Managing Patients with Dysphagia: Policies & Practices

Transcription

1 Managing Patients with Dysphagia: Policies & Practices

2 Agenda 6.40pm Welcome Address Anne-Marie Murray, Nutrition Product Specialist, Nutricia Medical 7.00pm National Guidelines for Meal Consistencies for Patients with Dysphagia Aoife Branigan, Nutrition Product Specialist, Nutricia Medical Workshop 1 Catering Staff 7.10pm Adopting Current Meal Plans for Patients with Dysphagia Neil Pallister Bosomworth, Consultant Diet Chef 7.50pm Menu Planning and the Nutritional Content of Meals Cliodhna Kirwan, Community Dietitian 8.10pm Questions & Answers 8.30pm Close

3 Agenda Workshop 2 Directors of Nursing, Clinical Nurse Managers, Nursing Staff 7.10pm Support and Advice in Drawing up Policy Documents Ciara O Connor, RGN. H.Dip Occ. H&S H. Dip Health Promotion, Diploma Person Centred Dementia Care, Person Centred Health Care Solutions Company 7.50pm The Role of Nutrition at End of Life Dr. Edel Duffy, Senior Dietitian, Nutricia Medical 8.10pm Questions & Answers 8.30pm Close

4 Introduction

5 Nutricia Medical Ireland s No. 1 Medical Nutrition Company We are committed to: Innovation: Nutilis Range: Salivary Amylase Resistant for patient safety Nutilis Complete: low volume, pre-thickened supplement Fortisip Compact: first low volume 2.4kcal to the market Widest range of disease specific products Supporting Healthcare Professionals: Sample request service (online, freephone) Dietetic advice line Educational events Educational resources MUST training Dedicated medical nutrition website

6 The NUTILIS Thickener Range Nutilis Powder 300g tins, 670g tin and sachets Nutilis Complete Stage 1 Grade 2 Consistency 125ml bottle

7 Nutilis Powder Nutilis Powder is a food and fluid thickener Number 1 choice of Irish hospitals Contains patented salivary amylase resistant ingredients What does this mean? The food and fluids are not broken down by the saliva in the mouth. Nutilis maintains the required thickness as directed by the SLT. Patient benefits: Neutral taste Mixes easily Maintains safe consistency

8 IMPORTANT- Not all Thickeners are the SAME! 1. Different scoop sizes between products and different numbers of scoops needed to thicken a fluid to a certain stage 2. Difference in price (Nutilis Powder is less expensive) 3. Nutilis Powder is the only thickening powder that is Salivary Amylase Resistant Combines starch with a gum coating to prevent salivary amylase from breaking down the starch Food and fluids thickened with standard starchbased thickeners fail to maintain consistency on contact with saliva

9 Nutilis Complete Stage 1 Safe and convenient nutrition in the smallest volume for patients with swallowing difficulties. Suitable for patients requiring Grade 2 consistency. Patient benefits: Low volume- 125ml bottle easy for patients to consume Saves on preparation time Maintains safe consistency in the presence of saliva. 2 great tasting flavours: strawberry & vanilla kcal/ml, 12g protein and 4g fibre per 125ml. And delivers greater cost savings- 38% less than other standard 200ml pre-thickened supplements.

10 Nutilis Patient Starter Packs- NOW AVAILABLE Each Nutilis Patient Starter Pack contains: 1 individual Nutilis Powder sachet and scoop Nutilis Shaker Scoop chart Patient information booklet Letter for their doctor Recipe book Packs can be ordered through

11 How to Thicken Drinks? Add the prescribed amount of Nutilis Powder to the drink in a shaker preferably, or else a beaker / glass / mug. Shake or whisk vigorously for approximately seconds until all the powder is dissolved. Remove the lid. Allow to stand for a few minutes until the desired consistency is reached.

12 Thickening Guidelines- NOW AVAILABLE

13 Resources: For you and your patients Shakers, recipe books, whisks and moulds Nutilis mixing guidelines and guidelines on how to mix Nutilis with Movicol Nutilis Patient Starter Packs Dysphagia.ie

14 Remember to get your copy of the NUTILIS RECIPE BOOK available now!!!

15 The premier source of information for the management of patients with dysphagia Recipe books and patient information to download and print Nutilis Patient Starter Packs Access to free Nutilis support/materials (training, shakers, product samples etc.) Clinical evidence and articles to download SIGN UP TODAY!

16 Fortisip Compact 40% Less Volume* *When compared to 200ml supplement

17 Fortisip Compact: The Best Choice* References: 1. Hubbard et al. (2010). 2. Hubbard et al. (2009) * Up to 97% of Fortisip Compact is consumed compared with 78% of a 200ml 1.5kcal product.

