JCPSLP Vol 19 No 2 2017

Shaping innovative services: Reflecting on current and future practice

The role of speech- language pathologists in food services A survey Katina Swan, Rachel Wenke, Marie Hopper, and Melissa Lawrie

Among allied health practitioners, dietitians have historically had the greatest involvement with food services. However, speech- language pathologists (SLPs) may work with food services when managing issues related to texture-modified diets and fluids. To date, the role of SLPs in food services has not been reported in the literature. A total of 116 SLPs from Australia and New Zealand completed an online survey investigating SLPs’ self- reported duties relating to food services, prevalence of dedicated food services SLP roles, and SLP perceptions of such a role. Results indicated that the majority of SLPs absorb food-services-related tasks into infrequently reported (8% of respondents), most SLPs (85%) perceived a dedicated role as having the potential to improve the quality and safety of patient care, enhance the relationship between SLPs and food services, and improve service-wide management of texture-modified diets and fluids. S wallowing difficulty, or dysphagia , is a common condition affecting people across the spectrum of care settings. Prevalence is estimated to be 16% in the general community (Eslick & Talley, 2008) and higher in populations with specific conditions such as stroke, dementia and Parkinson’s disease (Takizawa, Gemmell, Kenworthy, & Speyer, 2016). An Australian study indicated that up to one-quarter of hospital inpatients present with dysphagia on screening (Cichero, Heaton, & Basset, 2009). Dysphagia may result in a number of serious health conditions including malnutrition, dehydration, choking, and aspiration pneumonia (Lancaster, 2015), the latter being an acute lung infection that develops from aspiration of material from the oropharyngeal or upper gastric tracts (DiBardino & Wunderink, 2015). In Australia and New Zealand, dysphagia management is a role of the SLP and often involves prescription of texture modified diet and fluids (Jukes et al., 2012; Speech Pathology Australia, existing SLP clinical roles. Although dedicated roles in food services were

2012). These modified diets and fluids control the rate, or ease the transit of food and fluids through the oral cavity and pharynx in order to reduce the risk of aspiration and choking (Garcia & Chambers, 2010). When patients do not receive, or adhere to, the recommended diet and fluids, there may be severe repercussions. For example, in a retrospective study of 140 patients with dysphagia, Low, Wyles, Wilkinson, and Sainsbury (2001), reported that patients who did not comply with their prescribed diet recommendations had a higher mortality rate. Aspiration pneumonia was a common cause of death. Although no current figures are available on the cost of dysphagia within the Australian health care context, the cost is likely considerable based on international estimates. For example, the yearly cost of dysphagia in the North American acute care setting has been estimated to be US$547 million (Altman, 2010). Aspiration pneumonia is the second most common diagnosis among Medicare patients in North America (DiBardino & Wunderink, 2015). An episode of care for aspiration pneumonia costs US$17,000 (Cichero & Altman, 2012). Given the costs to both individuals and health services, effective management of dysphagia and accurate delivery of texture modified diet and fluids is paramount. Correct provision of diet and fluids to patients within health care settings involves input from several disciplines, including nurses, ward clerks, SLPs, dietitians, fluid preparation staff and personal service staff (Zaga & Sweeney, 2014), making it everyone’s business. Food services, or kitchen staff, in particular have an important role to play in the delivery of correct texture-modified diets and fluids. “Food services” is the term widely used in Australia to refer to the non-clinical ancillary staff involved in producing and delivering meals and fluids to patients (Xia & McCutcheon, 2006). These staff include chefs, cooks, stores officers, menu monitors, kitchen supervisors and managers. Due to the number and diversity of staff involved in the provision of correct diets and fluids in health care settings, there is significant potential for error to occur. Synthesis of the available literature indicates that failure to comply with texture-modifications in health care settings may arise from both accidental errors (i.e., due to systemic or process errors) and intentional non- compliance by staff. For example, a study was undertaken in an English acute hospital in which compliance with SLP diet recommendations for patients with dysphagia was audited (Rosenvinge & Starke, 2005). The authors

KEYWORDS DYSPHAGIA FOOD SERVICES ROLE SPEECH-

LANGUAGE PATHOLOGY

TEXTURE MODIFIED

THIS ARTICLE HAS BEEN PEER- REVIEWED

Katina Swan (top) and Rachel Wenke

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology