The workshops were all well received. Dysphagia - difficulty in swallowing - puts people at high risk of malnutrition, dehydration, aspiration pneumonia and choking. T: +44 1453 827 934 A care home provider evaluated the use of fluid thickeners to reduce these risks, and implemented an initiative to improve understanding of dysphagia among both care and catering staff. The latter could even increase risk of malnutrition and dehydration if a patient avoids eating and drinking. Each session was divided into an informative and lively overview of dysphagia, a comparison of starch-based and gum-based products with a practical demonstration, and tasting session. This is something weve developed. The IDDSI framework provides professionals with guidance around texture-modified diets. This would involve extensive staff training in the correct use of products to ensure residents safety.
There are also frequent safety concerns relating to dysphagia, such as the risk of aspiration (food or fluid entering the lungs). From then on (until Mom was cleared for normal swallowing during a follow-up study), I thickened her morning coffee, her orange juice even her clear broth soups were thickened. | August 28, 2015.
This will help us to influence the prescribing of gum rather than starch-based products. We are able share your email address with third parties (such as Google, Facebook and Twitter) in order to send you promoted content which is tailored to your interests as outlined above.
Thick-It Clear Advantage Food & Beverage Thickener Powder Single Serve Packets (30/bx) (Nectar Consistency)^Thick & Easy Packets 6.5 g packets, Honey Min.Order is 1 CS ( 100 Each / Case; ) by Diamond Crystal BrandsThick & Easy Instant Food and Beverage Thickener, 8 OunceHormel Thick & Easy Instant Food Thickener, Nectar Consistency, 0.16 Ounce (Pack of 100)Thick & Easy Honey Thickener, 6.5 Gram 100 Case. Please enter a city and state or postal code, Please enter a valid city and state (city, state) or postal code, Risk of developing dementia may be lowered when you drink tea, How tea can benefit your overall well-being. I think it takes industry to innovate and take things forward, because most of the SLT profession work in the NHS.
An online app version is also available and can be played anywhere on any device. A holistic approach
One of the treatments for this condition is drinking thickened liquids to prevent foods from slipping into the airway.
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By selecting any of the topic options below you are consenting to receive email communications from us about these topics. Suite 20 Westend Office Suites Thickeners and thickened liquids meet the requirements of Food for Special Medical Purposes in the EU (Cichero, 2019), highlighting the need to use thickeners under medical supervision.
Feedback suggested the training would result in: The training sessions were followed by an evaluation of starch-based and gum-based thickeners with regard to mixing and ease of use. For example, patients with dysphagia have a 40% increase in length of hospital stay (Altman, Yu & Schaefer, 2010). Have you made the shortlist for the Nursing Times Awards for 2022? Author:Bridget Penney is care specialist for Barchester Healthcare. We're as dedicated to our team members as we are to our residents. Treatment may include: Other people who also provide help for people with dysphagia may include: It is important to always follow the advice given by clinicians for people with dysphagia.
If information is presented to the patient in full, then they can judge the balance between risk and benefit of a modified diet for themselves. Learn more about working at Sunrise. This is especially important when we think about the people who are administering thickener or blending a meal; it is often a busy carer or nurse who requires clear, specific guidance to prepare appropriate food and fluids. You can make a perfectly thick beverage with just a few ingredients from your pantry. Snippet for ASC medicines information - find out more, Snippet for residential ASC assessment framework pages: this page is for, Adult social care: information for providers, pharyngeal stage of swallowing (in the throat), oesophageal stage of swallowing (in the tube leading to the stomach), inability to control food or saliva, drooling, Exercises to help improve the efficiency of the swallow, Strategies to follow when eating and drinking to improve safety and/or comfort, the rate of presentation of food or liquid, how the environment might help at meal and drink times (e.g.
There is, though, also a chance they are silently inhaling fluid or food, a situation which could only be identified with special investigations such as a video fluoroscopy of the swallow action. Feel free to swap out strawberries for your favorite fruit.
