Tribute Life Care ISSUED REVIEWED REVISED NO. Birmingham, AL 1-Nov-2008 APPROVED SUBJECT APPROVED Thickened Liquids PURPOSE: To ensure that thickened liquids are prepared and served at the proper consistency PROCEDURE: 1. Any resident who exhibits difficulty swallowing will be referred to Speech Therapy for screening and possible evaluation and treatment. 2. If the use of thickening agents is indicated, an order will be requested from the physician. Staff/caregivers are educated to instructions, measurements, etc. located on thickener directions. Direct care staff will be educated via demonstration and return demonstration regarding the use of the thickening agent by Speech Therapy staff. 3. The amount of thickening agent to be added to a fluid or food varies depending upon the original consistency of the fluid or food; therefore, the order will be stated to “add thickening agent to __________ consistency”. A readily recognizable form will be specified, i.e. honeys, pudding, etc. The Speech Therapist will, before discharging a resident from treatment, ensure that all direct care staff is competent in mixing to the ordered consistency regardless of the beginning consistency. 4. Residents whose condition require the use of thickening agents should be carefully monitored during feeding for signs of difficulty, aspiration or pocketing. Any difficulty should be reported as soon as possible to the facility speech therapist. 5. Any physician’s order for thickened liquids should be verified by the Director of Dietary Services and noted on the resident’s diet card. 6. The Director of Dietary Services should visit the resident for preference of beverages with meals and between meals. 7. The resident’s diet card should note the beverages to be given with each meal. 8. A note should be made in resident’s medical record documenting the liquids to be served at each meal and between meals. 9. Residents on thickened liquids are at greater risk for dehydration. The Director of Dietary Services should evaluate the acceptance of the thickened liquids on a regular basis. 10. If the resident is not receptive to the thickened liquids, try offering puddings, Magic Cup, and fruit for additional fluids between meals and at meals. 11. Buttermilk, shakes, and milk like products are considered to be nectar consistency, i.e. Ensure, buttermilk, etc., but not whole, 2%, or skim milk. Other nectar consistency liquids are tomato juice, creamed soup, V8, and resource supplements. Two Cal supplement is considered to be adequate for nectar or honey consistency. Carbonated beverages are allowed without thickener. 12. Liquids to be thickened to pudding consistency should be thickened with two packets of nectar thickener. Thicken nectar and honey consistency liquids according to directions of packet. 13. No straws with thickened liquids. RESPONSIBILITY: The Director of Dietary Services is responsible for the implementation of this policy and the Standard.