Resource® ThickenUp™ Clear Buckinghamshire NHS Trust Trial Results

NESTLÉ HEALTH SCIENCE 2016

Aim

To undertake a trial to compare Resource® ThickenUp™ Clear against their current starch based thickener and address the current difficulties.

Method

• Nestlé Health Science provided samples of Resource® ThickenUp™ Clear to the Stroke Unit to trial this thickener
• The trial consisted of numerous evaluation components:
• Taste test – included staff and patients with dysphagia
• Saliva test – undertaken by speech therapists
• Patient and relative feedback
• Staff feedback
• Thickening nutritional supplements
• Fluid balance charts

Key Findings

• Current health risk to patients with current starch based thickener due to consistency changes in relation to saliva
• Positive feedback from staff and patients regarding the appearance, taste and use of Resource® ThickenUp™ Clear
• Difficulty thickening supplements (particularly juices) with both types of thickening powder
• The general feedback and results from the trial indicated that Resource® ThickenUp™ Clear would be the preferred choice of thickener to use with patients

Taste test results

• Taste test for staff and patients with dysphagia – to rate thickened water from 1 to 10 and choose a preferred drink (Resource® ThickenUp™ Clear vs starch)
• Jugs were prepared of stage 1 thickened water and testing was conducted blind
• 7 staff members (2 x junior doctors, 3 x physiotherapists, 1 x stroke specialist nurse, 1 x occupational therapist) & 3 patients with dysphagia

Saliva test

Aim:

• To test 2 hypotheses relating to the safety of the patient with dysphagia and the likelihood that the patient with dysphagia will receive adequate hydration

1. That thickener will become increasingly thick over time
2. That thickener will change in consistency when saliva is added

Method:

• 4 x 200ml stage 1 thickened water (2 x Resource® ThickenUp™ Clear, 2 x starch based thickener)
• A 2.5ml teaspoon of saliva was added to 1 x Resource® ThickenUp™ Clear and 1 x starch thickened drink
• Measure of consistency was the ability of a plastic teaspoon to stand up in a thickened drink
• Consistency with and without saliva was observed at 0 minutes, 15 minutes, 3 hours and 24 hours

Results

• Neither Resource® ThickenUp™ Clear or the starch thickened drink became signifcantly thicker over time
• After 15 minutes, the fluid thickened with starch based thickener started to become thinner as demonstrated by the plastic teaspoon not standing up in the fluid
• After 3 hours, the starch thickened fluid became thin and clear
• There was no significant effect of saliva on drinks thickened with Resource® ThickenUp™ Clear therefore there is no risk to changes in consistency as a result of saliva

Patient and relative feedback

Staff feedback

 

Difficulties with supplements

• Based on historical issues with thickening supplements with starch based thickeners, this was an important consideration in this trial
• Previous issues included: poor mixing, lumpy and uneven consistency, no attempts made by ward staff to thicken supplement drinks, therefore unthickened supplements were given to patients presenting a risk of aspiration
• Challenges were also experienced with Resource® ThickenUp™ Clear (RTUC) and thickening supplement drinks, therefore the SLT department approached 4 SLT departments in other trusts for their experience using Resource® ThickenUp™ Clear

Questions asked:

• Have you had any difficulty thickening any supplements?
• Have ward staff found the waiting time for mixing RTUC with supplements problematic?
• How have you resolved the problems presented with thickening, compliance and supplements?

Fluid balance charts and other considerations

• Evaluation of fluid balance charts was not possible due to high turnover of patients and inconsistencies in the recording of the information in the patients’ charts
• Can Resource® ThickenUp™ Clear be used with patients on a renal diet, as it contains potassium and sodium?
  • Based on information provided by Nestlé Health Science on the contribution of potassium and sodium per 750ml of thickened fluid across the different stages. For renal patients who may be on sodium and/or potassium restrictions, the contribution of these nutrients from Resource® ThickenUp™ Clear would still be acceptable.
• Can Resource® ThickenUp™ Clear cause constipation?
  • Acceptability and tolerance data to support Resource® ThickenUp™ Clear was provided¹

Conclusion

• Resource® ThickenUp™ Clear was the preferred choice of thickener to use with patients based on the general feedback and results from this trial
• Buckinghamshire Healthcare NHS Trust are now using Resource® ThickenUp™ Clear in both the hospital and community

Disclosures

• Buckinghamshire Healthcare NHS Trust speech therapists (“Buckinghamshire speech therapists”) have consented to us disclosing their name and using the results of the trial for training with another third party
• Nestlé Health Science provided training to Buckinghamshire NHS Trust staff on Wycombe Hospital Hyper Acute and Acute Stroke Unit before the trial was undertaken

Reference

1. Acceptance, Compliance, and Tolerance of a Novel Xanthan Gum-Based Thickener in Oropharyngeal Dysphagia Patients, Judi Hibberd (2011)