Dysphagia (Swallowing Disorder) Policy · July 2015 DYSPHAGIA (SWALLOWING DISORDER) POLICY ... DoH...

1 Dysphagia (Swallowing Disorder) Policy Speech and Language Therapists of Older Persons Mental Health and Learning Disability Directorate Version 2 July 2015

SH CP 130

Dysphagia (Swallowing Disorder) Policy

Version 2

Summary:

The term dysphagia is used in this document to describe swallowing disorders characterised by difficulty in oral preparation for the swallow or in the moving the bolus from the mouth to the stomach. Subsumed in this definition are problems in positioning food in the mouth and in the oral movements, including suckling, sucking and mastication.

Keywords (minimum of 5): (To assist policy search engine)

Dysphagia, Swallowing, Disorder, Eating, Drinking

Target Audience:

All Speech and Language Therapists, Locality Team Managers, Ward Managers

Next Review Date: July 2019

Approved and ratified by:

Nutrition and Hydration Group

Date of meeting: 21st July 2015

Date issued:

July 2015

Authors:

Ian Gosling, Speech and Language Therapist Natalie Wagner, Speech and Language Therapist Rachael Middle, Speech and Language Therapist

Sponsor:

Della Warren, Director of Nursing


Version Control

Change Record

Date Author Version Page Reason for Change

July 2015

Speech and Language Therapists of Older Persons Mental Health and Learning Disability Directorate

2 multiple Major re-working to take account of changes in practice and professional guidelines.

Reviewers/contributors

Name Position Version Reviewed & Date

Ian Gosling Speech and Language Therapist

(Older Persons Mental Health) Version 1 and 2, October 2014 – July 2015

Abigail Hooper Speech and Language Therapist (Adult Learning Disability)

Version 1 and 2 October 2014 -July 2015

Mary-Helen L’Heureux Speech and Language Therapist/ Team Manager (Adult Learning Disability)

Version 1 and 2 October 2014 – July 2015

Annabel Edwards Speech and Language Therapist (Adult Learning Disability)

Version 1 and 2 October 2014 - July 2015

Natalie Wagner Speech and Language Therapist (Adult Learning Disability)

Version 2 December 2014 - July 2015

Rachael Middle Speech and Language Therapist (Adult Learning Disability)

Version 2 December 2014 – July 2015

Julie Sutch Speech and Language Therapist (Adult Learning Disability)

Version 2 December 2014- July 2015


Contents

Page

1 Introduction 4

2 Purpose 4

3 Responsibilities of all clinical staff 4

4 Scope of practice and professional responsibility for speech and language therapists

5

5 Local professional standards for working with patients and clients with dysphagia

6

6 Health and safety policies and procedures 7

7 Clinical standards for working with patients or clients with dysphagia 8

8 Standards of care 9

9 Training requirements 9

10 Monitoring compliance 10

11 Policy review 10

12 Associated documents 10

13 Supporting references 11

Appendices

A1 Dysphagia risk assessment - community/outpatients 12

A2 Dysphagia risk assessment - inpatients 13

A3 Training needs analysis 14

A4 Dysphagia competency 15

A5 Equality Impact Analysis Screening Tool 16


DYSPHAGIA (SWALLOWING DISORDER) POLICY

1 Introduction

1.1 The term dysphagia is used in this document to describe swallowing disorders

characterised by difficulty in oral preparation for the swallow or in moving the bolus from the mouth to the stomach. Subsumed in this definition are problems in positioning food in the mouth and in the oral movements, including suckling, sucking and mastication.

1.2 The Royal College of Speech and Language Therapists (RCSLT) commissioning paper (2014) states speech and language therapists (SLTs) “have a unique HCPC recognised and registered role in identifying and managing oropharyngeal dysphagia associated with a broad range of developmental, neurological and head and neck disorders “. RCSLT supports the principle that SLTs are able to take a central role within the multidisciplinary team in the assessment and management of swallowing disorders.

1.3 Early identification of the symptoms of dysphagia is essential and is the responsibility of all qualified nursing staff. Effective management of dysphagia has been shown to reduce unnecessary admissions to hospital, as shown in the www.rcslt.org/speech and language therapy/.../matrix report and to effect a reduction in the length of hospital stay (K.W. Altman et al Aug 2010) (Sandwell Community Services 2009; DoH 2013).

2 Purpose

2.1 The purpose of this policy is to provide clear guidance on roles and responsibilities of Southern Health Foundation Trust (SHFT) staff within the management of dysphagia. The aim of this policy is to ensure safe and effective management for service users with actual or suspected dysphagia.

