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BY ORDER OF THE AIR FORCE MANUAL 44-144 SECRETARY …

DEPARTMENT OF THE AIR FORCE . HEADQUARTERS UNITED STATES AIR FORCE . WASHINGTON DC. AFI44-144_AFGM2020-01. 9 September 2020. MEMORANDUM FOR DISTRIBUTION C. MAJCOMs/FOAs/DRUs FROM: AF/SG. SUBJECT: Air FORCE Guidance Memorandum to Air FORCE MANUAL (AFMAN) 44-144 , Nutritional Medicine By ORDER of the SECRETARY of the Air FORCE , this Air FORCE Guidance Memorandum immediately implements changes to AFMAN 44-144 , Nutritional Medicine. Compliance with this Memorandum is mandatory. To the extent its directions are inconsistent with other Air FORCE publications, the information herein prevails, in accordance with AFI 33-360, Publications and Forms Management. Changes include the inclusion of the Integrated Operational Support (IOS), Base Operational Support Teams (BOST), the Health and Readiness Optimization (HeRO) strategy, the Medical and Operational Readiness and Contingency Planning chapter and updates to attachments.

by order of the secretary of the air force air force manual 44-144 20 january 2016 medical operations nutritional medicine compliance with this publication is mandatory

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Transcription of BY ORDER OF THE AIR FORCE MANUAL 44-144 SECRETARY …

1 DEPARTMENT OF THE AIR FORCE . HEADQUARTERS UNITED STATES AIR FORCE . WASHINGTON DC. AFI44-144_AFGM2020-01. 9 September 2020. MEMORANDUM FOR DISTRIBUTION C. MAJCOMs/FOAs/DRUs FROM: AF/SG. SUBJECT: Air FORCE Guidance Memorandum to Air FORCE MANUAL (AFMAN) 44-144 , Nutritional Medicine By ORDER of the SECRETARY of the Air FORCE , this Air FORCE Guidance Memorandum immediately implements changes to AFMAN 44-144 , Nutritional Medicine. Compliance with this Memorandum is mandatory. To the extent its directions are inconsistent with other Air FORCE publications, the information herein prevails, in accordance with AFI 33-360, Publications and Forms Management. Changes include the inclusion of the Integrated Operational Support (IOS), Base Operational Support Teams (BOST), the Health and Readiness Optimization (HeRO) strategy, the Medical and Operational Readiness and Contingency Planning chapter and updates to attachments.

2 This Memorandum becomes void after one year has elapsed from the date of this Memorandum, or upon incorporation by interim change to, or rewrite of AFMAN 44-144 , whichever is earlier. DOROTHY A. HOGG. Lieutenant General, USAF, NC. Surgeon General Attachments (5): 1. Nutritional Medicine 2. 4D0X1 Diet Counseling Scope of Practice 3. Nutritional Medicine Subsistence Report 4. Memorandum of Agreement Template 5. Nutritional Medicine Service Oversight Checklist AFMAN44-144_AFGM2020-01. Attachment 1. Nutritional Medicine This guidance reflects significant changes in guidance and procedures in Nutritional Medicine operations. The Air FORCE Medical Service Agency and Air FORCE Medical Operations Agency references are replaced with Air FORCE Medical Readiness Agency (AFMRA).

3 Other updates include the addition of Integrated Operational Support, Base Operational Support Teams, the Health and Readiness Optimization strategy, the Medical and Operational Readiness and Contingency Planning chapter and subsequent attachment updates. Changed to read: Mission and Vision. The mission of Nutritional Medicine is to fuel warfighter readiness through nutrition. The Nutritional Medicine vision is a culture of nutritional fitness. Changed to read: Collaborate and coordinate nutrition policy with the Defense Health Agency (DHA) and US Air FORCE Deputy Chief of Staff for Manpower and Personnel (AF/A1). Changed to read: Coordinate with AFMRA Health Promotion and Air FORCE Medical Readiness Agency/Biomedical Sciences Corps (AFMRA/SGB) on nutritional guidance and programs.

4 Changed to read: Continuous process improvement activities, based on facility scope of practice and capability, are focused on high- risk, problem prone, high volume and high cost areas but are not limited to those areas, in compliance with Office of the Assistant SECRETARY of Defense for Health Affairs Research Regulatory Oversight Office, Guidance Research Determinations for Process Improvement, Quality Improvement, and Evidence-Based Practice Projects, number GD-20-003. Changed to read: Examples of high-risk patient process include: patient tray food temperatures, NPO/clear liquid tracking, inpatient screening timeframes, appropriate ordering and use of nutrition support ( , enteral and parenteral nutrition), and patient tray and menu accuracy.

