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found that inappropriate food being brought from the kitchen accounted for 54% of non-compliance incidents. In Australia, SLPs working in non-metropolitan health care settings also reported the actions of other staff, such as kitchen and ancillary staff, impacted compliance with SLP recommendations (Smith-Tamaray, Wilson, & McAllister, 2011). In addition to accidental or systemic errors, lapses may occur as a result of the attitudes and proficiency of staff. For instance, food services staff have been reported to lack knowledge of patient-specific needs, and/or hold untrue beliefs about dysphagia (Broz, 2009). A survey of food preparers and food deliverers at a large North American health care facility found 88% did not see the potential for pneumonia as a primary concern when patients aspirated liquids (Broz, 2009). Within Australia, food services personnel in some government health services complete an in-house mandatory food safety program which includes topics such as safe food handling, storage and transport, and health and hygiene of food handlers. However, the program does not routinely include information about dysphagia and texture modified diets or fluids. Such evidence reveals the need for SLPs not only to communicate and collaborate with food services staff, but to support development of knowledge about dysphagia within food services. Walton (2012), in an article reviewing opportunities for food services to improve practices in hospitals and residential aged care facilities, likewise suggested that health professionals need to build their knowledge of food services and challenge their perceptions of Food Services as “‘non-clinical”‘. Indeed, the perception of food services as a non-clinical service may have contributed to Ross, Mudge, Young, and Banks’ (2011) finding of a lack of clear “‘ownership”‘ regarding the nutritional intake of older hospitalised patients, ultimately impacting health and well-being outcomes. In the study by Ross et al. (2011), health care professionals working in a large tertiary hospital were interviewed regarding their perceptions of barriers to feeding and nutrition of hospitalised older adults. The findings included barriers such as poor communication between disciplines, lack of a sense of shared responsibility or a coordinated approach, competing priorities, and inadequate practical knowledge of nutrition care processes. Currently, the clinical staff who most commonly engage with food services are dietitians. However, a recent review of the role of dietitians in food services (Walton, 2012) advocated for more health care professionals to work with food services, noting that “it is imperative the health care professionals of today and tomorrow have more than a common interest in food and mealtimes” (p. 224). Although SLPs have a vested interest in correct provision of texture modified meals and fluids, and have been mentioned as “champions” advocating within their organisations for uptake of Australian national standards pertaining to texture modified foods and fluids (Jukes et al., 2012), there is a dearth of literature regarding the role of the SLP in food services. Although not specifically related to SLPs’ role in food services, the literature describes the need for coordinated multidisciplinary input at the individual patient level and at a food services level, to address issues of dysphagia (Bourdel-Marchasson, 2010; Ross et al., 2011; Zaga & Sweeney, 2014) and maximise patient safety. Zaga and Sweeney (2014) reported an example of the effect of SLPs collaborating with food services. In their project to reduce

the frequency of delivery of incorrect texture-modified diet and fluids, an intervention was designed to increase efficiency of services and communication and engagement between staff. The team that designed the intervention was multidisciplinary, comprising SLPs, nurse unit managers and the food services coordinator. This multidisciplinary collaboration resulted in a decrease in the number of meals of incorrect textures being delivered to patients. Anecdotally, SLPs are often involved with food services in Australia and New Zealand, including being part of working groups, advocating dietary recommendations and providing education. For example, in Queensland, Australia, the Queensland Health Speech Pathology Food Services Network includes a working group of SLPs with an interest in food services who are involved in both site- and state-level quality improvement tasks. This includes auditing items from the state-wide menu to assess compliance with national standards for texture modification, and collaborating on projects such as testing recipes for thickening fluids. However, these projects are often undertaken within existing, time-poor clinical roles. Despite anecdotal evidence that highlights the range of different tasks undertaken by SLPs in food services, there is a lack of published literature which describes the current practices of SLPs with regards to food services in the health care context. In light of this, the aim of this study was to explore the following within Australian and New Zealand health care settings: • the prevalence and practices of SLPs working in “dedicated” food services roles; • the nature of food services tasks undertaken by SLPs within existing general clinical roles; and • SLP’s perceptions of an existing or hypothetical dedicated SLP role in food services. Authors used the term “dedicated” to indicate SLPs that had funding for, or time exclusively allocated to, working on activities related to food services. Methods A pilot, prospective, cross-sectional survey was undertaken with a sample of SLPs within Australia and New Zealand. Ethics review was waived by the local Hospital and Health Service Human Research Ethics Committee (reference HREC/16/QGC/46) as the activity was deemed a Quality Activity. Participants A total of 1683 SLPs were invited to participate in an online survey. The survey is available upon request from the corresponding author. The survey was distributed to SLPs in Australia and New Zealand via Speech Pathology Email Chats (SPECS) and the Queensland Leaders in Speech Pathology (LISP) group now called the Queensland Health Speech Pathology Advisory Committee (QHSPAC). Emails containing the link were also sent directly to 26 speech- language pathology departments of tertiary health services identified within the Health Round Table data (The Health Round Table, 2015). A total of 116 SLPs completed the survey, most (80%) were from metropolitan health services. Approximately 9% were based in rural health services and the remaining 11% were non-specific in reporting their workplace settings. It was noted that 33 participants (28%) were from the same facility and an additional 26 (22%) worked within the same health services.

Marie Hopper (top) and Melissa Lawrie

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JCPSLP Volume 19, Number 2 2017

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