NACC South East Christmas Seminar

Dysphagia Diet Food Texture Descriptors

Caroline Lecko

Patient Safety Lead

NPSA/RCN

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?

• Impacts on both the potential life threatening risks and quality of life issues

The Global PictureThe 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 .......