Nestl Health Science offers support to care homes, other community organisations and individuals with dysphagia, for example through face-to-face or digital safety briefings. They were asked to outline their product, how it was used and the support their company could offer Barchester Healthcare and its homes. It is the latter where thickened fluids may be beneficial. Royal College of Speech and Language Therapists; British Association of Parenteral and Enteral Nutrition; Dysphagia puts people at risk of malnutrition, dehydration, choking and aspiration, The use of prescribed thickeners in food and fluid promotes safety and can enhance quality of life, Training for clinical and catering staff is key to understand modified diets and fluids, Communication between key staff is vital to make sure modified fluids and diet are appropriate and consistent, Involving all health professionals ensures a consistent approach to safety regarding people with dysphagia. I first became familiar with food thickeners when my elderly Mom was hospitalized with aspiration pneumonia. Your healthcare provider will be able to recommend oneof the three common types, as defined by the University of Pittsburgh Medical Center: Most adults need 6to 8 cups of fluid every day, and it can be hard to meet this requirement if you don't like the thickened beverage you're drinking. Do staff know how to spot warning signs such as difficulties and discomfort at meal or drinks time, dehydration, weight loss, and chest infections. She treats adult clients and provides dysphagia consultancy to business.
The role of Speech and Language Therapists Citation: Penney B (2014) Use of fluid thickener to reduce dysphagia risk. E: audience@researchoutreach.org. This would include information about dysphagia generally, followed by the correct use of thickening products.
Archives of otolaryngology--head & neck surgery, 136(8), 784789. 2019).
Note: before purchasing any food and beverage thickener, get very meticulous instructions from the doctor so you know how thick you need to make liquids! We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. Indeed, in acute settings, early identification and management of dysphagia is crucial and can reduce the risk of pneumonia three-fold (Hinchey et al, 2005). If you're a big fan of fruit juice, you may be upset to learn that this thin liquid isn't an option for dysphasia patients. Where is the use of thickeners recorded? Moving away from an acute setting, care home manager Jemma Robinson feels thickened fluids offer many benefits to her residents, particularly as safety is a priority in this vulnerable population. This is crucial to changing the culture around the use of thickeners, ensuring that it is not seen as the easy option, but is delivered by qualified professionals who understand the influence that thickener can have on gastric emptying times and other variables. The training sessions are viewed as essential for staff - although the numbers of residents using thickeners remains low, their safety and quality of life is paramount. Its the whole point. If individuals are using thickener, are hydration levels monitored? Luckily, there are recipes that taste delicious while still preventing aspiration.
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Who the heck knew???! Julie Cichero, co-chair of the IDDSI framework, reports that in the UK, the annual cost of chest infections requiring hospital admission with routine care is around 1.8 times more expensive than chest infections requiring hospital admission with treatment from a speech and language therapist (Cichero, 2019). All home managers were asked to discuss the evaluation with local GPs and given a pro-forma letter to send to them.
By submitting this form, you acknowledge that the information you provide will be transferred to MailChimp for processing in accordance with their Privacy notice and Terms, and to Salesforce Marketing Cloud in accordance with their Privacy notice and Terms. All homes are encouraged to hold monthly multidisciplinary nutrition meetings to discuss issues and opportunities; we have also developed a training academy for chefs and the use of thickeners in food and fluid will now become a key element in their training. The need for modified food and fluids was discussed with our central hospitality operations manager, who confirmed that catering and hospitality staff were not always aware of the correct use of thickeners, which may increase risk for residents with dysphagia. All data was anonymous. The aim is to reduce the risk of aspiration pneumonia by reducing the risk of fluid inhalation, thus making eating and drinking much safer for patients, as well as improving their quality of life. The safety of our residents is paramount and we felt that if staff were using thickeners incorrectly, this safety could be compromised.
Were welcoming brighter days while continuing to promote health and safety.
