This presentation is provided as an educational session from the

presenters on their work undertaken as approved in their

health services. This presentation is not to be reproduced in

anyway unless permission is given by the IHHC. Contact

ihhcqld@gmail.com for permission.

IHHC Webinar:Wednesday 26th August 2020

International Dyspaghia Diet Standardisation Initiative (IDDSI)

Food:

implementation, issues & outcomes

© The International Dysphagia Diet Standardisation Initiative 2019 @ https://iddsi.org/framework. Licensed

under the CreativeCommons Attribution Sharealike 4.0 License https://creativecommons.org/licenses/by-

sa/4.0/legalcode. Derivative works extending beyond language translation are NOT PERMITTED.

IHHC Platinum Supporters

IHHC Gold Supporters – Queensland & NSW

IHHC Gold Supporters – South Australia

IHHC Gold Supporters – Tasmania

IHHC Gold Supporters – Victoria

IHHC Gold Supporters – Western Australia

Housekeeping:

Please turn off your camera

Please place yourself on MUTE

Questions can be submitted via the chat function – we will endeavor to answer them at the end of all presentations

When asking a questions – please identify which presenter you are sending the question to

The session is being recorded – it will be available on the IHHC webpage www.ihhc.org.auwithin two weeks.

9

Introducing: Marie Hopper

Assistant Director Speech Pathology (Robina Hospital) - Gold Coast Health

Queensland Health

10

TExture modified DiEts in Dysphagia:

the inTEnDeD project

Marie Hopper 1, Shelley Roberts 2,3, Rachel Wenke 1,4,5, Zane Hopper 6,

Leisa Bromiley 6, Chelsea Whillians1, Andrea Marshall 3,7,8,9

(1) Speech Pathology Service, Gold Coast Health; (2) National Centre of Research Excellence in Nursing (NCREN); (3) Menzies Health Institute Queensland; (4) School

of Allied Health Sciences, Griffith University; (5) Allied Health Clinical Governance, Education and Research, Gold Coast Health; (6) Nutrition and Food Services, Gold

Coast Health; (7) National Centre of Research Excellence in Nursing; (8); Griffith University; (9) Gold Coast Health

Funding acknowledgements

▪ Gold Coast Health Private Practice Trust Fund

Project Investment Grant

▪ Gold Coast Health Allied Health Research Clinical

Backfill Scheme

▪ Gold Coast Health Allied Health Research –

research development support

What the evidence says….

▪ Dysphagia can lead to choking, aspiration, malnutrition

and death (Cichero, 2013)

▪ TMD and TF recommended in the acute phase of

dysphagia (Anderson et al., 2013) to reduce aspiration risk (Steele

et al, 2015)

▪ Failure to adhere to prescribed diet and fluids may lead to

significant health risks (Low et al., 2001)

What does aspiration look like?

▪ https://www.youtube.com/watch?v=fqG0QmlaFMs

The Problem

Globally:

▪ Correct meal provision highly complex process with error

rates as high as 52%(Rosenvinge & Starke 2005)

▪ Research to improve accuracy is not common and has

reported variable success

Locally:

▪ Persistent problems over

many years

Study aim:

a) Understand the barriers and enablers to the

provision and consumption of accurate dietary

items to inpatients prescribed TMD/TF in the

hospital setting;

b) Develop, implement and evaluate an

intervention designed to improve the receipt and

consumption of correct diet prescriptions within

this setting

Design – iKT (CIHR 2012) guided by K2A (Graham

et al 2006)

Phase 1: Assessing the

problem

Baseline clinical incident

data reviewed

Stakholder interviews

(staff, patients, families)

Phase 2: Intervention

development and

implementation

Intervention co-production

(with ward staff), based on

Phase 1 findings

Phase 3: Outcomes

evaluation

Quantitative analysis of

errors and incidents; and

qualitative analysis of

feasibility and acceptability

K2A Cycle Steps:

Select, tailor, implement

interventions

K2A Cycle Steps:

Monitor knowledge use,

evaluate outcomes

K2A Cycle Steps:

Identify problem; adapt

knowledge to local

content; assess barriers

to knowledge use

Results – Phase 1 (Assessing the problem)

▪ 35 participants

▪ 15 individual

interviews

▪ 8 group interviews(2-

5 participants)