3 Responsibilities of all clinical staff

3.1 All registered clinical staff and unregistered clinical staff who work with clients whilst they are eating/drinking should have awareness of the symptoms of dysphagia.

Acute symptoms of dysphagia include:

coughing during or immediately after drinking and/or eating

choking

wet vocalisations after drinking

change of skin colour

watering eyes

refusal of food before or during meal

increased anxiety at drink/meal times

behavioural difficulties at drink/meal times

Chronic symptoms of dysphagia include:

chest infections

signs of malnutrition – as identified by MUST assessment, weight loss, skin

http://www.rcslt.org/speech


breakdown, hair loss

signs of dehydration – constipation, strong urine, urinary tract infections, dry skin

3.2 A list of the above symptoms will be made available to all relevant clinical teams in

written form. It is the responsibility of relevant managers to ensure all registered clinical staff and unregistered clinical staff who work with clients whilst they are eating/drinking have seen this information and are aware of the need to seek further advice where required.

3.3 If a client presents with 1 or more of these symptoms, the staff member noticing the symptoms should immediately discuss this with a registered staff member and then seek further advice from a speech and language therapist where appropriate and ensure this is recorded within the client’s medical notes.

3.4 Where core assessments such as dysphagia screens are in use, they are to be completed and relevant action taken.

4 Scope of practice and professional responsibility for speech and language therapists

4.1 Arrangements for service provision may vary across different Trust localities and client groups. As such, SLT input for dysphagia may be provided by arrangement with SLTs who are not employed by SHFT. These SLTs are likely to work within the scope of practice of their own local dysphagia policy.

4.2 SLTs who are employed by SHFT and who are required to treat clients with dysphagia will be conversant with and work within the scope of this dysphagia policy.

4.3

SLTs will be aware of the extent and limits of their own skills. They will refer clients whose dysphagia is beyond their knowledge and experience to senior staff. Failure to act appropriately is a breach of the duty of care.

4.4 SLTs will work as part of a multi-disciplinary team with clients with dysphagia. Every attempt will be made to include the client and their relatives/carers in the decision making process. Composition of the multi-disciplinary team may vary according to client need and may include staff from Physiotherapy, Occupational Therapy, Nursing, Dietetics, Pharmacy. The medical practitioner and/or consultants responsible for the medical care of the client will be involved as appropriate and will be kept informed of dysphagia care.

4.5 Delegation

4.5.1 SLTs may delegate certain therapy tasks to other team members, relatives or carers. This may include assisting and supervision of oral intake. The decision to delegate must be clinically led and documented.

4.5.2 SLTs remain responsible for the care plan even when it is carried out by another person, providing that: a. the written instructions are correctly followed by the named person, and b. there has been no deterioration in the client or client’s physical condition, and c. the patient is on the SLT’s caseload for dysphagia intervention.


4.6 Duty of care

4.6.1 Relevant guidance from the RCSLT, including the document “Information on Duty of Care” (RCSLT, 2012) and Trust Policy CP 16 should be followed when working with dysphagia.

4.7 Disagreement between professionals, the client or carers

4.7.1 The Mental Capacity Act 2005 provides a statutory framework to empower and protect people who are not able to make their own decisions. A key principle of the law is that every adult has the right to make their own decisions and is assumed to have capacity to do so unless it is proven otherwise. Further guidance is available in the Trust’s Mental Capacity Act Policy and Guidance for Staff (April 2014) and in the Hampshire Mental Capacity Toolkit Assessment of Capabilities and Best Interests Decision Making (2010).

4.7.2 Where disagreement exists between the client or their relatives and the team, every effort should be made to resolve it through discussion. Where there is concern regarding carers not following guidance, safeguarding processes should be considered.

4.7.3 Where the client has capacity to decide on dysphagia issues and refuses to consent to intervention, this should be documented and communicated to the medical practitioner / GP surgery responsible for that client’s care. Where the client has capacity to make an informed decision regarding dysphagia issues they should not be prevented from making “unwise” decisions.

4.7.4 Where there is disagreement amongst the multi-disciplinary team, particularly between the doctor responsible for the client’s care and team members, every effort should be made to resolve it through discussion. Where the doctor chooses a course of action contrary to the opinion of the SLT, and the SLT believes that such an action may cause harm to the client, the SLT is advised to record their opinion in writing to the doctor and inform their line manager. In some cases it will be necessary to withdraw from involvement.

5 Local professional standards for working with patients and clients with dysphagia

5.1 The Inter-Professional Dysphagia Framework (Boaden et al, 2006) is recognised as a suitable framework for defining levels of competency amongst those who work with people with dysphagia. SLTs working with clients with dysphagia within SHFT work at the level of Specialist or Consultant Dysphagia Practitioner, as defined within this framework.

