Quality of care issues for dysphagia: modifications involving oral fluids

Abstract

Aims and objectives: This study examined practices of health care providers who thicken oral fluids for patients with impaired swallowing (dysphagia). It contrasts viscosity (thickness) of nectar-like and honey-thick consistencies prepared and measured in a laboratory setting to actual practices in health care settings and to guidelines of the National Dysphagia Diet.

Background: The care plans for many patients include changes to fluid thickness to maintain safe intake of oral fluids. Serving patients improperly prepared beverages may contribute to medical complications such as dehydration if patients consume less fluid, or aspiration of overly thin or thickened liquids, which may increase the risk of pneumonia.

Design: Descriptive analysis of group trends for viscosity measurements of liquids prepared by health care providers in four care settings to laboratory measurements and the National Dysphagia Diet.

Methods: Forty-two health care providers participated. Each prepared thickened samples in their natural work environment using typical procedures.

Results: Viscosity measurements of modified liquids prepared by health care providers did not compare favourably to published findings of laboratory viscosity measures or to the ranges of the National Dysphagia Diet. Participants who prepared overly thick or overly thin nectar-like liquids followed a similar pattern with honey-like samples. Many participants failed to use product label information in sample preparation.

Conclusions: Results suggest that many patients are served modified liquids that are too thick or too thin in relation to their target level of thickness, possibly increasing risk of further medical complications for those who consume them. Product directions that are too vague or general also may contribute to inaccurate results.

Relevance to clinical practice: The patient's nursing staff typically oversees nutritional care plans that may include modifications to oral fluids to enable their patients to safely drink by mouth. Additional consideration should be given to training procedures and possible noncompliance with preparation guidelines.