title: Quality of care issues for dysphagia: modifications involving oral fluids.
abstract: OBJECTIVE
  This study examined practices of health care providers who thicken oral fluids for patients with impaired swallowing (dysphagia). It contrasts viscosity (thickness) of nectar-like and honey-thick consistencies prepared and measured in a laboratory setting to actual practices in health care settings and to guidelines of the National Dysphagia Diet.
  
  
  BACKGROUND
  The care plans for many patients include changes to fluid thickness to maintain safe intake of oral fluids. Serving patients improperly prepared beverages may contribute to medical complications such as dehydration if patients consume less fluid, or aspiration of overly thin or thickened liquids, which may increase the risk of pneumonia.
  
  
  METHODS
  Descriptive analysis of group trends for viscosity measurements of liquids prepared by health care providers in four care settings to laboratory measurements and the National Dysphagia Diet.
  
  
  METHODS
  Forty-two health care providers participated. Each prepared thickened samples in their natural work environment using typical procedures.
  
  
  RESULTS
  Viscosity measurements of modified liquids prepared by health care providers did not compare favourably to published findings of laboratory viscosity measures or to the ranges of the National Dysphagia Diet. Participants who prepared overly thick or overly thin nectar-like liquids followed a similar pattern with honey-like samples. Many participants failed to use product label information in sample preparation.
  
  
  CONCLUSIONS
  Results suggest that many patients are served modified liquids that are too thick or too thin in relation to their target level of thickness, possibly increasing risk of further medical complications for those who consume them. Product directions that are too vague or general also may contribute to inaccurate results.
  
  
  CONCLUSIONS
  The patient's nursing staff typically oversees nutritional care plans that may include modifications to oral fluids to enable their patients to safely drink by mouth. Additional consideration should be given to training procedures and possible noncompliance with preparation guidelines.
authors.affiliation: Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, Manhattan, KS 66506, USA. jgarcia@ksu.edu
authors.forename: Jane M
authors.initials: JM
authors.lastname: Garcia
authors.forename: Edgar
authors.initials: E
authors.lastname: Chambers
authors.forename: Megan
authors.initials: M
authors.lastname: Clark
authors.forename: Jennifer
authors.initials: J
authors.lastname: Helverson
authors.forename: Ziad
authors.initials: Z
authors.lastname: Matta
mesh_terms: D000284:Administration, Oral; D003680:Deglutition Disorders / Q000453:epidemiology / Q000503:physiopathology*; D005440:Fluid Therapy; D006801:Humans; D015994:Incidence; D011787:Quality of Health Care