5.2 All SLTs who are required to work with dysphagia must have this within their job description.

5.3 All SLTs practicing dysphagia will adhere to current HCPC and RCSLT guidance regarding continuing professional development.

5.4 Whilst in the process of receiving education and training to Specialist Dysphagia Practitioner level, SLTs will work under direct and/or indirect supervision in accordance with the recommendations set out by the assessment centre responsible for their education program. The assessment centre’s recommendations may be


expected to include a minimum number of logged or directly/indirectly supervised hours covering areas of training which may include: - observation of skilled SLTs - directly and indirectly supervised work with clients - discussion sessions with a clinical supervisor. - criteria for transitioning to independent working

5.5 Within SHFT there will be at least one SLT working in each identified area of clinical specialty relevant to the field of dysphagia practice (for example, Adult Learning Disability or Older Persons Mental Health) who is identified as a consultant level practitioner. A consultant practitioner will demonstrate an ability to significantly meet the criteria for working at the level of consultant dysphagia practitioner as defined within the Inter-Professional Dysphagia Framework. They will have a minimum of 5 years experience working at the level of Specialist or Consultant Dysphagia Practitioner as defined within the Inter-Professional Dysphagia Framework and attend at least one national dysphagia conference/course or equivalent, e.g. CEN Study Day, annually.

5.6 All Specialist Dysphagia Practitioners will receive supervision from a consultant practitioner in dysphagia, through appropriate dysphagia forum meetings and/or through individual support and supervision.

5.7 SLT membership of relevant CENs will represent the client groups and clinical issues relevant to SLTs working within Southern Health NHS Foundation Trust and will allow for efficient feedback to staff teams across all relevant geographical areas.

5.8 Dysphagia practices and procedures will be periodically reviewed to ensure best practice is maintained.

5.9 The National Patient Safety Agency (NPSA) Dysphagia diet food texture descriptors “provide standard terminology to be used by all health professionals and food providers.” (NPSA 2011). SLTs will make recommendations in line with these descriptors. It is the responsibility of food providers within SHFT to provide appropriate food which is in line with these descriptors.

6 Health and safety policies and procedures

6.1 Therapists’ working practice should reflect local policy and procedures relating to the following: • Moving and Handling • Resuscitation • HIV/Aids • Control of Infection • Adverse Events

6.2

Where therapists have an open duty of care towards one or more client within a General Hospital setting they may also need to be aware of the hospital’s local procedures.


7 Clinical standards for working with patients or clients with dysphagia

7.1 Referrals

7.1.1 The process for referring to SLT may vary according to locality. It is the responsibility of registered clinical staff to be aware of the relevant referral procedure for their locality. Local arrangements for service provision may mean SLT input is provided by SLTs who are not employed by SHFT. Referral procedures to externally employed SLTs are outside the scope of this policy.

7.1.2 If a referral has been made to an SLT employed by SHFT for patients/clients with dysphagia requiring access to the SLT service, written acknowledgement will be sent to the medical practitioner responsible for the medical management of that person.

7.2 Consent

7.2.1 It is necessary to follow the guidelines relating to consent to treat (see Trust Policy CP16).

7.3 Liaison and communication

7.3.1 The medical practitioner is medically responsible for the client and must be kept informed in writing of relevant recommendations.

7.3.2

SLTs employed by SHFT who have an open duty of care towards a client who is an inpatient within a General Hospital setting may attend dysphagia assessments held at the hospital and give information about their recommendations to hospital SLTs. While the client is an inpatient, assessments and any resulting recommendations are the responsibility of SLTs employed at the hospital. SLTs working outside the General Hospital setting are unable to access the medical file of an inpatient within a General Hospital setting.

7.4 Delegation

7.4.1 Any recommendation or advice should be recorded in the client’s electronic medical notes (where available) and where necessary the paper file.

7.4.2 People acting under therapist’s advice must be given appropriate written information including food and fluid texture recommendations, how to identify deterioration of function and what to do if difficulties arise. Relevant establishment managers will then become responsible for ensuring that the instructions are carried out.

7.5 Adverse events or sudden death

7.5.1 Therapists must ensure that they understand how to document adverse events in accordance with SHFT Policy SH NCP 16.

7.5.2 Respiratory arrest, choking and other adverse events must be recorded in detail immediately following the event in the notes.

7.5.3 It is the responsibility of other staff present to follow their own policies and reporting procedures.


8 Standards of care

8.1 Responsiveness

8.1.1 A dysphagia risk assessment (appendix i for out-patient/community settings and appendix ii for in-patient settings) will be completed by an appropriately trained SLT within 2 working days of receipt of referral. If the risk assessment indicates SLT input to be appropriate, SLTs will follow current relevant guidance from the Royal College of Speech and Language Therapists (RCSLT) in relation to timeframes for responding to new referrals.