▪ 12 hours of interview

data

Number of participants

Nursing staff Food service staff

Doctors Speech pathologists

Speeh therapy assistants Dietitians

Dietitian assistants Patients

Family

TDF domains - Knowledge; Beliefs about

consequences; Skills; Beliefs about capabilities

Knowledge:

- Enabler

- Barrier

“It's very important,

because the potential risk

to the patient - if the

wrong diet is administered

it can be catastrophic”

(nurse 8)

“I feel that education to everyone is first and

foremost because during my clinical years

I've seen my patients not educated, they don't

understand why they're taking the modified

diet for. They would want to drink through the

taps so that they can get some normal water

without understanding the risks.” (Doctor 1)

TDF domains – Social / professional role

and identity; memory; attention and decision

processes

Enablers:

- Teamwork and

Communication“Everybody has a

role to keep

someone safe.”

(Doctor 2)

“When we go up, we make

sure the [white] board is

correct and we make sure

whatever is on the tray

matches what the board

says.” (Food service 4-6)

Barriers:

- Complacency

- Confusion

“…they [nurses] say that when

they go to put it [the diet code]

into the computer that the codes

are very confusing and they can't

understand what they are.”

(nurse)

“We are relying that the kitchen is

providing the right thing” (Nurse 2-6)

TDF domain – Environmental context

and resources

Enablers:

- Family assistance

“I think we just try - if the family

are here, we just try and

encourage them to feed [the

patient].” (Nurse 2-6)

“If it was up to him [the patient] he’d be drinking

thin fluids from morning until night. So it’s my role

to make sure that what the doctor says gets

done.” (Family 4)

Barriers:

- Access and storage issues for TFs

“If they don't eat all of that at meal

time, which they might get three

tubs on their tray, they might only

get through a half of one, the

others sit there and get hot.”

(Nurse 2-6)

“The fridge might be full

of extremely thick and

you need mild.” (Nurse

2-6)

TDF domain – Behavioural regulation

Protocols:

- Enabler

- Barrier

“Yeah, so there is a protocol to

follow if there is an

inappropriate diet or if that's

provided to the patient.” (SLP 1)

“I don’t think I've read it

[protocol], but I presume

there would be.” (Nurse 2-6)

“…within a hospital we’re so

regimented…There’s no flexibility. You can’t

really give them a croissant for brekky

[breakfast] and then minced-moist for lunch.”

(SLP 2)

Results – Phase 2 (Intervention

development and implementation)

Patient / family level

interventions:

DO NOT give outside

food or drink.Check with nurses first.

This patient is on a special diet.

VISITORS:

Bedside posters

Refrigerator sign

Staff level interventions:

Diet and fluid champions

Optimising patient whiteboards

Diet code lanyards and signs

Organisation level interventions:

Clarifying dietary

information in clinical systems

TF delivery process change

Results – Phase 3 (Outcomes evaluation)

Clinical incident reports - reduced by 50%

Meal accuracy audits:

2.3% error

rate (8 errors)

Breakfast, lunch,

dinner –Monday to

Friday

65 patients;

332 meals assessed

TMD / TF assessed for accuracy against diet prescription

Intervention acceptability and fidelity:

“I definitely wouldn’t say it’s

[intervention] any extra burden in my

caseload. I would like to think that, if

anything, it makes it more streamlined

because they [patients] are on the

correct diet at the right time, they’re

not missing out on meals and I’m not

having to chase up on meals... I would

think that the less errors mean it’s less

work for me.” (Dietitian)

“I think the

[visitor] signs

were very useful,

very effective.”

“I had a look around

the other day and all

the texture mods

were written out in full

[on the white board]…

(Food Service)

“It’s [champion training]

got me more aware and

a bit more enthusiastic.”

(Nurse)

“I don’t think

anyone knows

who the

champions are.”

“Um I actually thought it [diet

code lanyard] was too

brief…why would they need

to know that.”

(Foodservice staff)

“We have a large turnover and

movement of patients in this unit.

The problem is that the

provisioning of meals occurs

sometimes many prior to many

moves.” (Nurse)

“…just if the speech pathologist

could give us reminders every

now and then…just give us a little

talk every now and then.” (Nurse)

“I think from my point of view,

ongoing education, to not just

the nursing staff but our

colleagues as well…”

Discussion

▪ Theoretically driven approach.

▪ Underlying issues can span patient / family, staff

and organisation levels.

▪ Interventions targeting one level in isolation are

unlikely to be successful.

▪ Never assume the cause of a problem.