We hoped this would promote effective communication between the two areas and a clearer understanding of their roles and problem-solving skills.
GL10 3FA Below you can select how youd like us to interact with you and well keep you updated with our latest content. **This post may contain affiliate links. According to Ashford (2005), there are three pillars of pneumonia: health status, oral health status and swallow function. A series of three-hour training sessions were attended by key staff from each home - these were mainly head chefs, senior nurses and care staff with a keen interest in nutritional issues.
Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Individuals with dysphagia and their relatives were informed of the evaluation and had the opportunity to decline to participate if they wished. I think, as a profession, we need to be more open to that and to be saying, Yes, we will unlearn some of the old ways. Sandra Robinson recommends thinking about the following values when considering the use of thickened fluids; firstly, the patients needs, wishes and preferences, and then how the patient will feel, function and survive if prescribed thickeners. Would you like to learn more about our services?
The below food and drink thickeners all get good reviews on Amazon.com. This means an increase in the cost of their admission and an increased likelihood of experiencing complications secondary to prolonged hospital stay, such as hospital acquired infections. Any other browser may experience partial or no support. Just because you can't drink thin liquids doesn't mean you can't enjoy a caffeineboost.
While this treatment is effective, some seniors dislike the texture of thickened beverages. In acute settings, early identification and management of dysphagia is crucial and can reduce the risk of pneumonia three-fold. Combine all the ingredients in your blender and process them until smooth. We also needed to engage our key stakeholders including GPs, local speech and language therapists, residents with dysphagia and their families. Hormel Thick & Easy Hydrolyte Nectar Consistency Thickened Water 4 Ounce (Pack of 24)Thick-It Aquacare H2O Nectar Consistency Thickened Water Beverage, 8 Ounce (Pack of 24)Thick & Easy Thickened Water with Natural Lemon Flavor, Nectar Consistency Sold by (6)-48oz BottlesTHICK & EASY Clear Thickened Iced Tea Nectar Consistency (Pack of 24)Thick & Easy Clear Thickened Cranberry Juice Cocktail, Nectar Consistency, 46 OunceHormel Drink Thick & Easy Orange Juice (Nectar Consistency), 4-Ounce Portion Control Cups (Pack of 24), Thick & Easy Clear Hydrolyte Thickened Water, Honey Consistency, 46 Ounce (Pack of 6)Thick & Easy Clear Consistency Thickened Iced Tea, Honey, 4 OunceHormel Thick & Easy Dairy Honey Consistency or IDDSI Level 3, 8 ounce Case of 27Thick & Easy Clear Thickened Cranberry Juice Cocktail, Honey Consistency, 46 OunceHormel Drink Thick & Easy Apple Juice (Honey Consistency), 4-Ounce Portion Control Cups (Pack of 24)Thick-It Aquacareh20 Thickened Decaffeinated Black Tea Beverage, Honey Consistency, 24 CountThick & Easy Clear Thickened Kiwi-Strawberry Drink, Nectar Consistency, 46 Ounce, Filed Under: dysphagia Tagged With: aspiration pneumonia, can't swallow, difficulty swallowing, dysphagia, honey thickener, instant food thickener, nectar thickener, paralysis, pneumonia, puree, pureed, pureed foods, stroke, swallowing, swallowing disorder, thickened beverages, tickened drinks, Your email address will not be published. To coincide with World Continence Week in June, Nursing Times ran a series of five free webinars from 20 to 24 June. Thank you for expressing interest in joining our mailing list and community. We use MailChimp as our marketing automation platform.
<> I think for the speech therapy profession working with industry is highly necessary.
You can unsubscribe at any time by contacting us at admin@email.researchoutreach.org. Rather than a one-size-fits-all solution, thickeners are a useful tool as part of a broader approach. Although use of modified texture diets is not specified in this case, it is likely that many of those seen by a speech and language therapist were advised to thicken fluids, suggesting there is an economic benefit to intervention. Nursing Times; 110: 12, 16-18.
