Supporting safe swallowing of care home residents with dysphagia: How does the care delivered compare with guidance from speech and language therapists?

IF 1.5 3区医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY

International Journal of Language & Communication Disorders Pub Date : 2024-01-23 DOI:10.1111/1460-6984.13015

Hannah Griffin, Jennie Wilson, Alison Tingle, Anke Görzig, Kirsty Harrison, Celia Harding, Sukhpreet Aujla, Elizabeth Barley, Heather Loveday

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引用次数: 0

Abstract

Introduction

Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered.

Methods

Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents’ care plans and speech and language therapist recommendations.

Results

Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision.

Conclusion

Care homes need to be supported to establish a safe swallowing culture to improve residents’ safety and care experience.

WHAT THIS PAPER ADDS

What is already known on this subject?

Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents.
There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia.
Care for nursing home residents at mealtimes is often task-centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia.

What this study adds?

Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification.
Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas.
Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported.

What are the clinical implications of this work?

Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission.
Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia.
The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines.
Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely.
Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety.

查看原文本刊更多论文

为有吞咽困难的疗养院住户提供安全吞咽支持：提供的护理与言语和语言治疗师的指导相比如何？

简介吞咽困难影响着多达 70% 的护理院住户，增加了发病率和入院率。言语和语言治疗师提出了支持安全营养的建议，但提供持续指导的能力有限。本研究旨在了解为支持安全有效的护理而提出的建议是否得到实施，以及这些建议与实际护理之间的关系：在 2020 年期间，使用一种包含 12 项预期实践要素的工具，观察了有吞咽困难住院患者的 11 个用餐时间。将员工用餐时的行为与住客护理计划的遵守情况以及言语和语言治疗师的建议进行了比较：书面建议主要侧重于食物和液体的调整。观察结果（n = 66）显示，90% 的情况下都遵守了食物质地、姿势和警觉性的要求，但交替进食和饮水、提示和确保吞咽完成的遵守率低于 60%。浓稠的液体经常不符合国际吞咽困难饮食标准化倡议所要求的水平。由于缺乏专人监管，在餐厅提供营养护理的安全性较低：结论：需要支持护理院建立安全吞咽文化，以改善居民的安全和护理体验：关于这一主题的已知信息有哪些？吞咽困难与相当高的发病率和死亡率有关，已被确定为养老院居民死亡的独立风险因素。有证据表明，补偿性吞咽策略、安全喂养建议和饮食调整可以降低吸入性肺炎的风险。在进餐时间为疗养院住户提供的护理通常以任务为中心，并委托给受过有限培训的人员进行，这些人员缺乏有关支持吞咽困难住户营养和水合需求的有用策略的知识。本研究有何新意？言语和语言治疗师为有吞咽困难的住院患者提供的有关安全营养和水合的书面建议主要侧重于食物和液体的调整。护士和医护助理对国际吞咽困难饮食标准化倡议（International Dysphagia Diet Standardisation Initiative）的水平或安全吞咽策略的了解有限，而且为吞咽困难住户提供安全营养护理的建议措施的应用也不一致，尤其是当住户在用餐区用餐时。护理院并不了解英国皇家言语与语言治疗师学院关于如何为吞咽困难住客提供安全营养护理的指导。这项工作的临床意义是什么？护理院需要将安全吞咽文化放在首位，以确保协助有吞咽困难的住户进食和饮水，从而提高他们的用餐体验，并将可能导致入院的不良事件降至最低。言语和语言治疗师可以在培训和支持护理院员工方面发挥重要作用，帮助他们了解并对有吞咽困难的住户使用安全的吞咽策略。皇家言语和语言治疗师学院可以为护理院提供更多帮助，支持和指导他们如何实施安全的喂食程序。护理院员工对如何实施安全喂食程序的了解有限，他们需要言语和语言专家提供更多指导，以帮助有吞咽困难的住客安全进食。在护理院内创建安全吞咽文化有助于改善营养护理并提高患者安全。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Language & Communication Disorders AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

3.30

自引率

12.50%

发文量

116

审稿时长

6-12 weeks

期刊介绍： The International Journal of Language & Communication Disorders (IJLCD) is the official journal of the Royal College of Speech & Language Therapists. The Journal welcomes submissions on all aspects of speech, language, communication disorders and speech and language therapy. It provides a forum for the exchange of information and discussion of issues of clinical or theoretical relevance in the above areas.