▪ Interventions implemented by stakeholders – better

received and more likely to be successful. (Graham et al.,

2006)

Limitations

▪ Potential for increased incident reporting – however

this was not seen.

▪ Hawthorne effect (Wickstrom & Bendix, 2000) for meal audits.

▪ No baseline meal accuracy audits.

▪ Post-intervention meal accuracy audits only possible

Monday-Friday, and only captured main meals.

Conclusion

▪ Incidents / errors can be reduced and patient safety

increased through the use of a theoretically driven

approach to identify and target the underlying issues.

References▪ 1. Penman J, Thomson MJJoHN, Dietetics (1998) A review of the textured diets developed for the management of dysphagia. 11 (1):51-60

▪ 2. Cichero J (2013) Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutrition Journal 12 (1):54

▪ 3. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P (2009) Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age

and Ageing 39 (1):39-45

▪ 4. Altman KW, Yu G-P, Schaefer SD (2010) Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Archives of

Otolaryngology–Head and Neck Surgery 136 (8):784-789

▪ 5. Cichero JA, Heaton S, Bassett L (2009) Triaging dysphagia: nurse screening for dysphagia in an acute hospital. Journal of clinical nursing 18 (11):1649-1659

▪ 6. Sutherland JM, Hamm J, Hatcher J (2010) Adjusting case mix payment amounts for inaccurately reported comorbidity data. Health Care Management Science 13

(1):65-73

▪ 7. Jukes S, Cichero JA, Haines T, Wilson C, Paul K, O'Rourke M (2012) Evaluation of the uptake of the Australian standardized terminology and definitions for texture

modified foods and fluids. Int J Speech Lang Pathol 14 (3):214-225. doi:http://dx.doi.org/10.3109/17549507.2012.667440

▪ 8. McCurtin A, Healy C (2017) Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia

practice. International Journal of Speech-Language Pathology 19 (1):69-76

▪ 9. Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J (2017) Development of international terminology and

definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia 32 (2):293-314

▪ 10. Steele CM, Namasivayam-MacDonald AM, Guida BT, Cichero JA, Duivestein J, Hanson B, Lam P, Riquelme LF (2018) Creation and initial validation of the

International Dysphagia Diet Standardisation Initiative functional diet scale. Archives of Physical Medicine Rehabilitation 99 (5):934-944

▪ 11. Andersen UT, Beck AM, Kjaersgaard A, Hansen T, Poulsen I (2013) Systematic review and evidence based recommendations on texture modified foods and

thickened fluids for adults (≥ 18 years) with oropharyngeal dysphagia. e-SPEN Journal 8 (4):e127-e134

▪ 12. Steele CM, Alsanei WA, Ayanikalath S, Barbon CA, Chen J, Cichero JAY, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B, Lam P, Lecko C, Leigh C, Nagy A,

Namasivayam AM, Nascimento WV, Odendaal I, Smith CH, Wang H (2015) The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology

and Function: A Systematic Review. Dysphagia:30(31): 32-26

▪ 13. Murray J, Doeltgen S, Miller M, Scholten I (2014) A survey of thickened fluid prescribing and monitoring practices of Australian health professionals. Journal of

Evaluation in Clinical Practice 20 (5):596-600

▪ 14. Limited SPAoA (2012) Clinical Guideline: Dysphagia. Speech Pathology Association of Australia Limited,, Victoria, Australia

▪ 15. Cook IJ, Kahrilas PJ (1999) AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 116 (2):455-478

▪ 16. Kenneth W, Gou-Pei Y, Schaefer S (2010) Consequence of dysphagia in the hospitalized patient. Arch Otolaryngol Head Neck Surg 136 (8):784-789

▪ 17. Dietitians Association of Australia, Speech Pathology Association of Australia Limited (2007) Texture‐modified foods and thickened fluids as used for individuals with

dysphagia: Australian standardised labels and definitions. Nutrition & Dietetics 64:S53-S76

▪ 18. Low J, Wyles C, Wilkinson T, Sainsbury R (2001) The effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy. Dysphagia 16

(2):123-127

▪ 19. Berzlanovich AM, Fazeny-Dörner B, Waldhoer T, Fasching P, Keil W (2005) Foreign body asphyxia: a preventable cause of death in the elderly. American Journal of

Preventive Medicine 28 (1):65-69

▪ 20. Larby A, Roberts S, Desbrow B (2016) Accuracy and adequacy of food supplied in therapeutic diets to hospitalised patients: An observational study. Nutrition &

