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Shaping innovative services: Reflecting on current and future practice
58
JCPSLP
Volume 19, Number 2 2017
Journal of Clinical Practice in Speech-Language Pathology
The role of speech-
language pathologists in
food services
A survey
Katina Swan, Rachel Wenke, Marie Hopper, and Melissa Lawrie
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
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
existing SLP clinical roles. Although
dedicated roles in food services were
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,
Katina Swan
(top) and
Rachel Wenke
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
DYSPHAGIA
FOOD SERVICES
ROLE
SPEECH-
LANGUAGE
PATHOLOGY
TEXTURE
MODIFIED