Nor a sloppy diet.
Nor a runny diet.
Nor a chopped diet.
Nor a mashed diet.
Nor a dysphagic diet.
Because the wrong texture diet can kill.
Patient Safety Alert
They looked at National Reporting and Learning System (NRLS) incidents over a recent two-year period. It identifies seven reports where patients appear to have come to significant harm. They came to harm because of confusion about the term ‘soft diet’.
These incidents included choking, which required an emergency team to respond, and aspiration pneumonia. Two patients died.
It highlights an incident; “Patient with documented dysphagia given soft diet including mince and peas at lunch…unresponsive episode…. Difficulty ventilating patient overnight. Peas [suctioned out via] endotracheal tube.”
Before the IDDSI Framework[ii], there were several different ways to describe food and drink but no consistent and agreed terminology. One department may use a different term from another. One doctor may use a different term from another.
Effective communication in healthcare is key.
Food and drink might not seem as important as medication or surgery. But it is. Food and drink play an important role in recovery, overall health and quality of life.
Giving someone mince and peas when the person with dysphagia needs a specific IDDSI Level diet fails that person on several levels;
- The consistency could choke them
- The consistency could result in aspiration leading to possible chest infection or pneumonia
- The consistency could be too difficult and food goes uneaten; over time this leads to malnutrition
- The consistency could be difficult to pass and it sticks in the throat or oesophagus, possibly regurgitated, which can also cause aspiration
- Assumptions are made that can be fatal; just because one person with dysphagia managed mince with peas without overt signs of difficulty once does not mean every person with dysphagia will manage
- A culture of “that’ll do” arises rather than “this is what’s necessary and important”
- The focus is on the system of food delivery rather than the person with dysphagia
- It reflects a lack of understanding and appreciation of what dysphagia is and its consequences
It’s not for just people with dysphagia
One of the interesting results of the NRLS review was that using the IDDSI Framework could benefit everyone, not only those with dysphagia. The PSA states, “For practical reasons and to reduce the risk of errors, IDDSI food texture descriptors also need to be adopted for patients who do not have dysphagia but for other clinical reasons need a modified texture diet equivalent to IDDSI levels 6 to 4 (usually in the short-term).” [my emphasis]
Hello there surgical and gastro colleagues! No more ‘sloppy diet’ please!
I’m probably not the only speech therapist who has received a referral from an acute ward confused about why someone is on a sloppy/purée/liquid etc. diet and they check to see if it’s a swallowing issue. Fortunately, it’s often a nurse who spots this and refers to ‘SALT’. We can then double-check and provide clarity.
The PSA goes on to state that, “The needs of non-dysphagia patients should be noted in care
plans, including steps to address the cause of the problem and return them to a normal texture diet as soon as possible. We would not expect these patients to need to be prescribed thickeners.” [Again, my emphasis – unwise use of thickeners… another topic for another day].
Are healthcare professionals aware of the IDDSI Framework terminology and that it can be used for patients without dysphagia too?
What can be done to improve education and communication around descriptions of food (and drink) in hospitals, rehab units, care homes, community and in social care?
What good practice have you seen?
Look forward to reading your comments!
[i] NHS Improvement. 2018. Patient Safety Alert. Resources to support safer modification of food and drink. 27 June 2018. Alert reference number: NHS/PSA/RE/2018/004. [Online] Available from: https://improvement.nhs.uk/documents/2955/Patient_Safety_Alert_-_Resources_to_support_safer_modification_of_food_and_drink_v2.pdf Accessed 27/09/2020.