| TOPIC | Supporting Consumers with Modified Diet Procedure | ||
| AREA | Service Delivery | TYPE | Procedure |
1. Procedure
The purpose of this operating procedure is to provide instruction to Support Workers on how to effectively prepare meals for people we support who have a modified diet for Consumers who have mild to moderate dysphagia. If a Consumer is diagnosed with severe dysphagia, please refer to the Severe Dysphagia and Modified Diet Procedure.
Definitions
| Meal preparation | The process of planning and preparing meals with and/or on behalf of a Consumer. It may involve shopping for food, washing, chopping, cooking and storage of food. |
| Nutrition | Nutrition is about eating a healthy and balanced diet. Food and drink provide the energy and nutrients we need to be healthy |
| Dysphagia | Difficulty in swallowing. |
| Choking | Airway partly or completely blocked |
| Aspiration | Food or drink enters the airway, then the lungs |
| International Dysphagia Diet Standardisation Initiative (IDDSI) | An internationally recognised classification scheme to describe the texture of food and fluids prescribed in modified diets. |
| Positioning | How we position ourselves when we eat and drink. |
International Dysphagia Diet Standardisation Initiative:
Food and fluid are modified to make it safer and easier for people to eat and drink.
Before preparing meals or assisting a person with a modified diet it is important to understand what the ‘normal’ swallowing process involves. Watch the one-minute (1:09) video:
https://www.nestlehealthscience.com.au/health-management/dysphagia/drinking-with-dysphagia
When a Consumer’s swallow is impaired foods and fluids are modified to reduce the likelihood of choking and aspiration. The Consumer’s Support Plan will describe the way foods and fluids are modified according to the International Dysphagia Diet Standardisation Initiative.
| Food | Fluid |
| Regular | Thin |
| Easy to chew | |
| Soft and bite sized | Slightly thick |
| Minced and moist | Mildly thick |
| Pureed | Moderately thick |
| Liquidised | Extremely thick |
2. Scope
This procedure applies to Support Workers who prepare meals, assist with eating and drinking for Consumers who have a modified diet due to mild or moderate dysphagia.
The meal preparation process may commence at the point of shopping and choosing food, to preparing, cooking and storage of food items. Consumers must be involved in the choice and preparation of foods and drinks as much as possible.
When assisting a Consumer with dysphagia to drink or eat it is vital to ensure:
- Correct positioning of the Consumer
- Correct consistency of the food or fluid (use the IDDSI test instructions until you are familiar with the correct consistency).
- Correct equipment (modified cups, spouts or cutlery)
- Correct process – e.g. a double swallow technique; checking inside the mouth for food remnants and encouraging the Consumer to clear these if they can if not perform oral toilet.
3. Procedure
When preparing meals with and for Consumers and when assisting Consumers to eat and drink, we recognise that mealtimes may invoke strong connections to family and friends. Support Workers are encouraged to engage with Consumers during meal activities and listen and respond to Consumer preferences and nutritional requirements.
Where applicable, Support Workers will adopt a “do with, not for” approach when supporting Consumers to prepare and eat meals/drinks.
Support Workers are to use this procedure as a guide and an education tool for Consumers. Support Workers will, where applicable, support Consumers to assist with their own meal preparation and to do so in a safe and hygienic manner.
Support Workers will recognise that food safety is an integral part of the meal preparation process and will handle and store food to minimise the risk of contamination(refer to the Meal Preparation Procedure).
Meal preparation
Follow the meal preparation procedure. Refer to the Consumer’s Care Plan to ensure that you are preparing the Consumer’s food and drinks in accordance to their modified diet instructions.
A guide for fluids:
All fluids other than thin fluids will need to have a thickening agent added to the fluid to achieve the right consistency. Follow the instructions on the thickening agent label to ensure you get the right fluid consistency.
| Thin | Consistency of tap water. |
| Slightly thick | Thicker than water but can still be drunk through a straw. Some fluids are already slightly thick such as fruit nectar or cold milk. |
| Mildly thick | Mildly thick fluids flow at a slower rate. They are the consistency of a thick shake and will need to be drunk through a thick straw or from a cup. Follow instructions on the thickening agent to achieve a mildly thick consistency. |
| Moderately thick | Moderately thick fluids are used when people have poor tongue control. Moderately thick fluids give a person more time to ‘hold and move’ the fluid in their mouth. These fluids are best taken from a cup or using a spoon. Follow the instructions on the thickening agent to achieve the required consistency. As a guide when the fluid is scoped up with a fork the fluid should drop in dollops from the fork. |
| Extremely thick | These fluids are extremely thick and if you were to take a spoon or a fork they sit in a mound or pile above the fork. Ensure that the fluid is not firm or stick. See: |
Common thickening agents in Australia:
These thickening agents are commonly used in hospitals and residential aged care facilities in South Australia. They are readily available for purchase via the internet.
