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www.speechpathologyaustralia.org.au
JCPSLP
Volume 19, Number 2 2017
59
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.
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
Marie Hopper
(top) and
Melissa Lawrie