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Chefs' Club 狠狠撸show Session 2
- 1. DCHC CHEF CLUB: NUTRITION & HYDRATION CHAMPION COURSE: AN INTRODUCTION TO DYSPHAGIA AND IDDSI. What does it all mean and why is it so important?!
- 2. TEXTURE MODIFIED FOOD & THICKENED DRINKS FOR PEOPLE LIVING WITH A SWALLOW DIFFICULTY
- 3. Our National Patient Safety Alerts These alerts require action to be taken by healthcare providers to reduce the risk of death or disability. Resources to support safer modification of food and drink 27 June 2018 “A review of National Reporting and Learning System (NRLS) incidents over a recent two-year period identified seven reports where patients appear to have come to significant harm because of confusion about the meaning of the term ‘soft diet’. These incidents included choking requiring an emergency team response, and aspiration pneumonia; two patients died. Actions Who: All organisations providing NHS funded-care for patients who have dysphagia or need the texture of their diet modified for other reasons, including acute, mental health and learning disabilities trusts, community services, general practices* and community pharmacies* What: ..” ensure that all relevant staff are aware of relevant IDDSI resources and importance of eliminating imprecise terminology including ‘soft diet’……..” When: To start immediately and be completed by 1 April 2019” Alert reference number: NHS/PSA/RE/2018/004
- 4. DYSPHAGIA – WHAT IS IT?: Medical term describing difficulty swallowing Estimated to affect over 51%* of people living in residential settings Can affect all age groups Can result in harm or even death * RCSLT “Guidance on the management of Dysphagia in Care homes”
- 5. WHAT CAUSES DYSPHAGIA? Medical conditions such as Covid 19, Stroke or cancer Progressive Neurological disease such as Parkinsons, Huntingdons, MND and Dementia Learning Difficulties and Birth Injury Frailty and Old age, End of life. Other – non-medical such as; no teeth or poorly fitting dentures; are unable to sit upright; are drowsy…
- 6. POSSIBLE CONSEQUENCES OF DYSPHAGIA Dehydration Malnutrition Aspiration Choking Falls Weight loss Constipation Fatigue and frailty Expressive behaviours Emotional ill-being Depression Confusion Infections Increased and longer hospital admissions
- 7. IDENTIFICA TION, SCREENING , ASSESSME NT. TAKE ACTION! Whose responsibility is it? All healthcare staff in all settings should be aware of Dysphagia risks how to identify it & how to assist feeding and drinking safely. Anyone identified as being at risk of Dysphagia should be referred for assessment by the SALT team using your local referral pathway.
- 8. Dysphagia: How would you recognise it? Is it under- recognised in your setting?
- 9. How can we provide food and drink safely to people living with dysphagia in our settings? Capacity – best interests?
- 10. PROFESSIONAL ASSESSMENT AND SUPPORT MAKE SURE YOUR LOCAL REFERRAL PATHWAY, SALT ASSESSMENTS AND CARE PLANS ARE KNOWN, RECORDED, REVIEWED, UP-DATED AND SHARED WITH THE WHOLE TEAM Nurse/ Community nursing team GP SALT Community Dietician Denti st Occupational health Families/IMCA
- 11. “it is recommended that each health community ensures that staff (including care assistants) working in all settings including care homes are adequately trained to identify dysphagia, manage coughing and choking (including the Heimlich manoeuvre, also known as abdominal thrusts) and in the principles of good practice relating to ‘Feeding Safely Routines’” “RCSLT dysphagia in care homes 2018” Feeding Safely Routines: Conscious level, Distraction, Time, Position Your position Utensils, Glasses and hearing aids, Independence Portion size Size of mouthful Documentation Other professionals Modified Diet and fluids
- 12. CHAMPION – SHARE THE KNOWLEDGE: THE DYSPHAGIA GAME A TRAINING GAME TO PURCHASE FOR GROUPS OR ONLINE HTTPS://WWW.DYSPHAGIAGAME.COM/ https://games.focusgames.co.uk/DysphagiaIDDSI/iPhone/index.php
- 14. The IDDSI framework was formally adopted in 2019 and replaces previous descriptors such as pudding, soft, honey, etc. Thickeners such as “Thick and Easy” now carry the new descriptors.
- 15. What is IDDSI? (international dysphagia descriptor standardization initiative) A global standard with terminology and definitions to describe texture modified foods and thickened fluids used for individuals with dysphagia of all ages, in all care settings, and for all cultures. The standardised descriptors and testing methods will allow for consistent production and easy testing of thickened liquids and texture modified foods. For people living with dysphagia, we should only use IDDSI descriptors and avoid using the term ‘soft diet.’ Incorrect food consistency can lead to choking and even
- 16. THE IDDSI FRAMEWORK CONSISTS OF A CONTINUUM OF 8 LEVELS (0-7). LEVELS ARE IDENTIFIED BY TEXT LABELS, NUMBERS, AND COLOUR CODES TO IMPROVE SAFETY AND IDENTIFICATION.
