CHW230-Supporting People with Swallowing Difficulties Policy

Registration Number: {{org_field_registration_no}}

Supporting People with Swallowing Difficulties (Dysphagia) Policy

1. Purpose

The purpose of this policy is to ensure that residents with swallowing difficulties (dysphagia) receive safe, dignified, and person-centred care that minimises the risk of choking, malnutrition, dehydration, and aspiration pneumonia. {{org_field_name}} is committed to ensuring that residents are assessed, supported, and monitored in line with best clinical practice, CIW regulations, and speech and language therapy (SALT) guidance.

This policy provides clear procedures for identification, assessment, intervention, and ongoing support for individuals with swallowing difficulties, ensuring that staff are well-trained and equipped to manage these risks efficiently.

2. Scope

This policy applies to:

All residents at {{org_field_name}} who have, or are at risk of, swallowing difficulties.
All staff, including care staff, catering teams, and healthcare professionals involved in residents’ nutrition and hydration.
Visitors and family members, ensuring they understand the importance of supporting residents with swallowing difficulties.
External healthcare professionals, including speech and language therapists (SALT) and dietitians, who provide assessments and recommendations.

The policy covers:

Identifying and assessing swallowing difficulties.
Safe food and drink modifications.
Staff training and responsibilities.
Multi-agency collaboration.
Emergency procedures for choking incidents.
Ongoing monitoring and review.

3. Legal and Regulatory Compliance

This policy is aligned with:

The Regulation and Inspection of Social Care (Wales) Act 2016, ensuring safe, high-quality care practices.
The Social Services and Well-being (Wales) Act 2014, promoting dignity, person-centred care, and well-being.
The Health and Safety at Work Act 1974, ensuring safe working practices related to food preparation and choking prevention.
The Food Safety Act 1990, ensuring the provision of safe and suitable food for people with swallowing difficulties.
The Mental Capacity Act 2005, ensuring residents can make informed decisions about their diet, with best-interest decisions made when necessary.
NICE Guidance (NG174) on Dysphagia, outlining best practice for managing swallowing difficulties in care settings.
IDDSI (International Dysphagia Diet Standardisation Initiative) Framework, which sets international standards for food texture and drink thickness modifications.

4. Identifying and Assessing Swallowing Difficulties

4.1 Recognising Signs of Dysphagia

Staff must be trained to recognise the early signs of swallowing difficulties, including:

Coughing or choking while eating or drinking.
Frequent throat clearing during meals.
Wet or gurgling voice after swallowing.
Prolonged chewing or difficulty controlling food in the mouth.
Recurrent chest infections (a potential sign of aspiration).
Unexplained weight loss or dehydration due to reduced food intake.

4.2 Referral for Assessment

Any resident showing signs of dysphagia must be referred to a speech and language therapist (SALT) for an assessment.
A dysphagia screening tool will be used by trained staff to determine the level of urgency.
Residents must not be given modified diets or thickened fluids without professional assessment and confirmation of appropriate levels.

5. Safe Food and Drink Modifications

5.1 IDDSI Framework for Modified Diets

All food and drink modifications must comply with the International Dysphagia Diet Standardisation Initiative (IDDSI), which categorises foods and fluids into levels 0-7, such as:

Level 0 (Thin fluids) – regular drinks with no modifications.
Level 1-4 (Thickened drinks) – fluids are thickened to prescribed consistency using commercial thickening agents.
Level 5 (Minced & Moist food) – food that is easy to chew and does not require significant effort.
Level 6 (Soft & Bite-Sized food) – soft, tender foods that require some chewing but are safe for swallowing.
Level 7 (Regular food) – normal texture, suitable for residents without dysphagia.

5.2 Catering Team Responsibilities

The catering team must strictly adhere to SALT recommendations and IDDSI guidelines.
Staff preparing food must be trained in dysphagia-friendly meal preparation, ensuring correct consistency and presentation.
Separate meal preparation areas may be required to prevent cross-contamination of modified foods and fluids.
All meals must be labelled according to the correct IDDSI level before serving.

5.3 Hydration Management

Residents requiring thickened fluids will be provided with drinks prepared to the correct IDDSI level.
Staff must ensure adequate hydration, encouraging frequent sips of fluids in line with care plans.
Hydration monitoring charts will be used for residents at risk of dehydration.

6. Staff Training and Responsibilities

6.1 Training Requirements

All staff must complete mandatory training in:

Recognising and responding to swallowing difficulties.
Safe feeding techniques, including positioning and supervision.
IDDSI framework and food modification standards.
Emergency response to choking incidents.

Training is refreshed annually, with additional training provided if new guidelines or best practices are introduced.

6.2 Staff Roles and Responsibilities

Care staff must support residents during meals, ensuring safe swallowing practices are followed.
Catering staff must prepare meals according to IDDSI guidelines and SALT recommendations.
Nurses and senior staff must oversee dysphagia management, ensuring adherence to care plans.

7. Multi-Agency Collaboration

We work closely with Speech and Language Therapists (SALT), dietitians, GPs, and family members to ensure a holistic approach to care.
Any changes in a resident’s swallowing ability are immediately reported to the healthcare team.
Regular multi-disciplinary meetings review dysphagia cases and care plans.

8. Emergency Procedures for Choking Incidents

If a resident chokes:

Call for immediate assistance and alert a first-aid-trained staff member.
Encourage the resident to cough if they are still able to breathe.
If unable to cough or breathe, perform 5 back blows followed by 5 abdominal thrusts (if safe to do so).
If the resident becomes unresponsive, commence CPR and call 999.
Document the incident and report it as per CIW regulations.

9. Monitoring and Review

9.1 Ongoing Monitoring

All residents with dysphagia will have a nutrition and hydration care plan, reviewed monthly.
Weight monitoring, hydration records, and choking risk assessments are updated regularly.
Observations of mealtime experiences ensure safe and dignified support.

9.2 Policy Review

This policy will be reviewed annually or sooner if legislation changes or new best practices emerge.

10. Related Policies

This policy should be read alongside:

Meeting Nutritional and Hydration Needs Policy (CHW12).
Safe Care and Treatment Policy (CHW11).
Staff Training and Development Policy (CHW27).
Infection Prevention and Control Policy (CHW17).
Safeguarding Adults from Abuse Policy (CHW13).

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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