A Review of the Royal College of Speech and Language Therapists’ Position Statement on the Use of Thickened Fluids in the Management of People with Swallowing Difficulties

Here, Sharlene Haywood, Nutrition Clinical Nurse Specialist, and Rebecca Martin, Dietitian, reflect on their involvement with the new position statement, published earlier this year by the Royal College of Speech and Language Therapists (RCSLT), and what this means for nurses and dietitians.

Sharlene Haywood

Lead Nutrition Clinical Nurse Specialist, Kingston NHS Foundation Trust and NNNG Treasurer

I was delighted to be asked to review the ‘Position statement on the use of thickened fluids in the management of people with swallowing difficulties’ (RCSLT, 2024) for the National Nurses Nutrition Group (NNNG). The NNNG Committee are a group of nutrition nurses working to promote, improve and advance nutritional care amongst nurses and healthcare professionals (HCP). Hence, this position paper is significant to our objective as it provides clear, vital guidance in an area of care that can be emotive and challenging.

It is well acknowledged that nutrition and hydration is essential to an individual’s health and wellbeing, and fundamental to nursing care. The Care Quality Commission (CQC)¹ recognise this, stipulating that providers must meet individual’s needs. This position paper informs providers of when and how thickened fluids can be used to support an individual’s wellbeing. This is important to the nursing profession, as across health and social care settings nursing staff are involved in providing, and supporting, the delivery and consumption of hydration. Therefore, they are often the first HCP to notice changes in hydration status.

This paper details how relying on thickened fluids to meet hydration requirements can lead to dehydration, altered bowel pattern, reduction in quality of life and increased risk of aspiration pneumonia. It is imperative that all HCPs understand these connections and observe for these complications, so they can be managed appropriately to ensure wellbeing and quality of life.

^{Reference: 1. CQC (2023) Regulation 14: Meeting nutritional and hydration needs. Accessed online: www.cqc.org.uk/guidance-providers/regulations/regulation-14-meeting-nutritional-hydration-needs (April 2024).}

Rebecca Martin

Dietitian, Calderdale Community Learning Disability Team, South West Yorkshire Partnership NHS Foundation Trust

In 2023, I was asked by the British Dietetic Association (BDA) to be part of the consultation group on a project lead by the RCSLT to develop a position statement on the use of thickened fluids for people with swallowing difficulties.

Since completing the Manchester Post-Basic Dysphagia Course in 2019, I have been involved in managing a caseload of patients with both a dietetic and dysphagia need. Most of this work has been spent in the community learning disability team and I was also fortunate to have experience working with the community enteral feeding dietitians as part of the community rehab team.

Being part of the consultation group on the use of thickeners has been valuable, as my experience in the way clinicians use thickeners has varied widely, from areas where thickener is very rarely used, to situations where the use of thickener can help keep fluid within the oral cavity and make drinking more comfortable. Similarly, I have observed situations where incorrectly thickened fluids, or fluids that are very thick, have impacted on hydration status and potentially on the person’s enjoyment of drinking. This is important when considering that the evidence base does not definitively demonstrate that thickeners can prevent or reduce dysphagia-related chest infections or improve quality of life.

The position statement, I feel, presents a balanced overview of the evidence base and knowledge from experienced clinicians. This will support clinicians, including dietitians, to think about whether thickeners are the right option for a particular patient. It will support clinicians to consider the risks and benefits of implementing a thickener and encourages involvement from the multidisciplinary team. I think it emphasises the need to be clear about the aims of the use of thickener and to inform patients and their carers about the potential risks. It acknowledges the need to consider mental capacity and consent so that informed decisions can be made or made in a person’s best interests, where appropriate, and highlights the importance of reviewing interventions. Increased knowledge of thickeners will hopefully be useful to dietitians when working with their dysphagia trained colleagues to support the best possible outcomes for their patients.

 

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