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Improving Accuracy of Texture-Modified Diets and Thickened Fluids Provision in the Hospital: Evidence in Action

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Abstract

Ensuring inpatients with dysphagia receive and consume the correct texture-modified diet and thickened fluid prescriptions is challenging, and errors can result in significant complications for patients and increased costs to hospitals. The aim of this study was to investigate underlying factors that help or hinder receipt and consumption of correct dietary prescriptions for people with dysphagia in the hospital setting then implement and evaluate a range of strategies to address identified issues. A mixed-methods study design, using an integrated knowledge translation approach, was conducted in three phases. In Phase 1, clinical incident data (i.e., documented incidents of diet/fluid errors, with errors defined as the provision or consumption of any food/fluid not appropriate for a patient’s dietary prescription) were analyzed, and staff, patients, and family members were interviewed using the Theoretical Domains Framework to identify factors contributing to errors. In Phase 2, health professionals assisted with the development and implementation of interventions targeted at micro (patient/family), meso (staff), and macro (organizational) levels to address factors identified in Phase 1. In Phase 3, outcomes including the change in number of dietary clinical incidents pre- to post-intervention, meal accuracy error rates from mealtime audits post-intervention, and follow-up interviews were evaluated using quantitative and qualitative measures. Post-intervention, there was a 50% reduction in clinical incidents, and a 2.3% meal accuracy error rate was observed. Staff reported most interventions were acceptable and feasible within their workload, although some interventions were not well embedded in everyday practice. This study highlights the value in using an integrated knowledge translation approach to inform tailored interventions targeting improved dietary accuracy in the hospital setting.

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Acknowledgements

The authors would like to thank all participants who took part in the study and also Xavier Tham, Helen Ealding, and Michelle Hunt for their assistance with data collection.

Funding

This study was funded by Gold Coast Health Private Practice Trust Fund Project Investment Grant (Grant Number 022 – 01.02.17), Gold Coast Health Allied Health Research Clinical Backfill Scheme, and Gold Coast Health Allied Health Research – research development support.

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Authors and Affiliations

  1. Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD, 4215, Australia

    Marie Hopper, Shelley Roberts, Rachel Wenke, Zane Hopper, Leisa Bromiley, Chelsea Whillans & Andrea P. Marshall

  2. Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia

    Shelley Roberts, Rachel Wenke & Andrea P. Marshall

  3. Menzies Health Insitute Queensland, Griffith University, Queensland, Australia

    Shelley Roberts & Andrea P. Marshall

Authors
  1. Marie Hopper
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  2. Shelley Roberts
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  3. Rachel Wenke
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  4. Zane Hopper
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  5. Leisa Bromiley
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  6. Chelsea Whillans
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  7. Andrea P. Marshall
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Contributions

MH, SR, RW, ZH, LB, and APM contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The manuscript was drafted by Marie Hopper with input from all authors. All authors undertook critical appraisal of the manuscript and read and approved the final version of the manuscript.

Corresponding author

Correspondence to Rachel Wenke.

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Conflict of interest

All authors are employees of Gold Coast Hospital and Health Service, where this study was undertaken; Authors Andrea Marshall, Shelley Roberts, and Rachel Wenke have multiple affiliations, as outlined on the title page above.

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Hopper, M., Roberts, S., Wenke, R. et al. Improving Accuracy of Texture-Modified Diets and Thickened Fluids Provision in the Hospital: Evidence in Action. Dysphagia 37, 488–500 (2022). https://doi.org/10.1007/s00455-021-10294-4

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  • DOI: https://doi.org/10.1007/s00455-021-10294-4

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