Abstract
Ensuring inpatients with dysphagia receive and consume the correct texture-modified diet and thickened fluid prescriptions is challenging, and errors can result in significant complications for patients and increased costs to hospitals. The aim of this study was to investigate underlying factors that help or hinder receipt and consumption of correct dietary prescriptions for people with dysphagia in the hospital setting then implement and evaluate a range of strategies to address identified issues. A mixed-methods study design, using an integrated knowledge translation approach, was conducted in three phases. In Phase 1, clinical incident data (i.e., documented incidents of diet/fluid errors, with errors defined as the provision or consumption of any food/fluid not appropriate for a patient’s dietary prescription) were analyzed, and staff, patients, and family members were interviewed using the Theoretical Domains Framework to identify factors contributing to errors. In Phase 2, health professionals assisted with the development and implementation of interventions targeted at micro (patient/family), meso (staff), and macro (organizational) levels to address factors identified in Phase 1. In Phase 3, outcomes including the change in number of dietary clinical incidents pre- to post-intervention, meal accuracy error rates from mealtime audits post-intervention, and follow-up interviews were evaluated using quantitative and qualitative measures. Post-intervention, there was a 50% reduction in clinical incidents, and a 2.3% meal accuracy error rate was observed. Staff reported most interventions were acceptable and feasible within their workload, although some interventions were not well embedded in everyday practice. This study highlights the value in using an integrated knowledge translation approach to inform tailored interventions targeting improved dietary accuracy in the hospital setting.
Similar content being viewed by others
References
Cichero J. Thickening agents used for dysphagia management: Effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12(1):54.
Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2009;39(1):39–45.
Altman KW, Yu G-P, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol-Head Neck Surg. 2010;136(8):784–9.
Sutherland JM, Hamm J, Hatcher J. Adjusting case mix payment amounts for inaccurately reported comorbidity data. Health Care Manag Sci. 2010;13(1):65–73.
Jukes S, Cichero JA, Haines T, Wilson C, Paul K, O’Rourke M. Evaluation of the uptake of the Australian standardized terminology and definitions for texture modified foods and fluids. Int J Speech Lang Pathol. 2012;14(3):214–25. https://doi.org/10.3109/17549507.2012.667440.
McCurtin A, Healy C. Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice. Int J Speech Lang Pathol. 2017;19(1):69–76.
Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293–314.
Steele CM, Namasivayam-MacDonald AM, Guida BT, Cichero JA, Duivestein J, Hanson B, Lam P, Riquelme LF. Creation and initial validation of the international dysphagia diet standardisation initiative functional diet scale. Arch Phys Med Rehabil. 2018;99(5):934–44.
Penman J, Thomson M. A review of the textured diets developed for the management of dysphagia. J Hum Nutr Diet. 1998;11(1):51–60.
Andersen UT, Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (≥ 18 years) with oropharyngeal dysphagia. SPEN J. 2013;8(4):e127–34.
Steele CM, Alsanei WA, Ayanikalath S, Barbon CA, Chen J, Cichero JAY, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B, Lam P, Lecko C, Leigh C, Nagy A, Namasivayam AM, Nascimento WV, Odendaal I, Smith CH, Wang H. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015;30(1):2–26.
Murray J, Doeltgen S, Miller M, Scholten I. A survey of thickened fluid prescribing and monitoring practices of Australian health professionals. J Eval Clin Pract. 2014;20(5):596–600.
Speech Pathology Association of Australia Limited. Clinical guideline: dysphagia. Victoria: Speech Pathology Association of Australia Limited; 2012.
Royal College of Speech Language Therapists (2020) Dysphagia overview. https://www.rcslt.org/speech-and-language-therapy/clinical-information/dysphagia#section-2. Accessed 06 Aug, 2020
American Speech-Language-Hearing Association (2020) Adult dysphagia. https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942550§ion=Treatment. Accessed 06 Aug, 2020
Dietitians Association of Australia, Speech Pathology Association of Australia Limited. Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions. Nutr Diet. 2007;64:S53–76.
Low J, Wyles C, Wilkinson T, Sainsbury R. The effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy. Dysphagia. 2001;16(2):123–7.