- Easythick
- Instant thick
- Thickplus
https://www.flavourcreations.com.au/products/dysphagia/thickening-powders
- Resource thickenup clear
https://www.nestlehealthscience.com.au/health-management/dysphagia/drinking-with-dysphagia
A guide for foods:
Fluid consistency testing
To ensure you have prepared the correct thickness of fluid for a Consumer use a 10ml syringe. Place the fluid you have prepared in to the syringe and then time the amount of fluid that flows from the syringe after 10 seconds.
The amount of fluid left in the syringe should correspond with the IDDSI level, for example for Level One there should be between 1-4mls left in the syringe after ten seconds.
Positioning
In addition to modified food and fluid Consumers may have instructions from their Speech Pathologist that promote safe swallowing.
What is a safe eating position?
Appropriate positioning of the person’s head, neck and body can make the difference between safe and unsafe swallowing. An ideal safe eating position (see illustration below) means:
- seated, as upright as possible
- ‘90‐90‐90,’ meaning the hips, knees and ankles are each positioned at 90 degrees
- head is not turned to either side, not tilted up and not excessively tilted down.
Watch carefully. You may need to reposition the person during the meal. It is vital that you sit directly in front of the person you are supporting to eat and drink – this will allow you to maintain eye contact during the meal and observe for any signs of distress or discomfort.
Source: Mealtime Support Resources, 4th edition | June 2019
© The State of Queensland (Centre of Excellence for Clinical Innovation and Behaviour Support)
- Take small mouthfuls / sips.
- Alternate mouthfuls of food and drink.
- Allow one or two swallows per mouthful.
- Avoid talking whilst eating and drinking.
- Use teaspoon / dessertspoon.
Assistive Equipment:
- Use a cup with a spout.
- Only use a straw if recommended by the Speech Pathologist.
Useful safety tips:
- Listen to the voice – if it sounds “wet”, cough and clear the throat then swallow again
- Stop eating if there is ongoing coughing, choking, gurgly voice or pooling of food in the mouth
- Take frequent pauses during the meal
- Check that the mouth and cheeks are free from food after eating
- Other as specified in the Consumer’s Support Plan.
Changes in Consumer condition, risks, incidents – identification and reporting
If a Support Workers member is concerned about any change in condition of the Consumer, they will follow the AWACCS notification process or Incident and Near Miss Management Procedure, including:
- Ensure the Consumer’s health needs are addressed in the first instance by providing first aid if applicable
- If you are not a nurse or other health professional, speak to your supervisor about contacting the regular Medical Officer and if that person is unavailable an alternative Medical Officer must be notified e.g., a locum service, OR,
- Record the AWACCS or incident and case note in the Consumer record as soon as the Consumer’s needs are addressed.
4. Related Documents
6.1 Internal
- Severe Dysphagia and Modified Diet Procedure
- Consumer Support Plan
- Model Of Care
- Consumer Profile Form
- Incident and Management Procedure
- Dignity of Risk and Duty of Care Procedure
- Meal Preparation Procedure
- Swallowing and Choking Procedure
- Meal Preparation Procedure
6.1 External
- Mealtime Support Resources, 4th edition June 2019
- © The State of Queensland (Centre of Excellence for Clinical Innovation and Behaviour Support)
- NDIS Practice Standards and Quality Indicators 2020 (Cth)
- NDIS Practice Standards: Skills Descriptors, Version 1 July 2018
- https://iddsi.org/Resources/Patient-Handouts
- National Disability Insurance Scheme Act 2013 (Cth)
- Aged Care Quality of Care Principles 2014 (Cth)
- United Nations Convention on the Rights of Persons with Disabilities (ratified by Australia in 2008)
5. Document History
Reviewed by: Group Practice and Clinical Governance Lead
Authorised by: The CEO
Date Adopted: August 2022
Next Review Due: March 2025
Version Control
| Version | Date | Change |
| 1.0 | August 2022 | New |