1 residential care speech pathology service successful swallowing
TRANSCRIPT
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Residential Care Speech Pathology Service
Successful Swallowing
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Residential Care Speech Pathology Service
Successful Swallowing:Provision and Preparation of
Thickened Fluids in Residential Care Facilities: Greater Newcastle Region
Presented by Project Supervisor Selena McCaig, Speech Pathologist
Project Coordinators, Speech Pathologists
- Jessica Passmore, Kellie Meredith
Acknowledgement for contributions:
- Paula Machin, Maree Herzog,
Larissa Mason, Amanda Bailey,
Renae Mannix, Elisha Cooper
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Overview of presentation Scope of Project
Methodology
Results
Conclusions
Recommendations for future management
and development
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Who we are and what we do Residential Care Speech Pathology Service
Compensable - utilising Federal funding for Allied Health services for high care residents in RCFs
Provide assessment/treatment for communication and swallowing (Dysphagia) in RCFs
Our mission: to prevent hospital readmission due to aspiration
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Problems for solving Initial Findings:
• limited knowledge: preparation and provision of thickened fluids
• only one consistency provided
• no consistency in viscosity of fluids
• used as ‘quick fix’ for dysphagia
• no SP consult
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Scope of project
Initial Goals: 2008
– Encourage trial of pre-packaged thickened fluids - ideal consistency
– Limited shelf life / costly
Most RCFs were not willing to trial
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1. Review current knowledge and practices
2. Provide free educational inservice
3. Increase use of three consistent levels of thickened fluids
4. Impact referrals
Scope of project – revised March 2011
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Methodology Approached 50 RCFs : telephone
interviews
18 facilities participated: – 62 individuals interviewed:
• 44 nursing staff, 18 kitchen staff
Subjective rating:– allocated colour for perceived level
of knowledge/current practice • ‘Green’, ‘Yellow’, ‘Red’
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Methodology
Educational inservices (over 9 weeks)
Questionnaires assessedknowledge pre and post inservice
Interview data analysed qualitatively
Quantitative data analysis undertaken
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Colour Codes for Perceived Knowledge and Current Practices
Green Managing current system well.
Good knowledge of purpose / function of thickened fluids
Consistent & monitored approach to preparing thickened fluids
Three levels of thickened fluids available (if required)
Thickened water available
Staff have good knowledge of warning signs for swallowing issues
Facility consistently uses speech pathologist to provide swallowing assessments
Yellow Knowledge around current system is inconsistent
Reasonable knowledge of purpose / function of thickened fluids
Inconsistent approach to preparing thickened fluids
Three levels of thickened fluids available (if required)
Thickened fluids may not be consistent on a day-to-day basis
Thickened water available
Staff have some knowledge of warning signs for swallowing issues
Facility consistently uses speech pathologist to provide swallowing assessments
Red Knowledge around current system is inconsistent and/or poor
Poor knowledge of purpose / function of thickened fluids
Inconsistent approach to preparing thickened fluids with no monitoring system in place
Less than three levels available of thickened fluids
Limited knowledge of warning signs for swallowing issues
Facility may or may not use a speech pathologist to provide ‘swallowing assessments’ and prescribe thickened fluids
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Results– 4 green, 8 yellow and 6 red
– Most using thickening powder only
– RCFs not monitoring hydration levels
– RNs assessing and modifying
– variation with terminology used
– feel they have adequate knowledge of dysphagia/modified diet fluids
– Not all facilities offering 3 levels! Some did not offer thickened water at all!
– Consistently inconsistent
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Results1. The current level of knowledge of
preparation and provision is not sufficient
2. Resident safety breeched due to inability to provide modified diets/fluids to National Standards
3. SP input redundant if RCFs unable to follow our recommendations
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Results: pre/post educationComparison of nursing staff pre-test/ post-test scores
Comparison of kitchen staff pre-test post-test scores
0
20
40
60
80
100
Pe
rce
nta
ge
(%
)
Pre Post
0
20
40
60
80
100
RCF1
RCF2
RCF3
RCF4
RCF5
RCF6
RCF7
RCF8
RCF9
RCF10
RCF11
RCF12
RCF13
RCF14
RCF15
RCF16
RCF17
Pe
rce
nta
ge
(%
)
Pre Post
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Results% change
% change by colour classification
-10
0
10
20
30
40
50
Pe
rce
nta
ge
(%
)
Nursing Kitchen
0
5
10
15
20
25
30
RCF Colour Severity Classification
Perc
en
tag
e (
%)
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Results% change in key areas of education
0
20
40
60
80
100
Pre Post
Percentage (%)
Awareness of Standard Terminology Recognition of Clinical Signs of Aspiration
Rationale for Implementing Thickened Fluids Consequences of Dysphagia
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Results - 1: RCF education significantly improved:
– Awareness of dysphagia and aspiration– Awareness of consequences of inadequate
management. i.e. infection, dehydration, malnutrition
– Awareness of standard terminology and definitions for texture modified diets/fluids
– Understanding of the rationale for prescription of thickened fluid regimes
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Results - 2: Greatest change in knowledge
for ‘Red’ category facilities
Knowledge remains relatively low despite improvement being measured
Need for ongoing education!!!
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Results - 3: Kitchen/catering staff attendance –
approx. 20%.
- Kitchen staff complete most of the preparation of thickened fluids (up to 86%).
Need to target kitchen staff responsible for preparation of thickened fluids
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Conclusions Findings largely reflect available literature:
thickened fluids consistently inconsistent
Overall increased awareness - identified current weaknesses in provision of thickened fluids in Newcastle region
Ongoing consultation and education within RCFs is required! Specifically, education of kitchen staff
Greater input from speech pathologists to ensure that each facility is able to implement changes
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Were goals achieved? …1
Thorough review of current knowledge/practices re thickened fluids and dysphagia management within the Newcastle Region
Provide free education to those RCF who participated
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Were goals achieved? …2Knowledge and rationales for need
for three consistent levels of thickened fluids however….
– Unable to determine if this
education has led to %RCFs offering three consistent levels of thickened fluids
– Timeframe has not allowed for review of appropriateness of RCSPS referrals as a result of education provided
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Successful outcomes Open and ongoing dialogue
between RCSPS and RCFs
Increased awareness within RCFs of need for three levels of fluid thickness
Increased awareness of importance of referral to SP for dysphagia management
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Feedback RCF feedback
–SP need to provide clear guidance re: how to mix fluids. Suggested that “recipe” would be helpful
–RCFs identified need to change: ‘where to start?!?’
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Now what?Measuring long-term outcomes:
– ?Measure impact of training on patient outcomes
– Further questionnaire 3-6 months post education - are RCFs using 3 consistencies?
– ?Obtain feedback from nursing and kitchen staff re: impact of education on daily performance at mealtimes and confidence with feeding
– Measure any change in nature and quantity of referrals to the RCSPS
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Where to next….? The thick fluid ready
reckoner!?!
Stay tuned for project 2012
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Questions or Comments?
Residential Care Speech Pathology Service - 2011