Food and Fluid Safety in Healthcare Settings

First and foremost, regarding food/fluid safety, healthcare professionals need to ensure an individual is receiving appropriate nutrition, hydration, and services to meet their needs.  In all settings within the healthcare field, healthcare professionals can rely on a specific process to assess clients and develop care plans to address the specific needs of each individual.  This process includes assessments, identification of potential risks, evaluating and analyzing risks, implementing care plans, monitoring, and evaluating the interventions and making changes according to their needs.

According to the American Dietetic Association, “Nutritional assessment is a systematic process of obtaining, verifying and interpreting data in order to make decisions about the nature and cause of nutrition-related problems.” An important aspect of the assessment process for healthcare professionals is to consider the intrinsic and extrinsic factors that can affect an individual.  This information can be obtained from a variety of sources including the individual’s records, staff, family, patient interview, and direct and indirect observation.  The assessment will help the healthcare professionals define the nature of the problem and set the stage for individual interventions to be implemented.

Once a comprehensive assessment has been completed, healthcare professionals will begin to identify potential food safety risks.  The risks may include data gathered by identifying the intrinsic and extrinsic factors.  Certain diseases and conditions that are identified as intrinsic factors can increase or decrease an individual’s ability to safely consume both foods and fluids.  For example, an individual with cognitive impairments may not be able to properly determine the size or amount of food they can safely masticate, therefore requiring interventions to assist them during this process.  The extrinsic factors for this individual are just as important to take into account.  This same individual may become easily distracted during eating and drinking.  If they are eating in an area that has distractions, they may easily lose track of what they are doing and “forget” to fully chew or swallow their food/fluids, causing an increased risk for choking.

After all potential risks have been identified healthcare professionals will evaluate and analyze the risks.  At this point in the process they will take a detailed examination of all the intrinsic and extrinsic factors associated with the individual and develop appropriate individualized care interventions.  During the evaluation and analysis of risk, healthcare professionals will carefully determine what intrinsic and extrinsic factors can be decreased or eliminated through interventions to ensure safe food/fluid consumption for the individual.

The development of interventions for individuals in the healthcare setting is key for ensuring food/fluid safety.  The purpose of the interventions is to limit the risk of an adverse event.  The interdisciplinary team will review the assessments and risks identified and develop an individualized care plan.  The care plan will address identified causes, reflect the individual’s goals and choices, and identify specific interventions, time frames, and parameters for monitoring the interventions.   There are a variety of possible interventions associated with food/fluid safety which may include:

• Diet Liberalization
• Nothing by Mouth (NPO)
• Dietary Restrictions
  • Low Fat
  • Low Sodium
  • Carbohydrate Controlled
  • The avoidance or addition of certain foods directly related to the individual’s diagnosis and medications.
• Mechanically Altered Diets
  • Mechanical soft
  • Puree
  • Hand-cut
  • Chopped
  • Thickened Liquids (Honey, nectar, pudding consistency)
• Assistive Devices/Utensils
• Supervision

An important aspect to the development and implementation of the individual care plan includes communication between the interdisciplinary team, including both written and verbal.   This communication is particularly important for those who do not regularly interact with the individual.  For example, when an individual is partaking in an outing away from their traditional setting the persons with them need to be aware of the care plan interventions so they are not served foods or fluids that could negatively impact their health and safety.

Once the interventions have been developed, implemented, and communicated, the healthcare professionals will monitor and evaluate for the effectiveness.  The process of monitoring includes reviewing the intrinsic and extrinsic factors, assessments, and observation of the individual.  If during the process of monitoring it is determined there has been a change in the individual, or the interventions are not effective, the healthcare professionals may implement new interventions.  A consultation by a physician or speech therapist may be appropriate to best determine what interventions could be utilized.

Throughout the settings, supervision plays an important role in food/fluid safety.  Supervision will provide safety from the individual obtaining food/fluids that are too hot, of the wrong consistency, that can cause choking, or negatively impact their overall health.    In all healthcare settings food/fluid safety is a systematic approach which includes assessments and intervention development/implementation and monitoring from an interdisciplinary team.