Standard 33: Nutrition and Dietetics (Version 11)

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.

Rating: Must in humanitarian settings; Must in transition and fragile settings; Must in standard settings.

Not assessed (N/A) for: dental clinic, aesthetic and procedure clinic.

Guidance

Nutrition assessment and planning need the right skill. A qualified dietitian, or a clinician trained for the task, carries them out, and the scope of practice of each role is written down.

The competence of each author is checked against the nutrition staff competence register (NUT-REG-001). Dietitian input is recorded in every complex case, so that a plan that goes beyond routine care has a qualified review.

What good looks like

• A nutrition care policy (NUT-POL-001) defining who may assess and plan.
• A nutrition staff competence register (NUT-REG-001) with a current qualification for each author.
• Dietitian input recorded for each complex case.
• Scope of practice written for each nutrition role.

Common mistakes

• A feeding plan written by a care aide who has not been trained for it.
• Authors who are qualified but not on the register.
• Complex cases with no record of dietitian review.
• Scope of practice left undefined, so that roles overlap.

Questions the surveyor asks

• Nutrition assessment is carried out by a qualified dietitian or a trained clinician. The surveyor checks each assessment for the author and their qualification.
• The author's qualification is on the competence register. The surveyor checks each author against the register.
• Dietitian input is recorded where the plan is complex. The surveyor checks each complex case for the dietitian review entry.

How the surveyor verifies this criterion

References

1. No external reference is cited for this criterion. Its requirements are set out in the criterion, the checks and the evidence listed.

Each patient has a nutrition plan based on a documented assessment of their needs, including any diagnosis, allergy, intolerance, and cultural or religious requirement.

Rating: Minimum in humanitarian settings; Must in transition and fragile settings; Must in standard settings.

Not assessed (N/A) for: dental clinic, aesthetic and procedure clinic.

Guidance

Each patient has different nutritional needs. The plan is built from a documented assessment, and it records the diagnosis, any allergy or intolerance, and any cultural or religious requirement before a diet is set.

The plan is recorded on the individual nutrition plan record (NUT-FRM-001) and checked at each review, so that a change in the patient's condition changes the diet.

What good looks like

• An individual nutrition plan record (NUT-FRM-001) for each patient.
• Diagnosis, allergies, intolerances and cultural or religious needs recorded in every plan.
• Plan checked at each review.
• Allergy check made before the first meal is served.

Common mistakes

• A standard tray given to a patient with a known diagnosis.
• Allergies recorded in the nursing notes and not in the plan.
• A plan written once on admission and never reviewed.
• Cultural or religious diet not asked about.

Questions the surveyor asks

• The plan records diagnosis, allergies, intolerances and cultural or religious needs. The surveyor checks each plan for the four items.

How the surveyor verifies this criterion

References

1. WHO (2024). Long-term care for older people: package for universal health coverage. https://news.gmj.ge/guideline/long-term-care-for-older-people-package-for-universal-health-coverage/

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.

Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.

Not assessed (N/A) for: dental clinic, aesthetic and procedure clinic.

Guidance

Malnutrition slows recovery, weakens the immune system and can kill. Each patient is screened with a validated tool, and the tool and score are recorded.

Weight and intake are monitored against documented targets, recorded under the malnutrition identification and monitoring procedure (NUT-SOP-001). Where a target is not met, treatment is changed and the change is recorded.

What good looks like

• A malnutrition identification and monitoring procedure (NUT-SOP-001) naming the validated tool.
• A validated screen recorded for each patient.
• Weight and intake recorded against documented targets.
• Treatment changed and recorded when a target is missed.

Common mistakes

• A screen done once and not repeated.
• A screen with no tool and no score recorded.
• Weight loss recorded but no action taken.
• Targets set on paper but not used in practice.

Questions the surveyor asks

• Each patient is screened for malnutrition with a validated tool. The surveyor checks each record for the named tool and its score.

How the surveyor verifies this criterion

References

1. WHO (2024). Long-term care for older people: package for universal health coverage. https://news.gmj.ge/guideline/long-term-care-for-older-people-package-for-universal-health-coverage/
2. WHO (2020). Paediatric emergency triage, assessment and treatment: care of critically-ill children. https://news.gmj.ge/guideline/paediatric-emergency-triage-assessment-and-treatment-care-of-critically-ill-children/
3. WHO (2020). Standards for improving the quality of care for small and sick newborns in health facilities. https://news.gmj.ge/guideline/standards-for-improving-the-quality-of-care-for-small-and-sick-newborns-in-health-facilities/

Diet texture and fluid consistency are set from a documented swallowing assessment. The texture is reviewed as the patient's swallowing changes.

Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.

Not assessed (N/A) for: dental clinic, aesthetic and procedure clinic.

Guidance

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, and the texture is set from that assessment.

The swallowing assessment and texture record (NUT-FRM-002) is dated before the texture order. The texture is reviewed whenever the patient's swallowing changes, and each change is recorded.

What good looks like

• A swallowing assessment and texture record (NUT-FRM-002) dated before each order.
• A diet texture procedure (NUT-SOP-002) linking texture to the assessment result.
• Texture reviewed and recorded when swallowing changes.
• Staff trained to recognise swallowing difficulty.

Common mistakes

• Thin fluids given with no swallowing assessment.
• A texture order copied from the previous patient.
• A change in swallowing noticed but the texture not reviewed.
• Assessment dated after the first meal.

Questions the surveyor asks

• A documented swallowing assessment is on file before the texture is set. The surveyor checks each texture order for an assessment dated before it.
• Diet texture and fluid consistency match the assessment. The surveyor checks each order against the assessment result.
• The texture is reviewed as swallowing changes. The surveyor checks each record for the review and any change made.

How the surveyor verifies this criterion

References

1. What is the IDDSI Framework (International Dysphagia Diet Standardisation Initiative, 2016 (framework finalised November 2015)).

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.

Rating: Minimum in humanitarian settings; Must in transition and fragile settings; Must in standard settings.

Not assessed (N/A) for: dental clinic, aesthetic and procedure clinic.

Guidance

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, and staff who handle food are trained in them.

Temperatures and hygiene are checked on each shift and recorded in the food temperature and hygiene check register (NUT-REG-002). Checks are reviewed by the manager, so that a failed check leads to action.

What good looks like

• A food safety and hygiene policy (NUT-POL-002).
• A food temperature and hygiene check register (NUT-REG-002) completed on every shift.
• Training recorded for every person who handles food.
• A failed check followed by a recorded action.

Common mistakes

• Food left at room temperature for hours before service.
• Temperature checks written up at the end of the week.
• Food handlers without training.
• Hygiene checks done but failures not acted on.

Questions the surveyor asks

• Food is prepared, stored and served under documented food safety rules. The surveyor checks the rules against the practice records sampled.
• Temperatures and hygiene are checked and recorded on each shift. The surveyor checks each shift for the temperature and hygiene entries.

How the surveyor verifies this criterion

References

1. Five keys to safer food manual (World Health Organization, 2006).