Esther Clift is a Consultant Practitioner in Frailty and Chair of Wessex BGS, as well as the Vice Chair of the BGS Nurses and AHP Council. She tweets as @EstherClift
The Royal College of Speech and Language (RCSLT) held a Symposium on dysphagia to work collaboratively at a system wide level in order to improve patient care, safety and outcomes for adults with dysphagia. The current prevalence data was presented in conjunction with NHS Improvement and the Academy of Medical Royal Colleges. Kamini Gadhok, MBE, the CEO for the RCSLT opened the symposium.
Dysphagia is a significant issue for patient safety. The reality of choking and asphyxia is firmly on the agenda since some high stake cases in February 2015, over ‘a risk of death from asphyxiation by accidental ingestion of fluid/food thickening powder.’ A review by the National Reporting and Learning System identified system wide issues with the care of people with dysphagia. Four workstreams were developed around workforce, raising awareness, evidence and data, and resources and guidance. These had three key aims:
- To develop a system wide approach across professionals and providers
- To improve outcomes, to identify workforce challenges and opportunities for workforce transformation along the lines set by the five Year Forward View, and
- To agree the types of guidance and interventions required.
The reality is that there are no identified national pathways or standards, and a paucity of data to understand the extent and complexity of the issues around dysphagia.
So what has this got to do with geriatric medicine? A great deal! Dysphagia was described as one of the ‘geriatric giants,’ by Dr David Samford, (a BGS member, and the Chair of the UK Swallow Research Group) who explained that one of the commonest sequelae of sarcopenia is dysphagia. Dysphagia is an independent predictor of poor outcome in acute care.
Professor Pam Enderby explained that while thickeners reduce the risk of penetration aspiration, they increase the risk of post swallow residue in the pharynx, which may increase the chance of developing a chest infection. The single key factor in reducing chest infections is good oral hygiene, with timing for feeding, positioning of both the patient and person facilitating feeding, using suitable utensils, communication aids and dentition, as well as a modified diet also vitally important.
So what next?
The International Dysphagia Diet Standardisation Initiative (IDDSI) are implementing a global standard for texture with a scale of 0-7 with verbal descriptors to aid clear guidance for anyone feeding people with dysphagia see http://iddsi.org/framework for the detail. They are working particularly with people in Care Homes, and specifically targeting chefs, who prepare meals.
Dr Liz Boaden showcased the work in developing a consistent approach to training healthcare staff through the Inter Professional Dysphagia Framework. Cath Waterhouse, an ITU specialist nurse, described her journey of engagement with the framework, and the value of her additional skill set to the patients in ITU.
Can we move the management of dysphagia, from the specialist territory of highly trained Speech and Language Therapists who are as rare as hens teeth, into everyone’s business?
Could it be rather like #EndPJParalysis has become everyone’s business, not just physiotherapists?