Dietetics 73 (4):342-347

▪ 21. Rattray M, Desbrow B, Roberts S (2018) Identifying errors in meals provided to and sourced by patients on therapeutic diets in hospital. Asia Pacific Journal of Clinical

Nutrition 27 (3):533

▪ 22. Rosenvinge SK, Starke ID (2005) Improving care for patients with dysphagia. Age & Ageing 34 (6):587-593

▪ 23. Folio D, O'Sullivan-Maillet J, Tougher-Decker R (2002) The spoken menu concept of patient foodservice delivery systems increases overall patient satisfaction,

therapeutic and tray accuracy, and is cost neutral for food and labor. Journal of the Academy of Nutrition Dietetics 102 (4):546

▪ 24. Zaga C, Sweeney J (2014) Reducing error in a complex system: Texture modified diet and fluid provision. Journal of Clinical Practice in Speech-Language Pathology

16 (3):46-50

▪ 25. Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, Foy R, Duncan EM, Colquhoun H, Grimshaw JM (2017) A guide to using the Theoretical Domains

Framework of behaviour change to investigate implementation problems. Implementation Science 12 (1):77

▪ 26. Esmail R, Hanson HM, Holroyd-Leduc J, Brown S, Strifler L, Straus SE, Niven DJ, Clement FM (2020) A scoping review of full-spectrum knowledge translation

theories, models, and frameworks. Implementation Science 15 (1):1-14

▪ 27. Rycroft-Malone J, Bucknall T (2010) Models and frameworks for implementing evidence-based practice: linking evidence to action. John Wiley & Sons,

▪ 28. Canadian Institutes of Health Research (2012) Guide to knowledge translation planning at CIHR: Integrated and end-of-grant approaches. Canadian Institutes of

Health Research, Ottawa

▪ 29. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N (2006) Lost in knowledge translation: time for a map? Journal of Continuing

Education in the Health Professions 26 (1):13-24

▪ 30. Ivankova NV, Creswell JW, Stick SL (2006) Using mixed-methods sequential explanatory design: From theory to practice. Field methods 18 (1):3-20

▪ 31. Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation

Science 7 (1):37

▪ 32. Elo S, Kyngäs H (2008) The qualitative content analysis process. Journal of Advanced Nursing 62 (1):107-115

▪ 33. Kaizer F, Spiridigliozzi AM, Hunt MR (2012) Promoting shared decision-making in rehabilitation: development of a framework for situations when patients with

Dysphagia refuse diet modification recommended by the treating team. Dysphagia 27 (1):81-87. doi:http://dx.doi.org/10.1007/s00455-011-9341-5

▪ 34. Keller HH, Duizer LM (2014) Keeping consumers safe: food providers' perspectives on pureed food. Journal of Nutrition in Gerontology and Geriatrics 33 (3):160-178

▪ 35. Colodny N (2001) Construction and validation of the mealtime and dysphagia questionnaire: An instrument designed to assess nursing staff reasons for

noncompliance with SLP dysphagia and feeding recommendations. Dysphagia 16 (4):263-271

▪ 36. Wickstrom G, Bendix T (2000) The” Hawthorne effect”-what did the original Hawthorne studies actually show. Scand J Work Environ Health 26 (4):363-367

Introducing : Niccola Currie, APD

Senior Dietitian & Torres & Cape Hospital and Health Service Dietitian Lead

Weipa Integrated Health Service

Torres & Cape Hospital and Health Service

38

Implementing Moulded Texture Modified Meals in a Remote Rural FacilityNiccola Currie

Senior Dietitian and TCHHS Dietitian Lead

Credit for presentation to:

Christine Eadeh, Senior Dietitian, RBWH

Acknowledgement

The Torres and Cape Hospital and Health Service respectfully acknowledges the Traditional Owners and Custodians, past and present, within the lands in which we work.

Weipa

Population: 4,240Area: 11km2

4 hours by plane flying from Brisbane

Weipa HospitalBeds: 12 inpatient, 10 Residential Aged

Care

Dietitians: 1

Cooks: 1

Current status (2018)

• 3 pureed patients (RAC)

• Pre-plated Nutrifresh

• Heated & re-plated

Issues

• Excess Pork & Fish

• 5 Minced & 6 Pureed options

• 5 Pureed specific desserts

• $8.37/serve (Main + Dess)

• High wastage = poor nutrition intake

• Plate waste: 33.2% for texture mod hot protein,

• 11.7-28.2% wastage for veges.

