Following SALT advice, textures, thickeners and medicines

If a resident has assessed swallowing difficulties, staff must follow the current plan exactly. CQC expects dysphagia care plans to state the required food and drink consistencies, list any risks, and set out when to get further help. CQC also asks whether care and kitchen staff are trained to use thickeners and modify meals, and whether hydration is monitored when thickeners are used.

NHS England issued a patient safety alert to remove the vague term "soft diet" and promote standard texture terminology, including IDDSI where used locally. In practice, this means staff must use the precise texture and consistency named in the plan. Do not guess the meaning of a vague label or substitute a different texture because it seems easier; the recommendation must match the resident's assessment.

CQC and NICE also highlight medicines safety for people with dysphagia. Residents may need a medicines review. Do not crush tablets, open capsules or mix medicines into food or drink unless the care plan or a suitable clinician confirms it is safe. CQC also advises against directly mixing polyethylene glycol laxatives such as macrogol powder with starch-based thickeners.

Safer practice with textures and thickeners

• Use the exact plan: follow the current food texture and drink consistency instructions for that person.
• Use standard terms: check the IDDSI level or local standard wording where the plan uses it.
• Do not improvise: avoid vague terms, home-made guesses and unapproved swaps.
• Store thickener safely: accidental swallowing of dry thickening powder can be dangerous.
• Do not share prescribed thickener: use it only for the resident it is prescribed for unless local medicines governance says otherwise.
• Watch hydration: some residents drink less when fluids are thickened.
• Check medicines guidance: never assume a tablet is safe to crush.

Safer swallowing support depends on following clear, individual instructions rather than guesswork.