18 Fortisip Compact: 2 bottles contain *600kcals, 24g protein, 9.5mg iron and 60mg Vitamin C per 2 x 125ml bottles.

19 National Guidelines for Meal Consistencies for Patients with Dysphagia Ms. Aoife Branigan, Nutrition Product Specialist, Nutricia Medical

20 What is Dysphagia? Dysphagia is a medical term used to describe a swallowing disorder, characterised by difficulty in oral preparation for the swallow, or in moving material from the mouth to the stomach

21 Management of Dysphagia Dietary Adjustments Changing specific parameters in the patient s diet. Commonly consistency and food choices. Key Aims Modifying the consistency alters the rate at which food passes through the pharynx, to assist swallowing and reduce the risk of aspiration.

22 National Guidelines Guidelines produced by the Irish Association of Speech and Language Therapists (IASLT) Irish Nutrition and Dietetic Institute (INDI) Aim National consensus document regarding the terminology used for consistency Food Fluid Facilitate communication and reduce ambiguity

23 National Guidelines The guidelines are intended for adult and paediatric populations in all settings including acute care hospitals rehabilitation hospitals/units long stay hospitals/units, primary care intellectual disability services and physical disability services

24 New Terminology for Consistencies- Fluids

25 Food Consistencies Texture A Texture B Texture C Texture D

26 Texture A Soft Diet

27 Texture A - Soft Diet Food in this category may be naturally soft (e.g. ripe banana) or may be cooked or cut to alter its texture Soft foods can be chewed but not necessarily bitten Minimal cutting required easily broken up with a fork Food should be moist or served with a sauce or gravy to increase moisture content (NB sauces and gravies should be served at the required thickness level)

28 Texture A - Soft Diet: Recommended foods and foods to avoid Meat, fish, poultry, eggs, nuts and legumes Allowed: Casseroles with small pieces of tender meats Moist fish (easily broken up with the edge of a fork) Eggs (all types except fried) Well cooked legumes (the outer skin must be soft), for example baked beans Soft tofu, for example small pieces, crumbled Not recommended: Dry, tough, chewy or crispy meats Meat with gristle Fried eggs Hard or fibrous legumes Pizza

29 Texture B - Minced and Moist

30 Texture B - Minced and Moist Food in this category is soft and moist and should easily form into a ball Use tongue rather than teeth to break the small lumps in this texture Soft and moist and should easily form into a ball Food should be easily mashed with a fork No hard or sharp lumps

31 Texture C Smooth Pureed

32 Texture C - Smooth Pureed Food in this category is smooth and lump free Similar to the consistency of commercial pudding May have a grainy quality but should not contain lumps Moist and cohesive enough to hold its shape on a spoon when placed side by side on a plate these consistencies would maintain their position without bleeding into one another Nutilis Powder allows food to maintain their consistency Food could be moulded, layered or piped

33 Texture D - Liquidised

34 Texture D - Liquidised Smooth and lump free Has been pureed or sieved to remove any particles Do not hold their shape, they merge into one another when placed side by side on a plate and as result are generally served in a bowl Cannot be eaten with a fork Can be taken through a wide bore straw

35 Avoid High Risk Foods Stringy, fibrous texture e.g. celery, lettuce, cabbage Mixed consistency foods e.g cereals which do not blend with milk such as muesli, soup with lumps Crunchy foods e.g. toast, chips, flaky pastry, dry biscuits, crisps Crumbly items e.g. bread crusts, pie crusts, crumble Hard foods e.g. boiled and chewy sweets and toffee Husks e.g. sweetcorn and granary bread Chocolate & Jelly and Ice -Cream

36 Using Nutilis Powder for Meals

37 Thank You

38 Workshops Workshop 1 Catering Staff 7.10pm 7.50pm 8.10pm Adopting Current Meal Plans for Patients with Dysphagia Neil Pallister Bosomworth, Consultant Diet Chef Menu Planning and the Nutritional Content of Meals Cliodhna Kirwan, Community Dietitian Questions & Answers Workshop 2 Directors of Nursing, Clinical Nurse Managers, Nursing Staff 7.10pm 7.50pm Support and Advice in Drawing up Policy Documents Ciara O Connor, RGN. H.Dip Occ. H&S H. Dip Health Promotion, Diploma Person Centred Dementia Care, Person Centred Health Care Solutions Company The Role of Nutrition at End of Life Dr. Edel Duffy, Senior Dietitian, Nutricia Medical 8.10pm Questions & Answers 8.30pm Close

39 Adopting Current Meal Plans for Patients with Dysphagia

40

41 Breakfast

42 Strawberry and Banana Smoothie

43 Instant Honey Porridge

44 Full Breakfast

45 Savoury Meals Lunch & Dinner

46 Vegetables - peas and carrots

47 Piping and blending Piping puréed, thickened mince to make cottage pie

48 Piping Puréed cottage pies, frozen for storage Allow to defrost thoroughly before reheating

49 Scooping & Rolling Piping, scooping & rolling techniques give attractive results

50 Lasagne

51 Desserts

52 Tiramisu

53 Pureed Fruits

54 Fruit Fool

55 Chocolate Mousse

56 Questions

57 Menu Planning and the Nutritional Content of Meals Ms. Cliodhna Kirwan, Community Dietitian, Dublin Mid-Leinster

58 Agenda Food Pyramid Menu Planning Does your menu match the food pyramid? Nutritional Analysis of standard diet and modified diet