As speech and language therapist Sandra Robinson points out, industry innovation can lead to direct patient benefits: the recent move towards using gum-based thickener rather than starch-based thickener was a really useful change for our patients, because it meant that the thickener looked nicer, had an improved taste, and was safer one of the most important aspects. What? was my reply.
The gum-based thickener also demonstrated a low incidence of drinks changing over time (for example, continuing to thicken). It forms part of NICE Guideline NG128. This may be due to a refusal to drink adequate fluids or an inability to drink without assistance.
Such as: These can include, but are not limited to: Dysphagia is usually assessed and treated by Speech & Language Therapists. Where patients feel thickener helps, though, this risk can be managed, for example by encouraging additional swallow movements after each sip. Simply combine these ingredients in a blender and process until smooth.
All were happy to join the evaluation, which took place in two stages: data was collected over three days during which the residents used their current starch-based thickener followed by three days when they used the gum-based thickener. Problems may arise as a result of: Individuals may have difficulties with a range of actions required for eating and drinking safely and efficiently. Your information helps us decide when, where and what to inspect. The acceptability, ease of use and mixing of both types of thickeners were assessed using staff questionnaires.
Visit our, Use of fluid thickener to reduce dysphagia risk, Nursing Times Workforce Summit and Awards, download a print-friendly PDF, including any tables and figures, Dysphagia management: using thickened liquids, The Dysphagia Diet Food Texture Descriptors, 190314 Use of fluid thickener to reduce dysphagia risk, Webinar series: Develop skills and improve quality of care. While much evidence exists to support the use of thickeners in dysphagia, multiple parties are often involved when it comes to the actual application of thickeners. Thickeners in practice One approach often used by SLTs is the addition of thickening agents to normal fluids to make them more viscous, and therefore easier for patients to swallow. Browser Support
Effective communication within the homes; Examination of the variety of meals and drinks that can be produced using a thickener.
How can we bring that ultimately to the patients benefit, sooner rather than later?
I wish I had known these existed when Mom was with me! Implementation of change within any organisation must have the support of key people to drive it forward (Barnett, 2014) so it is crucial to select the right people to attend the training sessions.
We felt that GP support for the evaluation was important to ensure continued use of the most suitable product after the evaluation; most GPs were happy to support the evaluation. You can adjust the recipe with more or less pineapple juice to achieve your ideal thickness. This included changing the thickeners used and ensuring there was some consistency with regard to the terminology used related to food textures, as well as undertaking staff training.
Nine homes were asked to participate in the evaluation and were assisted by Nutricia to gather data on use of both types of products. Particles of food end up in the lungs and, as we all know, thats not where it should be. Studies have shown that starch-based thickeners have an undesirable starchy flavour, are grainy in texture and cause lumping when mixed with fluid, making them less likely to be tolerated (Lotong et al, 2003). One of the most common concerns with dysphagia is that food or fluids go down the wrong way, potentially entering the lungs rather than the stomach.
Psychologists for advice about distress at mealtimes. Physical impacts Below you can select how youd like us to interact with you and well keep you updated with our latest content. We recognised the importance of ensuring they can drink safely and that we needed to introduce staff training and education on the issue.
Mixed Fruit Juice Notify me of follow-up comments by email. This recipe is both sweet and energizing, so it's perfect for a morning snack. If you have any questions about how we handle your data, please review our privacy notice.
https://doi.org/10.1001/archoto.2010.129. Note: Thickeners have no nutritional value and simply change the consistency of food or fluid. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
In addition to the physical effects of dysphagia, the condition also has a negative effect on quality of life.
