Pre‐procedure

ActionRationale

1. 1.Show
   Ascertain whether the patient has dysphagia and is on a modified diet.
   All foods and fluids given must comply with diet modification recommendations from the International Dysphagia Diet Standardisation Initiative (IDDSI [69], C), which has developed a standard terminology with a colour and numerical index to describe texture modification for food and drink to reduce risk to patient safety (NHSI [118], C).
2. 2.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [126], C).
3. 3.Show
   Wash hands or clean them with an alcohol‐based gel, and apply personal protective equipment.
   To ensure that the procedure is as clean as possible and prevent cross‐infection (NHS England and NHSI [115], C).
4. 4.Show
   Ensure that the patient is comfortable – that is, that they have an empty bladder, clean hands, a clean mouth and, if applicable, clean dentures. Ensure there are no unpleasant sights or smells that would put the patient off eating.
   To make the mealtime a pleasant experience (Age UK [2], E).
5. 5.Show
   Position yourself in front of the patient or to their side and seated at the patient's level to assist with feeding.
   To enable the patient and helper to see each other and to assist communication. E
6. 6.Show
   Ensure that the patient is sitting upright in a supported midline position, preferably in a chair (if it is safe and appropriate) and at a table.
   To facilitate swallowing and protect the airway. E
7. 7.Show
   Protect the patient's clothing with a napkin.
   To maintain dignity and cleanliness. E

Procedure

1. 8.Show
   Assist the patient to take appropriate portions of food at the correct temperature but encourage self‐feeding. Tailor the size of each mouthful to the individual patient. If possible, each hot course of a meal should be served individually and items that may change in consistency, such as ice cream, served separately.
   To make the mealtime a pleasant experience. To maintain textures of foods. To ensure that swallowing is not compromised if the patient feels that they must hurry with the meal (Young et al. [190], E).
2. 9.Show
   Allow the patient to chew and swallow foods before the next mouthful. Avoid hovering with the next spoonful.
   To maintain the dignity of the patient and prevent them from rushing. E
3. 10.Show
   Avoid asking questions when the patient is eating, but check between mouthfuls that the food is suitable and that the patient is able to continue with the meal.
   To reduce the risk of the patient aspirating, which may be increased if they speak while eating. E
4. 11.Show
   Use the napkin to remove particles of food or drink from the patient's face.
   To maintain dignity and cleanliness. E
5. 12.Show
   Ask the patient when they wish to have a drink. Assist the patient to take a sip. Support the glass or cup gently so that the flow of liquid is controlled or use a straw if this is helpful. Take care with hot drinks to avoid offering these when too hot to drink.
   To give the opportunity for the patient to swallow. Hot liquids may scald the patient. E
6. 13.Show
   If the food appears too dry, ask the patient whether they would like some additional gravy or sauce added to the dish (except when a modified diet is recommended and additional gravy or sauce is not permitted).
   To facilitate chewing and swallowing (Wright et al. [189], E).

   All foods and fluids given must comply with diet modification recommendations (IDDSI [69], C).
7. 14.Show
   Observe the patient for coughing, choking, wet or gurgly voice, nasal regurgitation or effortful swallow. See Table 8.12 for details of problems that may be experienced by patients.
   May indicate aspiration, laryngeal penetration or weakness in the muscles required for swallowing (Langmore et al. [81], E; Leslie et al. [83], E).
8. 15.Show
   Encourage the patient to take as much food as they feel able to eat, but do not press them if they indicate that they have eaten enough.
   To improve nutritional intake but also maintain patient dignity and choice (Wright et al. [189], E).

Post‐procedure

1. 16.Show
   After the meal, assist the patient to meet their hygiene needs, for example wash hands and face and clean teeth.
   To maintain cleanliness and dignity. E
2. 17.Show
   If intake is being monitored then record what food was eaten on a food chart.
   To provide essential monitoring of intake (BDA [21], C).