8.1.2 A contemporaneous record of the initial assessment and an outline of the proposed management will be documented in the appropriate client notes.

8.2 Types of assessment used

8.2.1 Dysphagia trained SLTs will select appropriate assessments based on clinical reasoning and evidence based practice.

8.3 Discharges

8.3.1 Discharge will be at the discretion of the SLT after full consultation and agreement with the patient/client and carer.

8.3.2 Duty of care to the individual is terminated through completion of the discharge procedure or, in the case of an individual being transferred to another service, the duty of care will rest with the new service.

8.3.3 On discharge a report will be sent to the medical practitioner/GP surgery and other relevant parties including a summary of intervention given, appropriate recommendations for the long term and criteria for re-referral. A copy of this report will be held within the medical notes.

8.3.4 Following discharge, any ongoing dysphagia recommendations documented in the care plans will remain in place to be followed for the long term by the registered clinical staff and unregistered clinical staff who work with the client whilst they are eating/drinking. Long term dysphagia recommendations of patients/clients who have been discharged from the SLT service will not be routinely reviewed by SLTs. It is the

responsibility of all registered clinical staff and unregistered clinical staff who work

with clients whilst they are eating/drinking to identify any possible changes in the person’s dysphagia presentation. If any such changes are identified, unregistered staff should discuss their concerns with a member of registered clinical staff. If the registered clinical staff member considers further SLT assessment of swallowing to be appropriate, they must contact SLT to make a new referral. The SLT will then respond in accordance with the procedure described in section 7.1.1.

9 9.1

Training requirements Training requirements for SLTs employed within SHFT are described within section 5 of this policy.

9.2 All SHFT registered clinical staff and unregistered clinical staff who work with clients whilst they are eating/drinking should have access to a list of the signs of dysphagia


in written form, as described in section 3.2 of this policy.

9.3 All SHFT staff who work with clients with a diagnosis of dysphagia whilst they are eating or drinking should have relevant and appropriate knowledge and skills for supporting their clients. SLTs employed within SHFT may provide appropriate client-specific or setting-specific training to identified members of staff who work with clients while they eat or drink. Provision and content of the training will be at the discretion of the SLT.

10 Monitoring compliance Compliance with this policy should be monitored in line with SHFT Clinical Audit Policy SH NCP 6.

11 Policy review It is expected the dysphagia policy will be formally reviewed every four years to ensure it is reflective of current professional practice. Legislation changes will be implemented ad hoc as directed by changes to government statute at local, regional and national level and Trust recommendations.

12 Associated documents 1.National Patient Safety Agency (2011) Dysphagia Diet Food Texture Descriptors [Online] Available from: http://www.thenacc.co.uk/assets/downloads/170/Food%20Descriptors%20for%20Industry%20Final%20-%20USE.pdf [Accessed: 21.4.2015] 2.MUST screening tool Available at: www.bapen.org.uk/must tool.html 3.Boaden, E. & Davies, S. (2006) Interprofessional dysphagia framework [Online] Available from: http://www.rcslt.org/members/publications/publications2/Framework_pdf [Accessed:19th December 2014] 4.Hampshire County Council (2010) Hampshire mental capacity toolkit [Online] Available from: http://www3.hants.gov.uk/mentalcapacity-toolkit [Accessed: 19th December 2014] 5.Southern Health NHS Foundation Trust (2012) Consent for examination or treatment policy CP16 [Online] Available from: http://www.southernhealth.nhs.uk/EasysiteWeb/getresource.axd?AssetID=41135&type=full&servicetype=Inline [Accessed:19th December 2014] 6.Southern Health NHS Foundation Trust (2014) Mental capacity act 2005 policy and guidance [Online] Available from: http://www.southernhealth.nhs.uk/EasysiteWeb/getresource.axd?AssetID=41206&type=full&servicetype=Inline [Accessed:19th December 2014] 7.Southern Health NHS Foundation Trust (2014) Policy for managing incidents and serious incidents requiring investigation (SIRIs) SH NCP 16 [Online] Available from: http://www.southernhealth.nhs.uk/EasysiteWeb/getresource.axd?AssetID=71568&type=full&servicetype=Inline

http://www.thenacc.co.uk/assets/downloads/170/Food%20Descriptors%20for%20Industry%20Final%20-%20USE.pdf

http://www.rcslt.org/members/publications/publications2/Framework_pdf

http://www3.hants.gov.uk/mentalcapacity-toolkit

http://www.southernhealth.nhs.uk/EasysiteWeb/getresource.axd?AssetID=41135&type=full&servicetype=Inline

http://www.southernhealth.nhs.uk/EasysiteWeb/getresource.axd?AssetID=41206&type=full&servicetype=Inline


[Accessed: 19th December 2014]

13 Supporting references 1. Royal college of Speech and Language Therapists (2009) Resource Manual for

Commissioning and Planning services for SCLN, Dysphagia. Updated 2014. RCSLT: London.

