Transcript Residential Care Speech Pathology Service Feeding the

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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Scope of project – revised March 2011
1. Review current knowledge
and practices
2. Provide free educational
inservice
3. Increase use of three
consistent levels of
thickened fluids
4. Impact referrals
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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 assessed
knowledge pre and post inservice
 Interview data analysed qualitatively
 Quantitative data analysis undertaken
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Colour Codes for Perceived Knowledge and Current Practices
Yellow
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

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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Results
1. 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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Pre
C
R
C
R
C
R
C
R
C
R
C
R
C
F1
7
F1
6
F1
5
F1
4
F1
3
F1
2
F1
1
F1
0
F9
F8
F7
F6
F5
F4
F3
F2
F1
Pre
R
C
R
C
R
C
R
C
R
C
R
C
R
C
R
C
R
C
R
C
R
Percentage (%)
R
R
R
R
R
R
R
R
C
F
C
F
C
F
C
F
C
F
C
F
C
F
9
8
7
6
5
4
3
2
1
17
16
15
14
13
12
11
10
C
F
C
F
C
F
C
F
C
F
C
F
C
F
C
F
C
F
C
F
R
R
R
R
R
R
R
R
R
Percentage (%)
Results: pre/post education
Comparison of nursing staff
pre-test/ post-test scores
100
80
60
40
20
0
Post
Comparison of kitchen staff
pre-test post-test scores
100
80
60
40
20
0
Post
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Results
% change
40
30
20
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Nursing
F1
7
C
R
F1
6
C
R
F1
5
C
R
F1
4
C
R
F1
3
R
C
F1
2
C
R
F1
1
C
R
F1
0
R
C
F9
C
R
F8
C
R
F7
C
R
F6
C
R
F5
C
R
F4
C
R
F3
C
R
C
R
R
C
-10
F2
0
F1
Percentage (%)
50
Kitchen
% change by colour classification
Percentage (%)
30
25
20
15
10
5
0
RCF Colour Severity Classification
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Results
% change in key areas of education
100
80
60
Percentage (%)
40
20
0
Pre
Post
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? …2
 Knowledge 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
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