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How a collaborative, inter-professional team achieves quality and safety for clients with Dysphagia.

Updated: Aug 24, 2022

With estimates of about 8% of the world population having dysphagia,, there is great need for appropriate, individualised supports that ensure safety, adequate nutrition and hydration. In November 2020, The National Disability Insurance Scheme(NDIS) Quality and Safeguard commission, released an alert on Dysphagia, safe swallowing and meal time management. The content below is based on that alert and is most suitable for health workers and anyone looking after someone with Dysphagia. When providers and collaborative teams follow these guidelines high quality, safe supports are provided.

Defining Dysphagia:

Dysphagia is a medical term for difficulties with swallowing.

There are a wide range of disabilities and medical conditions associated with dysphagia. Examples are Neuro-muscular dysfunction, as in Cerebral palsy Congenital syndromes, Neurological conditions like stroke, other conditions like cancer and chronic lung disease.

What are the signs and symptoms to watch for in a person who may have Dysphagia?

  • Difficult, painful chewing or swallowing

  • difficulty controlling food or liquid in their mouth

  • a feeling that food or drink gets stuck in the throat or goes down the wrong way, into the airways.

  • coughing, choking, or frequent throat clearing during or after swallowing

  • Mealtimes taking much longer e.g. more than 30 minutes

  • Becoming short of breath when eating and drinking

  • Tendency to avoid certain foods they find hard to swallow

  • spitting out or vomiting of undigested food

  • drooling of food from mouth.

  • hoarse or gurgly voice

  • having a dry mouth

  • poor oral hygiene

  • frequent heartburn

  • unexpected weight loss

  • frequent respiratory infections.

Best Practice-Recommended strategies to support NDIS participants who experience Dysphagia.

Risks associated with Dysphagia include Chocking, Aspiration Pneumonia. These can result in serious health complications including death.

Each of the participants has individual needs and specific guidelines must be followed. A general approach is outlined below, highlighting collaborative approach between the participant, provider, support staff, Speech pathologist, Dietician, General Practitioner and others.

Each member of the team has a role to play towards development and implementation of the meal time management plan.

Speech pathologist to assess swallowing and make appropriate recommendations e.g consistency of fluids, any modification of diet and medication . Speech pathologist also indicates how often the plan should be reviewed and circumstances under which another speech pathology review should be organised.

General Practitioner to review general health and swallowing difficulties, and recommend appropriate treatment if needed and make appropriate changes. The participant is also supported to have medications reviewed regularly by the GP. Dietician to ensure the meals will continue to offer adequate nutrition and hydration.

Other members of the team who may have roles in supporting participants with Dysphagia are, Dentist, Pharmacist, Ambulance personnel, Occupational therapist, Physiotherapist, depending on individual participant’s needs and change in circumstances.

Staff involved in direct clinical support are responsible for:

  • Implementing the strategies as per meal time management plan.

  • Complete training on dysphagia offered by their organisation.

  • Take on responsibility for continually learning and striving for continuous improvement.

  • Role in monitoring participants, identifying new signs and symptoms of Dysphagia,

  • Supporting those already known to have dysphagia, as well as identifying and reducing risks associated with Dysphagia.

  • In the event that complications of Dysphagia, like Chocking or Aspiration Pneumonia occur., be prepared to identify the change and manage the incident accordingly. This involves first aid, or referral and documenting e.g incident report, progress notes etc.

  • That role requires maintaining high level of knowledge, skills and appropriate attitudes, empathy and compassion.

  • At all times staff need to comply with the NDIS Code of conduct.

The Provider has to comply with the NDIS code of conduct and NDIS practice standards when providing supports.

  • Ensure participant with Dysphagia are supported to have an individualised, meal time management plan that give clear directions to staff. The meal time management plan will address:

  • best seating position during meals.

  • Instructions on modified food texture, for ease of swallowing.

  • Specific meal time assistance techniques.

  • How to respond in the event of coughing or chocking and ensuring risks are monitored during food and fluid consumption.

  • Use of appropriate feeding equipment.

  • Ensure the meal time management plan is reviewed regularly.

  • Meals and medications are prepared as directed.

  • The provider must ensure people with Dysphagia are supported to eat and drink safely. This is achieved by making sure Staff receive necessary training.

  • Trained staff are available at all times to monitor and support people with Dysphagia.

  • Staff know how to respond in the event of chocking , including calling ambulance when needed.

  • During staff meetings ,safety for people with Dysphagia should be regularly discussed.

Compliance:

To comply with the NDIS Code of conduct, staff and providers must

  • Provide high quality services and supports in a safe, competent and compassionate manner.

  • Identify any concerns that might impact on quality and safety promptly and take appropriate action.

Compliance with NDIS practice standards.-Registered Providers.

Listed below are are the standards that link to Dysphagia management.

  • Human resources management

  • Access to appropriate supports

  • Safe environment for supports

  • Risk management

  • Quality management

  • Information management

  • Incident management

Conclusion:

To effectively manage Dysphagia, a team-based approach achieves best outcomes for the participant, their support system, the staff, and providers. By following the directions from this alert, providers will ensure adequate well-trained staff are always present to help meet the participant’s needs. Staff have a great responsibility to identify the presents of Dysphagia and following the meal time management plan. They take leadership by maintaining high levels of knowledge and skills for managing participants with Dysphagia. This includes first aid management , incident management, reporting, and referral, based on client’s needs. Both staff and providers collaboratively work towards provision of safe, high quality supports that meet the code of conduct and quality standards.

You can read more about Inter Professional Learning here.


References:

For more information please refer to the practice alert on Dysphagia, safe swallowing and meal time management by following link below.

2. The NDIS code of conduct

3. Workers can access free e-learning material easily by following link below.

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