Modified diets and fluids – changes to the consistency of food and drink
Following an assessment from a speech and language therapist, some patients with swallowing difficulties will be recommended to have a modified texture diet and / or thickened fluids to ensure they eat and drink as safely as possible.
If a patient has been recommended a modified diet, they will have a sign on their bedside board and a care plan in their folder.
What are the signs of a patient swallowing difficulties? These may include:
- Coughing or wet / gurgly voice or choking when eating or drinking.
- ‘Pocketing’ of food in the mouth.
- A sensation that food is stuck in the throat or chest.
- Regurgitation of food, sometimes through the nose.
- Persistent drooling of saliva.
If you spot any of these signs whilst supporting a patient STOP, ASK and CHECK with a nurse.
Volunteers won’t be expected to support patients who are struggling with swallowing, eating and / or drinking.
Modified food
If a patient is prescribed a modified diet, there are different levels of consistency.
This range helps people with swallowing difficulties to enjoy mealtimes again. Each meal is carefully prepared to provide the nutrients required with portion sizes and textures that suit their needs.
Nursing staff are responsible for ensuring patients get the right type of meal recommended.
Volunteers should let nursing staff know if they think the patient isn’t managing the meal.
If a patient has modified diet recommendations it will be shown by a magnet on their bedside board, and they will have a pink or blue sheet in their bedside folder.
Modified diets are recommended in the same internationally standardised levels as fluids and are covered by levels 4-7: the higher the number, the more texture the food will have.
Note that a patient can have any snacks from a lower recommendation if they wish, e.g., it is fine for someone on level 6 recommendations to eat a yogurt (level 4).
As mentioned previously, someone on a modified diet will already have been assessed by a Speech and Language Therapist. Therefore, if you notice signs they are not managing, please inform the nursing staff.
Level 4 is a completely smooth puree. In hospital, each part of the meal will have been individually blended and then moulded into the shape of the food it is. Examples of snacks would be thick yogurt, mousse, runny porridge.
Level 4: puree steak and chips
Level 4: puree sticky toffee pudding
Level 5 is called minced and moist. It has a little more texture than level 4 with small lumps but that don’t require much chewing. Example of snacks would be rice pudding.
Level 5: chicken and vegetable casserole
Level 5: apple sponge
Level 6 is called soft and bite sized. This is where the food is all cut into no bigger than 1.5cm pieces and is very soft. It requires more chewing than the previous levels but is still easy to chew. Example of snacks would be chopped banana.
Level 6: beef hotpot
Level 6: coconut sponge
Level 7 is a regular diet than hasn’t had any modifications.
Level 7: roast chicken breast in gravy
Level 7: chocolate chip sponge
Modified fluids
If a patient has modified fluid recommendations it will be shown by magnet on their bedside board, they will also have a pink or blue sheet in their bedside folder
If a patient has a modified fluids sign on their board, they may be on thickened drinks.
If people have difficulty swallowing, we can change the consistency of the drinks by adding a thickening powder to make them easier for some people to swallow.
Different levels are recommended for different consistencies.
Modified fluids are recommended in levels which have been internationally standardised. Fluids are covered by levels 0 to 3 – the higher the number, the thicker the drink.
Level 1 fluid will be slightly thicker than water and should run off a spoon easily. It can be drunk from a cup.
Level 2 fluid will be mildly thick. It should leave a thin coating on the back of a spoon. Can be drunk from a cup.
Level 3 fluid will be moderately thick. Should leave a thick coating on the back of a spoon. Will slide off a spoon.
Level 4 will be extremely thick. Needs to be served with a spoon. Will hold its shape when served.
STOP, ASK and CHECK
If someone you are assisting asks for a drink, check if they have a modified fluids magnet on their bedside board, and / or an eating and drinking care plan in their folder, as this may mean that they need their drinks thickening.
Always ask the nursing staff to prepare a drink for a patient that needs thickened drinks.
If a patient needs thickened fluids avoid jelly or ice cream as it will melt into thin liquids.