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Nurses told to stop using term ‘soft diet’ due to safety concerns

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Healthcare professionals should stop using the term “soft diet” following 277 incidents in two years in which patients have been given food that is unsuitable for them, the NHS watchdog has said.

In seven of those cases patients came to “significant harm” and in two cases the patients died, NHS Improvement said in a new safety alert.

“We are calling on everyone providing NHS-funded care to start using precise terminology to help avoid further harm”

Kathy McLean

In addition to the serious harm incidents, there were about 270 cases of less severe problems, such as coughing or a brief choking episode, the agency said.

NHS Improvement said it had received reports of hash browns, mince and sponge cake being fed to patients in England who were supposed to be on liquidised food.

Issuing the new resource, the agency said that “the continuing widespread use of the term ‘soft diet’ can lead to patients needing a particular type of modified diet being harmed”.

The document – Patient Safety Alert: Resources to support safer modification of food and drink – is aimed at all NHS funded care for patients who have difficulty swallowing or need the texture of their diet modified for other reasons.

It noted that food texture modification was a widely accepted way of managing dysphagia – swallowing difficulties that affects people of all ages in all types of care setting.

The NHS Improvement guidance called for health services to replace the term “soft diet” with the framework drawn up by the International Dysphagia Diet Standardisation Initiative (IDDSI). This uses a colour and numerical index to describe texture modification for food and drink.

Food manufacturers are changing their labelling and instructions to the IDDSI standard by April 2019.

“Patients have died or been harmed because there is confusion in the way people describe what type of food is suitable”

Kathy McLean

Even for patients who do not have dysphagia there may be other conditions that require a modified texture diet in the short-term, the guidance said.

A senior clinical leader should be identified who can bring together key staff such as speech and language therapists, dieticians, nurses, doctors, pharmacists and catering services to plan local transition to the IDDSI framework, the document said.

A local implementation plan should then be drawn up and all relevant staff should be made aware that “imprecise terminology” such as soft diet is no longer being used, the guidance said.

Dr Kathy McLean, executive medical director at NHS Improvement, said: “Vulnerable patients have died or been harmed because there is confusion in the way people describe what type of food is suitable for those with swallowing or chewing difficulties.

“We are calling on everyone providing NHS-funded care to start using precise terminology to help avoid further harm,” she said. “This will help save lives and make the NHS safer.” 

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