Option 1: Mould own food on site

• Puree existing menu options – cook fresh

• Less freezer space req

• Flexible

• Low cost initially $174.90 for pack

• Meet QHNSMM

• Success at GCUH

• Labour & time

• Skills/consistency of pre

• Food safety – blenders

• New equip req

• No SP for confirmation

• Space in kitchen

• Auditing++

• Rec: Low feasibility, too many barriers & process

change

Option 2: Purchase more Nutrifresh individual portioned meals

• Variety = 7 minced, 18 puree

• Long shelf life

• $4.21 for protein, green, orange vs $6.81 for pre-plated

• Wouldn’t meet QHNSMM for variety

• Not visually appeal

• Similar to current set up

• Rec: Is an option to add variety to current model

Option 3: TCF ‘Mixed Packs’ of Moulded Meals

• Increased intake, visually appealing

• Low labour

• Tully & Innisfail use – can share processes

• Freezer space

• $17.99 per meal – cost for 1 person per day = $35.98 (L&D)

• No integration with existing menu

• New supplier

• QHNSMM for variety – 7 minced, 14 pureed

• No flexibility e.g. with vegetarian patient etc…

• Rec: Keep 1 box in freezer as a back up for short term acute.

Option 4: TCF Moulded Meals –full variety + Desserts

• Increased intake, visually appealing

• Low labour

• Tully & Innisfail use – can share processes

• Freezer space

• Safety in texture

• B&W can be used across full menu, integrated & long shelf life

• $7.16 (prot, orange, green & dess) vs current $8.37 (prot, orange, green, starch & dess)

• May need plate guard

• Needs Mash daily at L&D (is most often)

• QHNSMM for variety

• New supplier

• Rec: Proceed

Implementation

• Re-adjusted cook times: carrot/broccoli

• Crust on mashed potato

• 24hr thaw in fridge

• Microwave 5mins ½ power or combi oven 12 mins 120oC

MQAT

MOULDED UNMOULDED

Roast beef 4 3.6

Chicken breast

4 3.75

BBQ pork 4.4 3.8

Thank You!

Introducing: Cristal Newman, APD

Senior Dietitian, Roma Hospital

South West Hospital & Health Service

49

Staff Training is the Key to Implementing IDDSI:

The South West Experience

Cristal Newman

Senior Dietitian Roma

South West HHS11 Hospital / MPHS

Facilities

2 RACFs

Cook Fresh Menu

Foodservice Challenges

• Variables - equipment, food supply,

service demand

• Distance

• Time

• Resources

Implementing IDDSI in SWHHS

Awareness Raising Implementation

SWHHS

Work Group

Established

Gap Analysis & Meal Audits

Recipe

Revision

Menu

Updated

& Training Developed

IDDSI

Training Provided

IDDSI & Menu

Implemented

IDDSI

Review Project

IDDSI

Training Repeated

Feb 2018 May 2019 Jun 2020

Operational Staff TrainingFace to Face workshop (2 hours)

Theory

➢ Background

➢ Food Textures

➢ Fluids

➢ Audit tools

➢ Discussion questions

Practical

➢ Texture audits

➢ Flow test

Quiz / Test

Training Feedback

“I liked the face to face interaction.”

“I liked the question and answer time.”

“very Interesting, I learnt a lot of

new things and techniques.”

“I feel supported to call about any

questions.”

“It allowed me to see

things from a whole new

perspective.”

Where Are We Now? – Food Audits

0

10

20

30

40

50

60

70

80

90

Pass Fail Pass Fail Pass Fail

Soft & Bite-Sized Diet Minced & Moist Diet Pureed Diet

Food Audits (n=71)

Areas for Improvement

Soft & Bite-Sized

Particle size

Separate thin liquid

Minced & Moist

Separate thin liquid

Pureed

Stickiness

Where Are We Now? – Staff Surveys

Operational Staff Survey (n=22)

• Knowledge retention – 79% passed IDDSI Quiz

• Staff requested more frequent training

• Identified challenges – adapting to new terminology

Nursing Staff Survey (n=23)

• 78% were aware of IDDSI

• 78% were able to correctly identify food textures

The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/

South West Journey…. Next Steps

• Annual IDDSI F2F Training

• Refresher Training Session

(6monthly via VC or online)

• Training for Nursing Staff (online)

• Information Resources (ward)

