تاءارــجلإاو مـظـنـلا Policy & Procedures

Policy & Procedures ‫الـنـظـم واإلجــراءات‬
Department Clinical Nutrition No. of Pages 1 Of 9

Policy No. CN 008\03
Policy Title Therapeutic Diet And Menu Effective Date 18/1/2023
Planning And Diet Order
Purpose:
1-To define the process of ordering normal or therapeutic diets and provide food and
nutrients that meets the patient’s needs in accordance with physician’s written diet
orders.
2-To ensure that the patient will receive the suitable therapeutic diet according to his/her
disease status.
3-To define the nutritional and dietary requirements of hospital patients. To ensure that
food is appropriate for the patient’s age according to cultural and dietary preferences, and
plan of care is available.
4-To define the policy and establish applicable on procedure that will serve as guidelines
for all staff involved in ordering meals (regular, therapeutic diets & nutritional
supplements) for patients through the automated ordering system (CARE).
5-To ensure that food is appropriate for the patient’s age according to cultural and dietary
preferences, and plan of care is available.
Definition:
-Therapeutic Diet : These are the diets used by the professional nutritional therapist to
help individuals suffering from nutrition-responsive health problems.
-Regular Diet: A full, well-balanced diet containing all of the essential nutrients needed for
optimal growth, tissue repair, and normal functioning of the organs. Such a diet contains
foods rich in proteins, carbohydrates, high-quality fats, minerals, and vitamins in
proportions that meet the specific caloric requirements of the individual.
-Clear Liquid Diet: Consists of clear fluids or foods that are liquid at body temperature and
leave a minimal amount of residue in the gastrointestinal tract. It does not meet the
Dietary Reference Intakes for all nutrients.
-Full Liquid Diet: This diet can be nutritionally adequate with careful planning. It is used for
acute gastritis, as a transition between clear liquid and soft diet, and in conditions in which
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there is intolerance to solid food. Milk, strained soups, and fruit juices are allowed.
-Blenderized Liquid Diet: Consists of fluids and foods blenderized to a liquid form for
patients who are unable to chew, swallow or tolerate solid foods. DRI can be met with this
diet, depending on the volume the patient can tolerate.
-Diabetic Liquid Diet: As Blenderized Liquid Diet, but consistent with diabetes care
guidelines.
-Pureed Diet: Consist of thick, smooth, homogenous food with pudding-like consistency. It
does not contain any coarse textures and supplementation might be required to reach the
DRI depending on the patient’s intake.
-Mashed/Minced Diet: Consists of mashed or minced foods that require a minimum
chewing. Depending on the individual’s intake, supplementation might be required to
achieve the DRI.
-Soft diet: Includes foods modified in texture to promote ease of mastication, usually
patients who have limited chewing ability, but tolerate a wider variety of textures than a
liquid or blenderized diet.
-High Fiber Diet: A regular diet with the emphasis on fiber-rich foods. It provides
approximately 1013g fiber /1000kcal/day, i.e. about 25-30g fiber/day.
-Low Fiber Diet: Contains less indigestible carbohydrates with the aim to reduce the
frequency and volume of fecal output while prolonging the intestinal transit time.
-High Calorie Diet: One that furnishes more calories than needed to maintain weight,
often more than 3500–4000 calories per day.
-High Protein Diet: One containing large amounts of protein, consisting largely of meats,
fish, milk, legumes, and nuts.
-Ketogenic Diet: One that produces ketones or acetones, or mild acidosis, such as one that
is low in calories within sufficient carbohydrate and protein; it is occasionally used in the
treatment of epilepsy.
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-Bland Diet: A diet where foods that are known to aggravate GERD such as fried foods,
citrus foods, gas producing vegetables and strong spices are excluded.
-Diabetic Diet: Following the healthy diet guidelines, high in fiber, low in fat and sodium
with controlled amounts of carbohydrates and energy at regular times during the day.
-Gestational Diabetes Diet (GDM Diet): Controlled energy diet with carbohydrate intake
restricted to 35 - 40% of daily energy intake.
-Low Fat Diet (Low Cholesterol Diet): A diet where the quantity and types of fat in the diet
are restricted. Cholesterol intake is limited to 300mg/day, saturated fats to <10% of daily
energy intake, polyunsaturated fats up to 10% and mono-unsaturated fats up to 15% of
daily energy intake.
-Low Salt Diet: A diet where the intake of sodium is limited to 2400-3000mg/day, unless
otherwise indicated.
-Low Potassium Diet: This diet limits the potassium intake from food to 2000- 2500mg (40-
60mmol) potassium/day. It might be used in conjunction with the renal Diet when
indicated and does not meet the DRI for nutrients such as calcium, iron, vitamin C, folate
and vitamin B.
-Renal Diet: A diet that should be individualized for each patient. In general it is indicated
for patients with pre-end-stage renal disease that are not on replacement therapy.
Restrictions of protein and phosphorous are indicated unless otherwise requested. Protein
restriction to 0.6-0.8g/kg/day and phosphorous restriction to 8-10mg/kg/day are
indicated. Sodium is restricted to 2000mg/day. Potassium restriction is only considered
when indicated. It does not meet the DRI and supplementation of micronutrients is usually
indicated. For patients on replacement therapy (hemodialysis) the protein restriction is
1.0-1.2g/kg dry body weight/day.
-Anti Diarrhea Diet: A diet that limits refined carbohydrates and concentrated sweets
while still providing sufficient protein to sustain growth and development. BRAT diet:
acronym for bananas, rice, apples (juice or sauce), and toast.
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-DASH Diet (Dietary Approach to Stop Hypertension): A diet high in fruits, vegetables, an
low fat dairy products, low in saturated and total fat, low in cholesterol; and high in fiber.
Research studies support the hypothesis that this diet reduces blood pressure and may
play a role in prevention of high blood pressure.
-Low Purine Diet: Diet low in precursors of purines (for example, tissues rich in cells with
abundant nuclei, as in liver and glandular meats) to minimize formation of uric acid.
-Gluten Free Diet: A diet in which wheat must be avoided, as well as other grains such as
barley, oats, and rye that contain analogues to wheat gluten. Exceptions to this essentially
grain-free diet are corn, rice, and millet. Wheat starch, which has been washed free of
GLIADIN, is not restricted nor are there restrictions on carbohydrates or fats.
-Enteral Formula: Refers to nutritional supplements (either ready to feed or reconstituted
formula, infant formula, medical devices) served to patients as prescribed by the
Physicians Clinical Dietitian and ordered by Nursing Department.
-System's Users: All authorized staff will be trained and will be required to utilize the
automated system as part of their regular operational activities.
-Diet for Age (DFA): Food appropriate for the infant or toddler’s age is provided according
to the following age groups: 4- 6 months; 6-9 months; 9-12 months; 12-18 months;
>18months.
Policy:
Therapeutic diet orders shall be recommended by the clinical dietitian or physician order.
Therapeutic diet orders shall be communicated to the Dietary Service by nursing services.
Procedure:
1-Initial diet order shall be documented in the physician initial assessment form in the
medical record file by the attending physician.
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1. 1.Therapeutic diet will be ordered by the physician which includes:

