Thickener Changes in Primary Care in Sunderland – Information for Community Pharmacy

Patients with dysphagia may have difficulty swallowing thin liquids. Some can however manage thicker liquids more easily. Whilst some drinks are naturally thicker eg fruit juices, smoothies some drinks are not eg tea, water, coffee.

Commercially manufactured thickeners can be added to drinks to make them up to the required consistency for the individual patients. For patients who cannot manage thin liquids without the risk of aspiration this supports them to be able to meet their hydration needs and reduce the risk of chest infections and pneumonia.

Speech and Language Therapists (SALT) assess patients with
swallowing problems and may then recommend that a thickener is used.
There is a range of different thickener products currently in use in primary care in Sunderland, and we felt that this represents a risk to patient safety, especially in settings such as care homes where there may be potential for scoops to be used with the wrong product. Neighbouring areas have already aligned to use a single thickener in primary care, and we felt that Sunderland should do the same.

IDDSI Guidance
There are also new International Dysphagia Diet Standardisation (IDDSI) descriptors coming into practice (see below). There is an expectation that these are implemented by April 2019, however manufacturers of thickener products have decided to change their packaging well in advance of this.

As you can imagine, there are concerns about patients potentially
continuing to use their own numerical stage in the new level, which would make their fluids too thin and potentially increase the risk of aspiration.

Switch to Resource ThickenUp Clear
Sunderland SALT did some local field testing on mixing the Nutilis Clear product (the most widely used product in Sunderland) with the new scoop size and tested against the old and new descriptors. There was concern about the differences in thickness when fluids were mixed to the new descriptors. When testing with Resource ThickenUp clear, there was not the same level of concern, therefore a decision was made to switch to this as the thickener of choice for Sunderland. It is also the thickener product which is used in South Tyneside.
Practice pharmacists will be making the switch to the new product and informing patients about the change, and their new levels over the coming months. There is also working going on to ensure care home patients all switch to the new product at the same time.

Community pharmacy support
We are aware that the product packaging may change before practice pharmacists have time to inform patients (some products may have already changed). We would like community pharmacists to help support patients in this transition period. Please ensure that patients know:
 What their new level is in relation to their old ‘stage’ (where patients know what their old stage was)
 That the products themselves aren’t changing, but scoop sizes may
 The patients that may be at increased risk are those that have stage 2 thickened drinks and get new IDDSI packaged Nutilis Clear (with levels 1-4 on the tin) before the switchover by practice pharmacists to RTUC .
 If they experience any difficulties with the new thickness and are experiencing signs of aspiration (see below) they could contact the SALT team at CHS for guidance as a matter of urgency
Signs of aspiration include:
 coughing or becoming short of breath when eating and drinking
 chest infections
 wet, gurgly voice associated with eating and drinking.
Patients or community pharmacists can contact the CHS SALT team on: 0191 5699009

Education and training materials
There are downloadable resources, training materials and summaries available on IDDSI and the Resource ThickenUp Clear website at:
Ensure that you indicate that you are a healthcare professional by clicking the button in the top right-hand corner of the webpage (see below).