5 Patient safety report trends may reveal areas for improvement. Changed to read: Computrition and/or other commercial nutrient analysis programs may be used for more detailed nutritional analysis as needed. Evaluate all menus for nutritional adequacy. Added. Local menus may be developed in collaboration with medical staff to meet unique patient needs ( , bariatric surgery patients in collaboration with surgeons). Added. Inpatient facilities with Computrition will use the program to the maximum extent possible. (T-3). Accurate and complete data must be entered into Computrition , to include Likes/Dislikes/Allergies tables, items with accurate nutrient links, and recipes with accurate nutrient links for all food and beverage items.

6 (T-3). With accurate and complete data entry, Computrition will increase patient safety and staff efficiency by automating certain functions such as tray ticket printout, creation of a meal tally and elimination of inappropriate foods from a patient tray ticket based upon diet ORDER . Added. Ensure personnel are adequately trained to use Computrition , to identify errors within Computrition , and to identify errors Computrition does not catch. (T-3). Computrition automation augments but does not replace adequately trained personnel. Changed to read: The Nutritional Medicine Flight Commander will ensure that policies, procedural guidelines and national care standards are followed in accordance with Defense Health Agency Procedures MANUAL , Implementation Guidance for Defense Health Agency Procedures MANUAL , Clinical Quality Management in the MHS, Volumes 1-7 and AFI 44-119, Medical Quality Operations.

7 (T-0). Changed to read: Dietitian Credentialing and Privileging. Registered Dietitian Nutritionist (RDN) competency is documented through the credentialing and privileging process. Regular Air FORCE , reserve, civilian, contract, and any volunteer RDNs will be credentialed and awarded MTF clinical privileges in accordance with Defense Health Agency Procedures MANUAL , Clinical Quality Management in the Military Health System, Volume 4: Credentialing and Privileging, before providing care to patients. (T-0). Changed to read: Recommendation for reappointment of privileges will be based upon the following criteria: maintaining registration status as a RDN, active practice of dietetics, evidence of demonstrated proficiency based upon quarterly peer reviews that show no negative trends nor validated occurrences that would warrant privilege limitations, current Basic Life Support training and evidence of completion of required Continuing Education Units in accordance with Defense Health Agency Procedures MANUAL , Clinical Quality Management in the Military Health System, Volume 4:Credentialing and Privileging.

8 (T-0). Changed to read: Nutritional Medicine work schedules will comply with Defense Healthy Agency Interim Procedures Memorandum 18-001, Standard Appointing Processes, Procedures, Hours of Operation, Productivity, Performance Measures and Appointment Types in Primary, Specialty, and Behavioral Health Care in Medical Treatment Facilities (MTFs). Changed to read: Fire Safety. Develop a Job Safety Training Outline that identifies and addresses section specific safety hazards in accordance with AFMAN 91-203, Air FORCE Occupational Safety, Fire, and Health Standards and documented on AF Form 55, Employee Safety and Health Record. Changed to read: Disaster Preparedness. The Nutritional Medicine function is responsible to develop an annual training plan that ensures each member receives annual and make-up training to maintain proficiency standards and ensure training is documented in Medical Readiness Decision Support System ULTRA.

9 Changed to read: Comprehensive Medical Readiness Program. The AF Specialty Code (AFSC) functional training managers, will manage, conduct, and document comprehensive medical readiness training in accordance with AFI 41-106, Medical Readiness Program Management. Changed to read: Functional Cost Codes and Usage. Functional Cost Codes are used for all DoD Nutritional Medicine organizations. Functional Cost Codes are used to record Nutritional Medicine expenditures, personnel time, and workload. Specific written guidance governs MEPRS procedures and Functional Cost Code usage: Defense Health Agency Procedures MANUAL , Volume 1, Medical Expense and Performance Reporting System (MEPRS) for Fixed Military Medical and Dental Treatment Facilities MANUAL , and AFI 41-102, Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities.

10 Changed to read: Medical nutrition therapy is an essential component of comprehensive healthcare. Credentialed RDNs and/or authorized diet therapy personnel (under the supervision of a credentialed RDN) provide medical nutrition therapy. Changed to read: Diet therapy technicians provide medical nutrition therapy as authorized by AF Form 628, Diet Instruction/Assessment Authorization, and can be authorized to provide medical nutrition therapy in accordance with Attachment 2, 4D0X1 Diet Counseling Scope of Practice. Using this guide, the authorizing/credentialed RDN determines what diets a diet therapy technician may be certified on based on their assessment of the diet therapy technician's knowledge, ability, and skills.