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Swallowing Difficulties Policy

Policy Statement

This policy shows how this care service helps those people who have difficulties with swallowing and who might then be at risk of choking. The service recognises that people who have difficulties with swallowing, whatever the causes, will find eating and drinking less pleasurable and with no or inappropriate help would suffer from dehydration and malnutrition.

People who have difficulties swallowing their food are described as suffering from dysphagia. It is a common complaint among older individuals and is often a problem for people who have had strokes, who are living with dementia, who have mouth or oesophageal cancer, or who have a neurological condition such as Parkinson’s disease or multiple sclerosis.

1. Any person receiving our care who is known to have difficulties in masticating and swallowing food and keeping their drinks down or who develops such difficulties has a full assessment of those difficulties by their medical practitioners so that the causes are understood and {{org_field_name}} can give the appropriate help.
2. It is recognised that swallowing difficulties can have different physical causes, which result in different levels of difficulty and psychological effects. It is important therefore to have a full medical assessment in order to provide the appropriate help for the affected person.
3. In line with the medical assessment, the service carries out a nutritional needs assessment to identify the nature and level of the person’s difficulties and the nutritional risks, including any risks of choking that might be involved. This will involve, where needed, a local health service dietician, who will advise on the nutritional plan and / or occupational therapist, who will advise on any eating and drinking aids that might be appropriate.
4. All relevant information is built into the person’s plan of care so that all involved are aware of the needs and how they should be addressed and of any risks to personal safety. The aims are always to enable a person to be as independent as possible, to retain their self-respect and dignity, to exercise choice and generally to feel in control of their eating and drinking.
5. The person’s consent is always sought over any matters that affect their chosen ways of eating and drinking, eg for regulating types of food to be eaten, meals portions, liquid diets, presentation and cutting up of foods. People who are unable to give their consent on any of these matters are assessed on a “best interests” basis in line with the service’s policy on mental incapacity.
6. All decisions are recorded on the person’s care plan together with information on how any risks are to be managed.
7. Where a person’s exercise of choice over, for example the prior cutting up food or preferences for solids over liquids, creates risks of choking or failure to swallow, the issues are always discussed with the person (and relatives where involved) so that a suitable solution can be agreed. In this process, the service is mindful of its duty of care and will not agree to provide help that creates unacceptable risks to people who use the services or staff.
8. Close checks are then always made where the person continues to pose risks of choking or bringing up food, eg because they continue to eat food that is likely to be difficult to swallow or refuse to have meat cut up into sufficiently small portions. There is always continuing discussion with the individual and their relatives to obtain a suitable solution to any ongoing difficulties that could be avoided by the person modifying their behaviour to reduce the risks.
9. Staff helping users with their eating and drinking are instructed to follow each care plan and are alerted to any risks to personal safety so that they can provide appropriate emergency action if necessary. There is always someone with the relevant first aid training available to carry out the emergency procedures necessary in the event of someone physically choking on their food.
10. Where thickeners are used to thicken the consistency of liquids should only be used on the recommendation of a speech and language therapist (SLT) following a diagnosis of dysphagia and a holistic assessment.
11. Thickeners must be administered correctly, monitored, reviewed, and used in conjunction with other approaches such as swallowing rehabilitation and use of appropriate drinking vessels, and the choice of thickener based on the persons degree of dysphagia, desired consistency, the texture required and palatability.
12. Consideration should be given prior to their use and precise instructions followed. Thickened fluids may alter swallow physiology and reduce aspiration for people with dysphagia. See Meal and Mealtimes topic and Use of Thickening Liquids Policy.
13. Care staff who support people to use oral suction devices to clear blockages, debris and accumulations of saliva will be trained in the procedures involved and assessed as being competent to carry them out as required on the person’s care plan. Their role will vary but could involve: maintenance of the devices used, including cleaning and disinfecting, monitoring and supporting people who self-care and actively carrying out the procedures for users who cannot manage themselves. {{org_field_name}} will ensure that their care workers always have access to professional medical guidance to ensure that they carry out their agreed roles effectively and safely.
14. Management carries out periodic reviews of the numbers and nature of users’ swallowing difficulties so that it can respond accordingly, eg by increasing staff training, obtaining more external professional advice, adjusting menu planning, etc.

Training

As part of their training in nutrition, staff receive training and instruction over people who use services with swallowing difficulties and who might be at risk of choking. Training involves:

• range of causes of swallowing difficulties and choking
• roles and contributions of external health care professionals such as dieticians to care planning and risk assessments
• staff including kitchen staff who prepare food should be adequately trained in the use of thickeners, and staff responsible for using such products should ensure manufactures recommendations are followed regarding this
• plans for individuals needing help with their eating and drinking or who might be at risk
• emergency first aid procedures (see the First Aid Principles and Emergency Support for Common Chronic Diseases — Part 2 Training Presentation)
• use of suctioning methods and devices.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

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