59 Menu planning and the food pyramid (DOH 2012)

60 Breads, cereals and potatoes 6+ portions daily Main Function in the body: Main source of energy in the form of Carbohydrate Provide fibre and B vitamins A portion of carbohydrate should be included at every meal A serving of carbohydrate is: 1 slice of bread Half a bagel or roll 2 x whole wheat breakfast cereal biscuits 1 x cup of cooked rice or pasta

61 Fruit & Vegetables 5 +/day Main Function in the body: Protective function Provide Fibre and other vitamins and minerals especially vitamins A,C and B vitmains A serving is: A medium apple or orange (200g, about the size of a tennis ball) A cup of fruit juice (150ml) Half a cup of chopped vegetables (about as much as you can fit in the palm of your hand) A cup of raw, leafy greens (a pile the size of a fist)

62 Dairy 3 x portions/day Main Function in the body: Provide calcium Provide Protein Bone health A serving of milk, yoghurt or cheese is: 1 cup of milk (200ml) 1 carton of yoghurt (125ml) 30g (1oz) of cheese (about the size of a small matchbox) 2 slices of cheese

63 Meat, Fish, Eggs, Beans, Nuts, Seeds 2 x portions/day Main Function: Provide protein, vitamins and minerals especially iron Important during growth A serving of meat, poultry, fish, dry beans, eggs, nuts is: 85g lean cooked meat, poultry or fish (the size of a deck of playing cards) 1 small fish fillet Half a whole chicken breast or a medium chicken leg A handful of nuts or seeds (25g)

64 Menu Planning To make sure your menu is nutritious and varied: Count the number of portions from each food group on the menu Compare this number to the recommended number of portions as per the food pyramid If there is one food group that is lacking incorporate an extra portion of this food into your menu.

65 Nutritional intake of a patient's typical one day menu Breakfast Mid Morning Lunch 1 cup of tea + milk + 1 tsp. of sugar 1 x Weetabix 100ml of milk 2 x rich tea biscuits 1 x cup of coffee 1 tsp. sugar Shepard's pie Peas Jelly + ice-cream Tea 1 scrambled egg + 1 slice of toast 1 cup of tea + milk + 1 tsp. sugar Evening 2 x rich tea biscuits 1 x cup of coffee 1 tsp. sugar Energy (kcal) Protein (g) Total Estimated Daily Requirements 1,800 70

66 How does this menu match up to the food pyramid?

67 Dietary analysis based on the food pyramid Food Group Breads, Cereals, Potatoes Fruit and Vegetables Dairy Meat, Fish No. of portions original menu Adapted Menu 5 x portions 1 x portion 1 x portion 2 x portions 5 x portions 5 x portions 3 x portions 2 x portions

68 How to match the food pyramid? Breakfast + 1 x glass of orange juice Lunch + 2 x portion of vegetables ( 1 x large piece of broccoli) Tea + 1 x yoghurt + 1 x portion of cheese + 1 x piece of fruit Evening + 1 x piece of fruit

69 Detailed Nutritional Analysis of 1 Day Menu Breakfast 1 bowl of Porridge 1 glass of Orange Juice 2 slices of Brown Toast with butter, 1 cup of Tea with 1 Sugar Lunch Homemade Vegetable Soup Creamed Potatoes, Roast Beef, Steamed Carrots & Cabbage Tea Fried Egg, 1 small tin of Beans, 1 fried Sausage, 1 fried Tomato Snacks Strawberry Yoghurt, 1 Fruit Scone, 1 medium Banana

70 Detailed Nutritional Analysis of 1 Day Menu Vit C Iron Actual Intake Recommended Intake Fibre Need to increase Fibre and Iron

71 Detailed Nutritional Analysis of 1 Day Menu Vit A Actual Intake Recommended Intake Calcium

72 How to increase fibre in the Diet Offer brown bread, brown rice, brown pasta Increase intake of fruit and vegetables Have fruit as dessert option or Fruit Hour later in the afternoon Add seeds to dishes (if they can swallow safely) How to increase Iron Offer meat 2 x times per day Use fortified breakfast Cereals

73 Comparison of two diets Normal Consistency Diet B fast: Porridge/cereal, Toast with low fat spread Cup of tea Dinner: Soup + bread Beef Stew Apple pie and custard Afternoon: Cup of tea + biscuit Tea: Savoury omelette + Tomato Total Energy Intake kcals 60g Protein Pureed diet B fast: Porridge Thickened Tea Dinner: Thickened Soup (no bread) Pureed meat, potato + veg Mousse Afternoon: Thickened Tea Tea: Pureed Chicken + beans Mousse Total Energy Intake 1000kcals 40g Protein With pureed diet the patient is reliant on supplements and food fortification to boost their nutritional intake

74 Questions & Answers

75 The NUTILIS Thickener Range

76 The NUTILIS Thickener Range