NACC South East
Christmas Seminar
Dysphagia Diet Food Texture Descriptors
Caroline Lecko
Patient Safety Lead
NPSA/RCN
Aims
To provide a background to the development of the new descriptors
To discuss what’s different
To discuss why it’s important
To provide an update on the international position
Dysphagia Diet Food Descriptors
 Launched in April 2011
 Developed by:
NPSA
RCSLT
NNNG
HCA
 Supported by:
NHS Supply Chain
 Endorsed by the NACC August
2011
 Engagement with industry
Why did we need new descriptors?
• Original descriptors issued in 2002 by the BDA &
RSCLT
• BDA review document published in 2009
• Recognised that there needed for engagement with
industry and caterers
• Compliance with National Descriptors for Texture
Modification in Adults was poor
• Requests from industry and caterers fro detailed
guidance on categories of texture
Examples from the National Reporting and
Learning System
•
patient requires soft moist diet . however soft options on menu not suitable as
contains lumps . patient started to cough and choke . patient was asked to stop
eating and rest for 30 minutes . patient recovered and to commence of puree diet
•
Patient was transferred to ward .... on .... , had been seen by colleagues and it
was recommended she have a syrup consistency fluids and soft diet due to
dysphagia . Went to review patient and found patient drinking normal fluids , with
difficulty . Spoke to a nurse who informed that the recommendations had not
been handed over , however the recommendations are recorded extensively in
notes , including nurses entry immediately prior to transfer .
•
Pt previously assessed by SALT as requiring a Soft Grey Diet / meal arrived with
boiled pots, whole peas & sweetcorn, should have been mashed pot, mushy peas
& no sweetcorn.
•
What new?
• Endorsement from all of the key professional
organisations
• All care settings are required to have 2 available
textures:
 Texture C (Thick Puree Dysphagia Diet)
 Texture E (Fork Mashable Dysphagia Diet)
• Texture D ( Pre-mashed Dysphagia Diet) & Texture B
(Thin Puree Dysphagia Diet) may be required in some
care settings
• Have been developed to include children
What does the new
document include?
• Specific standards for each texture B, C, D,
&E
• Audit checklists so that food can be
measured can be measured against the
standards for each texture
For example
General description:
√ Food has been pureed or has a puree texture. It does
not require chewing.
√ It is a thick puree*
√ It is smooth throughout with no ‘bits’ (no lumps,
fibres, bits of shell/skin, bits of husk, particles of
gristle/bone etc.) It may need to be sieved to
achieve this.
Check before serving:
× No hard pieces, crust or skin have formed during
cooking/heating/standing
× Fluid/gravy/sauce/custard in or on the food has not
thinned out or separated off.
•
Note – definition of ‘thick’ puree
Holds its shape on a plate or when scooped.
Can be eaten with a fork because it does not
drop through the prongs.
Food has been pureed or has
puree texture
Pass
Fail
Borderline
It does not require chewing
Pass
Fail
Borderline
It is smooth throughout with
no ‘bits’ (no lumps, fibres, bits
of shell/skin, bits of husk,
particles of gristle/bone, etc)
Pass
Fail
Borderline
No hard pieces of crust have
formed during
cooking/heating
Pass
Fail
Borderline
It has not thinned out and any
liquid within the food has not
separated off
Pass
Fail
Borderline
Holds its shape on a plate or
when scooped
Pass
Fail
Borderline
Can be eaten with a fork
because it does not drop
through the prongs
Pass
Fail
Borderline
Who are the descriptors for?
• Primarily designed
for food producers
• Useful for staff
teaching and training
So why is it important?
The risks – potentially life threatening
Malnutrition
Death
Aspiration
pneumonia
Dehydration
Choking
The risks – quality of life
Low selfesteem
Loss of
taste/smell
Embarrassment
Limited
social
activity
Loneliness
Anxiety
Depression
The role of food in the management of
dysphagia
• Impacts on both the potential life threatening
risks and quality of life issues
Dyphagia affects a lot of people
US –
Dysphagia
occurs in
approximately
51% - 71% of
patients with
stroke and
75% of nursing
home
More than
60,000 people
die annually
from
complications
related to
dysphagia,
making it the
sixth leading
cause of death
in the US.
22% of the
world’s
population
over 50 years
old are
affected by
oropharyngeal
dysphagia
20 – 30% of
patients within
acute care
59 – 60% of
residents in
care homes
99% of children with
severe cerebral palsy
have dysphagia
> 900,000 people in
England are living with
the effects of stroke
(NICE 2008). Of all
those with dysphagia
following stroke 76%
will remain with severe
and 15% profound
dysphagia
200/100,000 UK
population have
dysphagia due to PD.
More than 90% of
those with MND will
have dysphagia
27% of those with
COPD
68% of those with
dementia in homes
Between 50% 75% of nursing
home residents
5.27% of all adults
with LD were
referred for advice
regarding
dysphagia
10% of acutely
hospitalised elderly
The Global Picture
The Tango has just began ......
Potential for International
Dysphagia Descriptors
Potential collaboration with interest
from UK, Canada, Australia,
Ireland, so far
Discussed at the European Society
of Swallowing Disorders (ESSD) in
September 2011
Watch this space .......