language therapist | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
| Dietitian / nutritionist | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
| Catering manager | Hotel services manager | Chef | Facility induction; safeguarding adults (general recommendation) |
| Dietary aide (patient meals) | Dietitian / nutritionist | None | Facility induction; safeguarding adults (general recommendation) |
Questions and answers
The criterion text is the authority. These answers summarise it.
Who does Standard 33 apply to?
Services that provide nutrition care and food service, including hospitals, long-term care and other settings where meals are prepared and served to patients.
What do the colours mean for this standard?
Red (Must) is required. Green (Medium) is recommended. Yellow (Minimum) is the lowest acceptable level in humanitarian settings. Standard setting is Must on every criterion.
Who can provide nutrition care?
Under 40.1 nutrition assessment and planning are carried out by a qualified dietitian, or by a clinician trained in nutrition, and scope of practice is defined.
Does every patient have a nutrition plan?
Yes. Under 40.2 each patient has a nutrition plan based on a documented assessment, including any diagnosis, allergy, intolerance, and cultural or religious requirement.
How is malnutrition handled?
Under 40.3 malnutrition and the risk of it are identified with a validated tool, and weight and intake are monitored and treatment is adjusted when targets are not met.
How is the texture of food chosen?
Under 40.4 diet texture and fluid consistency are set from a documented swallowing assessment and reviewed as swallowing changes.
What makes food service safe?
Under 40.5 food is prepared, stored and served under documented food safety rules, staff who handle food are trained, and temperatures and hygiene are checked on a recorded schedule.
Guidelines for this standard
16 guideline(s) are held in the GMJ Guidelines Library and listed here. Each link opens the full guideline on news.gmj.ge. The complete library, grouped by standard, is at Guidelines.
- Five Keys to Safer Food Manual (WHO)
- Standards of Proficiency: Dietitians (HCPC)
- Complete IDDSI Framework — Detailed Definitions (International Dysphagia Diet Standardisation Initiative (IDDSI))
- Model and Process for Nutrition and Dietetic Practice (British Dietetic Association)
- Five keys to safer food manual (2006) (World Health Organization)
- ESPEN guideline on clinical nutrition in the intensive care unit (European Society for Clinical Nutrition and Metabolism (ESPEN))
- Severe acute malnutrition — MSF Clinical guidelines (Médecins Sans Frontières)
- Hypoglycaemia — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines (Médecins Sans Frontières)
- Healthier food and healthier food environments at sports events: an action guide for sports event organizers (World Health Organization)
- Good practices in traditional food markets in the Region of the Americas (Pan American Health Organization)
- Breastfeeding and COVID-19 (Pan American Health Organization)
- Recommendations to Prevent COVID-19 Transmission at Food Fairs and Markets (Pan American Health Organization)
- SHAKE the salt habit, 2nd edition (World Health Organization)
- Guideline on fortification of edible oils and fats with vitamins A and D for public health (World Health Organization)
- Policies and interventions to create healthy school food environments (World Health Organization)
- Guidelines on the integrated management of obesity in adolescents (World Health Organization)
Also relevant to this standard:
- Anaemia — Clinical Guidelines — Diagnosis and Treatment Manual — MSF Clinical guidelines (Médecins Sans Frontières)
- Postnatal consultations — MSF Essential obstetric and newborn care (Médecins Sans Frontières)
- Postpartum care for the mother — MSF Essential obstetric and newborn care (Médecins Sans Frontières)
- Care of the low birth weight neonates (< 2500 g) — MSF Essential obstetric and newborn care (Médecins Sans Frontières)
- Long-term care for older people: package for universal health coverage (World Health Organization)
- Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the Baby-friendly Hospital Initiative: monitoring manual (World Health Organization)
- Parent counselling guide on kangaroo mother care (KMC) (World Health Organization)
- Kangaroo mother care: a clinical practice guide (World Health Organization)