DDS: Safety Alert Directive: Adherence to Correct Liquid Consistency for Individuals with Modified Diets

TO: DDS Regional Directors, STS Director, Private Providers, CO Quality Management Personnel
Lakisha Hyatt, Director of Health and Clinical Services
Daniel A. Micari, Director, Quality Management Services
DATE: May 13, 2013
RE: Safety Alert Directive:   Adherence to Correct Liquid Consistency  for Individuals with Modified Diets
Safety Alert Directive

This Safety Alert is to bring immediate attention to a concern which exists throughout our entire service delivery system regarding not adhering to a prescribed liquid consistency. There have been recent incidents of inappropriate consumption of the thin liquid Jell-O by individuals with a modified liquid consistency. Over the course of nine months there have been three fatalities involving Jell-O consumption and aspiration. For each of the cases, the individual had a prescribed modified nectar liquid consistency. 
As stated in Health Standard #07-1: Dysphagia and Swallowing Risks, Attachment F, DDS has clearly defined liquid consistencies which identify Jell-O as a thin liquid, “Thin: includes all liquids, Jell-O, sherbet, Italian Ice and ice cream…..”
In addition to the aspiration risk associated with Jell-O given to someone requiring a thickened liquid consistency, Jell-O also has high motility.  This requires the ability of an individual to control the Jell-O once placed in their mouth. This requires careful consideration and an added degree of caution with Jell-O use..

Outlined below are essential safety precautions for all individuals for whom the department bears direct or oversight responsibility for their health and safety. Agency protocols must ensure the following:
  • Direct care providers are informed that Jell-O is a thin liquid and should never be administered to an individual requiring a modified liquid consistency.
  • All staff shall receive the dysphagia training upon hire and every two years thereafter.
  • Verification of dysphagia training and implementation of the appropriate choking prevention strategies  shall be documented and available on-site at the service location.
  • All agencies must have written defined processes for communicating diet modifications in such a way that care providers can easily obtain the information.
Below are dysphagia related resources available on the DDS website:
Preventing aspiration pneumonia:
Health Standard #07-1: Dysphagia and Swallowing Risks:
Dysphagia education sheet:
Any questions regarding the above should be referred to Lakisha Hyatt, Director, Health and Clinical Services, or Daniel Micari, Director, DDS Quality Management Services at
C: Terrence W. Macy, Ph.D., Commissioner
Joseph Drexler, Deputy Commissioner
Quality Management Services Staff
Health and Clinical Services Staff