1.1.1.The total calories needed.
1.1.2.Any restrictions.
1.1.3.The rout either oral or enteral.
1.1.4.The frequency of meals.
2-Dietitians shall be authorized to modify diet orders at the time of nutritional assessment
to apply nutritional therapy for conditions such as cardiac, cancer, diabetes, obesity, renal
diseases and others.
3-Dietitian shall gathering information about food preferences and diet history at the time
of interviewing the patient.
4-Interview with the patient will include but not limited to: understanding of diet order,
appetite, food preferences, food intolerance and food allergy.
5-Potential food-drug interactions also dictate the modification of the diet order.
6-Dietitian may modify the diet orders if the patients desire to restrict intake as the
continuation of their previous food habits or to comply with healthy eating practices. Such
modifications shall be based on the nutritional assessment done by the dietitian and will
not be drastically different from the physician’s diet order.
7-Any changes done by the dietitian for the patient diet order will be discussed with the
attendant physician or a member of his team or may documented in the physician order or
interdisciplinary progress note.
8- Patients are not permitted to bring food from outside for consumption, except when
permitted by physician. In such cases permission shall be documented in the patient
medical record by physician and the food brought from outside hospital must be limited to
Physician and Dietitian recommendation.
9-Dietary staff will interpret and fill physician’s diet order in accordance with the hospital
diet menu.
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10-All dishes and menus are analyzed for nutritional content by a state registered dietitian
at the planning stage.
11- Authorization and implementation of therapeutic diets:
11. 1.Patient who may require a therapeutic diet will be identified through either
the health examination process or a nutrition assessment evaluation performed by
clinical dietitian.
12-The hospital menu planning must provide ( for adult requirements ) :
12.1.A minimum of 300 kcal per main meal and 500 kcal for an energy-dense main
meal and 18 grams protein.
12.2.A variety of substantial snacks must be provided a minimum of twice per day.
12. 3.One snack must be capable of providing a minimum 150kcal Must include
fruit as a choice.
12. 4.An ‘out-of-hours’ service must be provided for all patients who do not have
the opportunity to have a meal at the normal mealtime.
13-The following diets are routinely available and should be requested as per the meal
ordering procedure
13.1.For any diet not mentioned in the policy the Clinical Dietitian should be
contacted to review the diet order and plan a diet accordingly.
13. 2.The Clinical Dietitian shall provide written instructions to the Food Service
Contractor for those diets not routinely available.
14-CARE System shall provide all system users with an access to the Food Services
Automated System as well as the Food Services Contracts Operations, Support Services
with a system facility linked to monitor food services requests.
15-Diet List Program will be utilized by Food Services Department system users. The
particulars of the print-out of this system will contain the following:
15.1.Patient Name.
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15.2.MRN (Medical Record Number).

