Beyond the Dypstyk: tool to measure consistency of thickened fluids
Research type
Research Study
Full title
Beyond the Dypstyk: production of a 'ready to market' tool to measure the consistency of thickened fluids.
IRAS ID
298646
Contact name
Sue Pownall
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS Foundation Trust
Duration of Study in the UK
1 years, 5 months, 31 days
Research summary
Research Summary
50-75% of residents in nursing homes have swallowing difficulties. Difficulties with eating and drinking can be life threatening and result in pneumonia, the second most common infection found in nursing home residents. When individuals experience swallowing difficulties it is often recommended that their drinks are thickened by adding a thickening powder. Thicker consistencies (like milkshakes) are swallowed more safely than thin fluids as they move more slowly through the mouth and throat and are less likely to enter the person’s airway and lungs. When someone is given this recommendation, all their drinks must be thickened to the correct consistency to improve the safety of their swallowing. The information on consistency is explained to the individual and carer so that each drink the person is given is thickened correctly. Despite this, guidelines for thickening fluids in care settings are often imprecise. Crucially, these are often not accurately followed due to carers and care staff being unsure how to make the correct consistency. International descriptors have been developed through the International Dysphagia Diet Standardisation Initiative(IDDSI) to provide a consistent method of describing textures. There are four stages of thickness: slightly thick, mildly thick, moderately thick and extremely thick fluids. The IDDSI includes a method of measuring the thickness of fluids. However, this approach has limitations, not least it is time consuming and messy to complete. They suggest the test is only used periodically to check people are able to make the correct consistencies rather than using on a daily basis as an aid for the person thickening the fluid.
This study proposes to evaluate an easy to use, reliable, cheap and valid tool to facilitate the consistent production of thickened fluids by care home staff and healthcare professionals on each occasion a drink is made.Summary of Results
Dysphagia (difficulties with swallowing) may increase risk of aspiration (food and drink going into the lungs), pneumonia, dehydration and malnutrition. Commonly, when people have difficulty swallowing they are recommended to modify the texture of food and drinks often using thickening agents. To improve reliability of the consistency of the fluids provided by care professionals an international framework was developed (known as the IDDSI framework). The framework breaks food and drinks into eight bands (band zero being an unmodified liquid) with liquids categorised as thin, slightly thick, mildly thick, moderately thick and extremely thick. Part of this IDDSI categorisation is defining these bands from a timed gravity flow test using a 10ml syringe. This test is time consuming and fiddly to carry out in real life situations.
Funded by the Abbeyfield Research Foundation a project was developed to produce a device that could be used to measure fluid thickness within a care setting. The first ‘pump-priming; project used design methods, interviews, questionnaires and computer dynamics for fluids to develop device ideas with care professionals. A second phase took these initial designs and developed them further to answer the following questions:
So in essence are the designs:
• reusable/easy to clean?
• easy to train?
• reliable and repeatable in a range of contexts?
• affordable?
• sturdy?In this second project prototype devices were produced and tested to determine performance in real care home settings.
Fifteen care homes were recruited with 60 participants in total. Within each care home care staff were shown how to use the device and asked to make differing thickened drinks at various IDDSI levels. These drinks were compared to the IDDSI syringe flow test and the accuracy of the prepared drinks against the so-called IDDSI levels. The devices were left with staff for a minimum of two days and up to two weeks. On this second visit the accuracy of their prepared drinks was also measured.
From the 15 care homes using the device the following results were found;
• The device was seen to perform well in user trials
• A reduction in user error from 43% error to 18.9%
• The device worked in a care environment as intended
• The device worked in a dishwasher
• The device was quick, simple and easy to use
• The device provided reassurance to usersSome feedback from users is shown below; "I love the fact that you can’t put it in the wrong way round, it sits on top of the cup really nicely" (P17) "I like that there was enough room that you could put your spoon down the side and then just lift it up and then you didn’t have to put your spoon somewhere else. You know, it’s not something that sits on the whole of the top of the cup" (P17) "It’s so simple. Just a spoonful in it and it drips through or doesn’t drip through. " (P10) "it’s literally so simple" (P12) "Just a very easy sort of device to use. Simple device. Not complicated." (P12) "it’s pretty easy to use and…small and compact…" (P12)
Discussions with a mould manufacturer have provided insight into the cost of production at scale and have shown that the device can also be produced at a low cost (approximately a few £’s depending on numbers produced). Discussions are currently ongoing with a third party to bring the device to market so that it can be purchased by care homes, carers and health professions who make thickened drinks for people with swallowing difficulties.
REC name
London - West London & GTAC Research Ethics Committee
REC reference
21/PR/0894
Date of REC Opinion
20 Jul 2021
REC opinion
Further Information Favourable Opinion