• Texture Audits

Acknowledgements: Bond Uni, Sunshine Coast & Griffith Uni Students, SWHHS Dietitians and SWHHS Speech Pathologists

Introducing: Geoffrey Schultz, Catering Manager – Toowoomba Hospital

Darling Downs Hospital & Health Service

58

Implementation of Texture Moulded

Meals

Background

a) Toowoomba Hospital had a bulk frozen / reheat meal service model.

b) There were manufactures of bulk & texture food leaving the market.

c) In 2019 we introduced a Cook Fresh Service Model {except textured modified

food}

d) Our Speech Therapy Department was very keen to implement moulded food

e) Staff suggested we needed to make changes to our texture modified meals.

f) We included the need to change texture foods as one of our goals in our

operation plan

Limited Supplier options of bulk texture food:

a) We had been considering moving towards moulded food for some time.

b) Our fresh cook model was implemented and running.

c) As manufactures were leaving the market, it was decided that the time was right to move to moulded textured food

d) Discussions were held at our CSPD “Catering, Speech Pathology & Dietetics” meeting

Supplier, availability & storage:

a) The team decided to use “Texture Concept Foods” for the implementation of moulded texture foods in our facility

b) Samples were organised, trialled & tasted by the CSPD members

c) Purchasing was direct from the manufacturer {required Pallet buy},

d) Freezer storage was an potential issue {our store staff changed some racking in the freezer,

e) Purchasing & holding costs {The director & finance staff were informed of initial increase of $ spent {first order was around $25 000}

Stock in the freezerSample of product & Packaging

1. The increased cost of a meal using moulded food

a) Textured Avg meal cost:

i. Bulk {protein $2.00} + {Veg x 2 = $2.10} + {instant potato $0.50} + {Gravy $0.20} = $4.80 avg

ii. Moulded food {protein $3.30} + {Veg x 2 = $2.70} + {instant potato $0.50} + {Gravy $0.20} = $6.70 avg

iii. Average meal cost increase of 52%

b) However, there is no waste.

i. We previously relaxed bulk product 24 hours before the meal service

ii. Staff would guess how many boxes of texture modified to take out of the freezer to relax {we are very paper based}

iii. We often only used Τ1 4 – Τ3 4 of box of bulk textured food, with the rest being thrown out, thereby increasing the cost per serve.

iv. Staff now check texture meal numbers just before meal service and plate the required meals

2. The cost of purchasing & holding pallets of product

a) Was originally a concern when purchasing direct from manufacturer {pallet buy}

b) No issue now due to Local supplier holding stock

c) We now purchase cartons of product we need to top-up through BidFood {Toowoomba}

d) There has been no issue with supply, and we hold just over 2 weeks of stock in our freezer

3. Heating & Holding for plating line service

a) After some trialling, staff have found that placing moulded food direct on the plate {frozen} & cover the plate.

b) They put the meal into Combi-oven on steam for around 16 minutes

c) Due to our ovens being close to the plating line, texture meals are kept in the oven

d) Gravy/sauce if required is placed on the meal at the plating line

Meals being heated on the oven

Previous serving

{We at least had a plastic divided plate}Sample of moulded meal

{served on a Crockery plate}

Some photos

Dietetic Food Service Student Project

We were fortunate to have Dietetic students who as part of their foodservice placement compared patient satisfaction & plate waste data to previous years.

In summary, the texture modified meal data indicated:

a) Food quality satisfaction improved pre to post implementation. With a score of 3.83 up from 3.14.

b) A significant reduction in plate waste was also seen, 42.9% down from 52.16% pre implementation

c) Both verbal {patient/carer} and written feedback has overall been positive

Copy of recent “Letter to the Editor” in our local paper

Speech & Catering Information video presentation

a) Our speech therapy Department created a video about both, IDDSI & moulded foods implementation in the Toowoomba hospital.

b) Video runs for about 3 minutes

c) Link: https://www.youtube.com/watch?v=wLvbQmeVVOc

Thank you

Acknowledgments & thanks:

• Veronique Anderson & Speech Pathology team

• Justin Shine & Dietetics team

• Toowoomba Hospital Catering team

• Darling Downs Health Media Team

Some of Catering team

Thanks for your participation and attending!

We look forward to seeing you at the next session on

Wednesday 23rd September 2020 @ 2.00pm AEST

Session title:

Cost effective sustainability in Food Services

Feedback, comments or questions can be emailed to:

admin@ihhc.org.au

66