- 17. IDDSI – MODIFYING FOOD & DRINK
- 18. PARTNERS IN DYSPHAGIA TRAINING, FOOD PREPARATION AND FLUID THICKENERS Nutrition,Hydration,Dysphagia incollaborationwith Fresenius Kabi Limited Via MS Teams Discussing various aspects of this topic Next Session Thursday 2nd December 2021 (to be confirmed) Hosted by the Eastern Care Services Team
- 19. Guide to IDDSI. Bidfood UK
- 20. IDDSI TESTING METHODS & AUDITS WWW.IDDSI.ORG
- 22. IDDSI FORK & SPOON TESTS FOR FOOD LEVELS 3 - 7 Level 3 – Liquidised Level 4 – Pureed Level 5 – Minced and Moist Level 6 – Soft and Bite-sized Level 7 – Easy chew (courtesy of Nutricia UKIR Digital Team)
- 23. WHAT MEALS CAN I COOK TO MEET IDDSI? Most things – but do check with your SALT professional: Full English Salads Sandwiches Biscuits Cream tea Birthday cake https://www.nutricia.co.uk/content/da m/dam/amn/local/gb/approved/pdf/n utriciahcp-nutilis-clear-recipe- book.pdf
- 24. FOODS TO AVOID: Fibrous Vegetables such as leeks and celery Foods with Pith or skin such as grapes Anything that changes texture in the mouth such as jelly or water melon Floppy food such as lettuce or cucumber
- 25. EQUIPMENT FOR TEXTURE MODIFYING FOOD robu st Easy to clean Large enough Domestic or commercial?
- 26. FACTORS THAT CAN CHANGE THE CONSISTENCY OF TEXTURE MODIFIED FOOD: Temperature Content Reheating method Safety point: Always check the consistency and temperature of meals at point of service
- 27. THICKENING UP & THINNING DOWN Thicken up: Prescibed thickeners (medication) eg Thick & Easy, Nutilis, Thicken-up Thickening granules eg Mc Dougalls Natural food starch eg potato or Smash Thickening agents eg Sosa products – vegetal, instangel, pro-pannacotta etc Temperature - chill Thinning down: Milk/Cream Stock/Gravy Custard Fruit Juice/puree Condensed Milk Chocolate sauce/buttercream icing Fortified milk
- 28. ADDING CALORIES AND NUTRIENTS: The importance of fortification: “The use of modified-texture foods, particularly pureed diets, contributes to the high prevalence of malnutrition in those with dysphagia, especially in long-term care residents. A reduction in food intake is common, and pureed diets are often poorer in calories, protein and micronutrients than regular diets.” O’Keeffe, S.T. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. BMC Geriatr 18, https://www.rdash.nhs.uk/wp- content/uploads/2018/08/DP8201-Food-First-leaflet- 08.18-3.pdf
- 29. Sample IDDSI recipe methods (level 4): (Nutricia) : 1. Chicken Fricassee 2. Coffee Cake Don’t forget: Fortify, Taste, Season, Test, Present.
- 30. Key messages ? Training – identification, support, correct terminology, correct texture/thickness, ? Referrals & Support – who, where, how? ? Funding & Budget – extra time to support eating and drinking, extra cost of ingredients – eg fortification, thickeners ? Document and Evidence – care plans, risk assessments, policies and procedures, share with whole team ? Capacity, best interests. Involvement in decision-making and choice, ? Food first – dysphagia food and drink not only has to been nutritionally valuable and the right texture, it has to look, smell and taste good – would you want to eat it every day? (biozoon) ? Dignity in Dining – always remember how it must feel
- 31. NHS PATIENT SAFETY ALERT 27/04/21 Addition of a polyethylene glycol (PEG)-based laxative to a liquid that has been thickened with a starch-based thickener may counteract the thickening action, placing patients with dysphagia at a greater risk of aspiration. Constipation and dysphagia coexist more commonly in the elderly and in people with disabilities that affect swallowing. Therefore these populations may be of particular risk if a PEG laxative is added to liquid thickened with starch. PEG laxatives – Movicol, Macrogel 3350, Movipeg
- 32. NHS PATIENT SAFETY ALERT 05/02/15 Stage One: Warning Risk of death from asphyxiation by accidental ingestion of fluid/food thickening powder 05 February 2015 NHS England has received details of an incident where a care home resident died following the accidental ingestion of the thickening powder that had been left within their reach. Whilst this death remains under investigation, it appears the powder formed a solid mass and caused fatal airway obstruction.
- 33. IDDSI AND DYSPHAGIA – RESOURCES: www.iddsi.org official website with all the information on different textures and testing methods Other useful resources/training: https://portal.e-lfh.org.uk/LearningContent/LaunchForGuestAccess/651254 EDSCF.pdf (e-lfh.org.uk) Dysphagia - e-Learning for Healthcare (e-lfh.org.uk) https://www.nutricia.ie/content/dam/dam/amn/local/gb/approved/pdf/nutriciahcp-nutilis-clear-recipe-book.pdf https://www.rcslt.org/wp-content/uploads/media/Project/RCSLT/inter-professional-dysphagia-framework.pdf https://www.skillsforcare.org.uk/Documents/Events/RM-conference/RCSLT-dysphagia-in-care-homes.pdf https://www.skillsforcare.org.uk/Documents/Learning-and-development/Care-Certificate/Standard-8.pdf https://www.uwl.ac.uk/research/research-centres/richard-wells-centre/i-hydrate Dorset HealthCare :: The golden rules of swallowing (PEARS) Nb: Be aware that online and printed resources prior to 2019 may use the wrong descriptors – eg “level 7 easy chew” was added later
- 34. And finally! Any questions? www.iddsi.org NEXT SESSION ON THURSDAY OCTOBER 28TH: NUTRITIONAL SCREENING & FORTIFICATION Information from this week: 1. Dysphagia – what it is and the consequences, how to recognise it, who can help, safe feeding and drinking strategies, texture modification for different IDDSI levels. 2. IDDSI – the framework. “for people living with Dysphagia we should only use IDDSI descriptors and avoid the term “soft diet” 3. Partners and resources. Actions: Work with your clinical/care team and manager to identify any actions required. For example: 1. Review anyone in your setting who has or may have Dysphagia and check you have the correct and up to date assessment/care plan/information in the kitchen 2. Carry out an audit of each level you produce using: https://iddsi.org/IDDSI/media/images/AuditSheets/Au ditToolL6SoftAndBiteSized26Jun2020.pdf Finally: Complete quiz and survey on Google forms.