As research has shown, there is a place for thickeners in dysphagia, but only if used correctly, monitored, reviewed and used in conjunction with other approaches such as swallowing rehabilitation and use of appropriate drinking vessels (Lippert et al, 2019). Are staff (including kitchen staff who prepare foods), trained on the use of thickeners, and on any food modifications required by individuals? We found this one to be very easy to use. Medicines: information for adult social care services, For further advice, contact medicines.enquiries@cqc.org.uk, IDDSI: Complete IDDSI framework - Detailed definitions (PDF).
If the recipe makes too much for you to drink in one serving, you can refrigerate the remaining smoothie to enjoy later in the day. Fluids thickened with a starch-based product have also been shown to become thinner over time as the thickener is broken down by amylase, the enzyme found in saliva, posing a potential safety risk. In contrast, gum-based thickeners have been shown to be more stable and maintain their thickness due to their amylase-resistant properties.
Staff feel empowered to improve nutritional practices to improve the quality of care for our residents with dysphagia, and are more aware of and confident in using the relevant screening tools and management guidelines available to them. Staff also reported being happy with the gum-based product and said residents preferred the texture, taste and appearance of that over the starch-based alternative. This site is dedicated to the most wonderful parents ever - Joe and Gertie.
The training brought together clinical and catering staff from the homes who have key responsibility for nutrition and hydration. We chose to work with Nutricia and developed a plan to introduce its gum-based thickener (Nutilis Clear).
Have all people who have dysphagia had an appropriate assessment? We decided to meet representatives from two key companies, one producing a starch-based thickener and one manufacturing a gum-based product. Research takes time and its companies like Nestl Health Science who can really help bring things along and say to the profession, Look, this is what we can deliver.
Therefore, multidisciplinary working between healthcare professionals is key to ensure that thickeners are used appropriately, especially where there may be a tendency to overthicken (Garcia and Chambers, 2019). Altman, K. W., Yu, G. P., & Schaefer, S. D. (2010). Many seniors experience dysphasia, or difficulty swallowing, as they get older. Foley et al (2008) found that using a combination of texture-modified diet, thickened fluids and intensive support from speech and language therapists resulted in reduced risk of aspiration for the first seven days after a stroke. I either served her food pureed or liquids were thickened to honey consistency. Due to the above symptoms, dysphagia has physical and emotional costs to the patient, as well as economic implications for healthcare systems. Staff felt it was easy and quick to mix and instructions were easy to follow.
How is it monitored?
Im happy to have that, just as Im happy to unlearn. Combine all the ingredients in your blender and process until smooth. This is where the role of producers in supporting the use of their thickeners is so paramount. Box 1 outlines correct use of fluid thickeners. Dysphagia can occur at any age, from premature babies, through to the elderly and those at the end of life. Emotional impacts Barchester Healthcare has actively worked in partnership with the following organisations to develop this unique game-based training tool: The Dysphagia Game is a board game for face-to-face engagement in healthcare. Phrases such as just add enough until it looks right or add some more if it looks too thin have been heard. However, you can still get the taste you love and all the beneficial nutrients of fruit with this recipe from UPMC.
Thickeners: The evidence for their appropriate use in dysphagia management Research OUTREACH. The NHS moves at a very, very slow pace, as do a lot of higher education institutes. We incorporated the Dysphagia Diet Food Texture Descriptors (National Patient Safety Agency et al, 2012) into our nutrition strategy to standardise terminology used by staff, but recognised that we needed to take a structured approach to education to ensure consistently high-quality care for people with dysphagia in all our homes. Results from the staff questionnaires showed that a gum-based thickener was clearer when mixed and easier to mix with fewer problems, and no lumping was reported (Table 1).
As a result of the evaluation we decided to extend the training nationally across all our homes. I dont think we can get results without each other. Whether its a patient or a peer, Im happy to question and learn new things. Lets find new ways of working together and help give patients exactly what they want.
I am forever grateful to them for their guidance, love, and support.
These handy already-thickened drinks would be great to take along on outings!
Forty Barchester Healthcare homes were asked to provide information about the number of people currently prescribed a thickener and what product this was.
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