15.3.Age.
15.4.Isolation.
15.5.Hold Tube Fast/NPO.
15.6.Known Allergies.
16-Patient Meal Orders:
16.1.Patient meals can only be ordered by Nursing Staff, Physician and Clinical
Dietitian.
16.2.Patient meals must be ordered through the Hospital Information System
Dietary Procedure online computer system (CARE).
16.3.Patient meal orders must be accompanied by the Badge Number of the
authorized personnel entering the order.
16.4.Patient meals delivered by Food Services Contractor to the ordering
department are for consumption by a valid current patient only.
16.5.All employees are forbidden to consume a patient meal. Patient Meal Orders
Originating from the Wards - Patient meal orders must be identified by a valid
(MRN) medical record number.
Accountabilities:
- Clinical Dietitians
- Nurses
- Food Service Department .
Forms :
- Nutritional Assessment and Reassessment form .
- Follow up form .
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References:
- American Dietetic Association (ADA), 2011.
- American Society for Nutritional Sciences, 2011.
- United States Department of Agriculture for healthy diets, 2016.
- International confederation of dietetic associations, 2011.
- Policies of King Abdul Aziz Medical City, 2014.
- Joint Commission International Accreditation Standards for Hospitals (JCIA), the Forth (4)
Edition, 2011.
- Utah State Hospital Nutrition Care Policies and Procedures.
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Flowchart:
Approval:
Name – Job Title Signature Date QPS Stamp
Prepared Dt. Wejdan Obaidallah Al- 1/1/2023
by: beshri
Quality Coordinator of Clinical
Nutrition Department
Dt. Maram Fadhel 4/1/2023
Altowerqi
Reviewed Head of clinical nutrition and
by: food services department
Dr. GHADA Saleh Al- 8/1/2023
Faqawi
Director Of Quality And
Patient Safety Dept.
Ms. Shima Ali 10/1/2023
Head of nursing dept.
Approved Dr. Abdulnasir Batouk 15/1/2023
by: Medical Director .
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Policy & Procedures ‫الـنـظـم واإلجــراءات‬

Department Clinical Nutrition No. of Pages 1 Of 9

1. 1.Therapeutic diet will be ordered by the physician which includes:

15.2.MRN (Medical Record Number).

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