Helping a Patient Eat Safely

Eating looks simple until a stroke, dementia or weakness changes how someone chews and swallows. Food or liquid can then go down the airway instead of the esophagus. This is called aspiration, and it can cause choking or aspiration pneumonia, a serious lung infection. Helping someone eat safely protects their lungs, keeps them fed and lets them keep some dignity at a meal.

What You Will Be Able to Do

• Check a meal against the person's identity and diet order.
• Position a person and yourself correctly for eating.
• Help someone eat at a safe pace.
• Recognize signs of swallowing trouble and aspiration.
• Respond if a person coughs or chokes at a meal.

Before the Meal

1. Clean your hands, and help the person clean theirs.
2. Help with the toilet if needed, and offer mouth care. Dentures, glasses and hearing aids should be in place.
3. Check the person's identity and make sure the tray matches their diet order, including texture and any thickened liquids. Report anything that does not match instead of serving it.
4. Check whether the person is NPO, which means nothing by mouth, including food, drink and oral medicines.
5. Sit them upright, ideally at 90 degrees in a chair, or as upright as they can safely sit in bed. Tuck in a pillow if they lean.
6. Remove distractions. Turn off the TV if it pulls their attention.

During the Meal

Sit at the person's eye level. Standing over someone rushes them and makes them tilt their head back, which can make swallowing unsafe.

1. Tell them what is on the tray, and ask what they want first. For a person with vision problems, describe where things are using a clock: "The chicken is at 3 o'clock."
2. Let them do as much as they can. A built-up spoon or a plate guard can help.
3. Offer small bites and small sips, using a teaspoon rather than a large spoon.
4. Wait for a full swallow before offering more. Watch the throat rise and fall, and check that the mouth is empty.
5. Alternate food and drink unless the care plan says otherwise.
6. Keep your pace slow, and let them rest. Talk, but do not ask questions while their mouth is full.
7. Check for pocketing, which is food held in the cheek.

Never use a straw, a syringe or a spoon held to the back of the throat unless the care plan allows it. Follow any swallowing strategies that a speech-language pathologist has ordered, such as a chin tuck.

Following Texture and Liquid Orders

A person with dysphagia, or trouble swallowing, may have a specific order for foods and liquids. Many facilities now use a set of levels from the International Dysphagia Diet Standardisation Initiative (IDDSI). Level 4 food, for example, is smooth, lump-free puree that holds its shape. Thickened liquids slow the flow, which gives the throat more time to close the airway.

Thickened liquids apply to everything the person drinks, unless the order says otherwise. Water, coffee, juice and soup all count. Ice, ice cream and gelatin turn into thin liquid in the mouth, so check the order before you offer them.

Warning: Never give a person on thickened liquids a regular drink, even if they ask. Tell the nurse if they keep refusing, and let the nurse and speech therapist make a plan.

After the Meal

1. Keep the person upright for at least 30 minutes after eating. This applies to anyone with swallowing trouble or reflux, and it is a good rule for most people. It lets food move down and lowers the risk of aspiration.
2. Check the mouth for leftover food, and give mouth care.
3. Clean your hands and theirs.
4. Record how much they ate, as a percentage, and how much they drank, in mL or ounces.

Signs of Trouble

Some people aspirate silently, with no cough at all, so report any of these signs to the nurse. If you suspect a swallowing problem, stop the meal and tell the nurse before you offer more.

If the Person Coughs or Chokes

1. Stop feeding right away.
2. Keep them upright and let them cough. A strong cough is the best way to clear food.
3. Do not give water or food, and do not slap them on the back while they are coughing well.
4. If they cannot cough, speak or breathe, start your choking response and call for help or 911.
5. Tell the nurse, even if they recover. Document what happened.

When a Person Does Not Want to Eat

A poor appetite is common with illness, depression, pain and many medicines. Offer the meal anyway, encourage small amounts and document what they eat. Ask about favorite foods, and offer smaller meals if they get full quickly. Do not force food. Pushing a spoon into someone's mouth is unsafe and it takes away their right to refuse. If they are eating very little, tell the nurse.

At the end of life, it is normal for a person to want less food. Comfort matters more than calories, so follow the nurse's direction.

Common Mistakes

Check Your Understanding

1. A resident with a recent stroke is lying at 30 degrees when lunch arrives. What do you do first?

Check the tray against the diet order, then sit her upright, ideally at 90 degrees, before offering any food.

2. While you are helping him eat, a man starts coughing and his voice sounds wet. What should you do?

Stop feeding, keep him upright and let him cough. Tell the nurse and do not continue until you get instructions.

3. A patient on thickened liquids begs for a sip of regular water. What do you say?

Tell him kindly that you cannot give it, offer the thickened drink, and tell the nurse about his request.

4. The meal is finished and the resident asks to lie down. What do you do?

Explain that she needs to stay upright for at least 30 minutes, and help her stay comfortable until then.

Key Takeaways

• Check identity and the diet order before you serve food.
• Sit the person upright and sit at their eye level.
• Use small bites, small sips and a slow pace.
• Keep them upright for at least 30 minutes after eating.
• Coughing or a wet voice can mean aspiration, so stop and tell the nurse.
• Never force food or change a texture order.