Berzlanovich AM, Fazeny-Dörner B, Waldhoer T, Fasching P, Keil W. Foreign body asphyxia: a preventable cause of death in the elderly. Am J Prev Med. 2005;28(1):65–9.
Larby A, Roberts S, Desbrow B. Accuracy and adequacy of food supplied in therapeutic diets to hospitalised patients: an observational study. Nutr Diet. 2016;73(4):342–7.
Rattray M, Desbrow B, Roberts S. Identifying errors in meals provided to and sourced by patients on therapeutic diets in hospital. Asia Pac J Clin Nutr. 2018;27(3):533.
Rosenvinge SK, Starke ID. Improving care for patients with dysphagia. Age Ageing. 2005;34(6):587–93.
Folio D, O’Sullivan-Maillet J, Tougher-Decker R. The spoken menu concept of patient foodservice delivery systems increases overall patient satisfaction, therapeutic and tray accuracy, and is cost neutral for food and labor. J Acad Nutr Dietetics. 2002;102(4):546.
Zaga C, Sweeney J. Reducing error in a complex system: Texture modified diet and fluid provision. J Clin Pract Speech-Lang Pathol. 2014;16(3):46–50.
Esmail R, Hanson HM, Holroyd-Leduc J, Brown S, Strifler L, Straus SE, Niven DJ, Clement FM. A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implement Sci. 2020;15(1):1–14.
Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, Foy R, Duncan EM, Colquhoun H, Grimshaw JM. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.
Rycroft-Malone J, Bucknall T. Models and frameworks for implementing evidence-based practice: linking evidence to action. Oxford: Wiley; 2010.
Canadian Institutes of Health Research. Guide to knowledge translation planning at CIHR: integrated and end-of-grant approaches. Ottawa: Canadian Institutes of Health Research; 2012.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof. 2006;26(1):13–24.
Ivankova NV, Creswell JW, Stick SL. Using mixed-methods sequential explanatory design: from theory to practice. Field Methods. 2006;18(1):3–20.
Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(1):37.
Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.
Kaizer F, Spiridigliozzi AM, Hunt MR. Promoting shared decision-making in rehabilitation: development of a framework for situations when patients with dysphagia refuse diet modification recommended by the treating team. Dysphagia. 2012;27(1):81–7. https://doi.org/10.1007/s00455-011-9341-5.
Harvey G, Kitson A. Implementing evidence-based practice in healthcare: a facilitation guide. London and New York: Routledge; 2015.
Kothari A, Wathen CN. A critical second look at integrated knowledge translation. J Health Policy. 2013;109(2):187–91.
Crowe C, Manley K. Assessing contextual readiness: the first step towards maternity transformation. J Int Pract Dev. 2019;9:2. https://doi.org/10.19043/ipdj.92.006.
Wickstrom G, Bendix T. The "Hawthorne effect”- What did the original Hawthorne studies actually show? Scand J Work Environ Health. 2000;26(4):363–7.
Acknowledgements
The authors would like to thank all participants who took part in the study and also Xavier Tham, Helen Ealding, and Michelle Hunt for their assistance with data collection.
Funding
This study was funded by Gold Coast Health Private Practice Trust Fund Project Investment Grant (Grant Number 022 – 01.02.17), Gold Coast Health Allied Health Research Clinical Backfill Scheme, and Gold Coast Health Allied Health Research – research development support.
Author information
Authors and Affiliations
Contributions
MH, SR, RW, ZH, LB, and APM contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The manuscript was drafted by Marie Hopper with input from all authors. All authors undertook critical appraisal of the manuscript and read and approved the final version of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
All authors are employees of Gold Coast Hospital and Health Service, where this study was undertaken; Authors Andrea Marshall, Shelley Roberts, and Rachel Wenke have multiple affiliations, as outlined on the title page above.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Hopper, M., Roberts, S., Wenke, R. et al. Improving Accuracy of Texture-Modified Diets and Thickened Fluids Provision in the Hospital: Evidence in Action. Dysphagia 37, 488–500 (2022). https://doi.org/10.1007/s00455-021-10294-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-021-10294-4