2. Altman, KW et al (2010) Consequence of dysphagia in the hospitalized patient. Archives of Otolaryngology- Head and Neck Surgery. 136 (8). P.784-789.

3. Marsh, K. et al (2010) Matrix evidence- an economic evaluation of speech and language therapy [Online] Available from: http://www.rcslt.org/delete/giving_voice/matrix_report [Accessed: 19th December 2014]

4. Royal College of Speech and Language Therapists (2012) Information on duty of care [Online] Available from: http://www.rcslt.org/members/supervision/duty_of_care_information [Accessed: 19th December 2014].

5. Sandwell Community Healthcare Services (2009) Primary care rapid response assessment of dysphagia in end of life care [Online] Available from: https://www.evidence.nhs.uk/search?q=sandwell%20community%20healthcare%20services [Accessed:19th December 2014]

6. Tanner, D. ( 2006) Case Studies in communicative sciences and disorders. Columbus, OH: Pearson Prentice Hall.


Appendix 1

Dysphagia Risk Assessment for Community/Out-Patients

Check referral has been logged on RiO.

Name …………………………. ………D.O.B. ……………………… NHS No: …………....

Date referred: …………………………… Risk assessment completed …..……….... Information collected from: ……………………………Contact Number: ………………………………..

Symptoms of aspiration?

/ If yes - high risk symptoms?

/ Comments

Chronic Chest infections. More than 2 in previous year.

Evidence of malnutrition.

Evidence of significant weight loss and / or evidence of skin breakdown or severe fatigue.

Evidence of dehydration.

Currently more than 1 symptom of dehydration i.e. UTI’s, dry skin, constipation, strong urine.

Refusal to eat. Has resulted in symptoms of malnutrition (see above).

Refusal to drink. Has resulted in symptoms of dehydration (see above).

Behaviour difficulties at meal times e.g. increased anxiety

Has resulted in symptoms of malnutrition or dehydration (see above).

Acute Coughing when eating. Regularly at meal times. Results in

redness, watery eyes, gasping for breath.

Coughing when drinking.

Regularly at drink times. Results in redness, watery eyes, gasping for breath.

Choking. More than 1 incident of choking in the past 6 months.

Difficulties chewing food.

Results in choking incidents.

Losing food / fluid from front of mouth.

Results change/increase or results in symptoms of malnutrition or dehydration (see above).

Client is high risk: (1 or more high risk symptoms or a number of non-high risk symptoms- therapist’s discretion)

Comments……………………………………………………………………………………………………………………………………………………………………………………… Action: Assess within 10 working days (high risk) Assess within 4 weeks of receipt of referral Signed…………………………………………….... Speech and Language Therapist


Appendix 2 Dysphagia Risk Assessment for In-Patients

Check referral has been logged on RiO.

Name …………………………. ………D.O.B. ……………………… NHS No: …………....

Date referred: …………………………… Risk assessment completed …..……….... Information collected from: ……………………………Contact Number: ………………………………..

Symptoms of aspiration?

/ If yes - high risk symptoms?

/ Comments

Chronic Chest infections. More than 2 in previous year.

Evidence of malnutrition.

Evidence of significant weight loss and / or evidence of skin breakdown or severe fatigue.

Evidence of dehydration.

Currently more than 1 symptom of dehydration i.e. UTI’s, dry skin, constipation, strong urine.

Refusal to eat. Has resulted in symptoms of malnutrition (see above).

Refusal to drink. Has resulted in symptoms of dehydration (see above).

Behaviour difficulties at meal times e.g. increased anxiety

Has resulted in symptoms of malnutrition or dehydration (see above).

Acute Coughing when eating. Regularly at meal times. Results in

redness, watery eyes, gasping for breath.

Coughing when drinking.

Regularly at drink times. Results in redness, watery eyes, gasping for breath.

Choking. More than 1 incident of choking in the past 6 months.

Difficulties chewing food.

Results in choking incidents.

Losing food / fluid from front of mouth.

Results change/increase or results in symptoms of malnutrition or dehydration (see above).

Client is urgent: (1 or more urgent symptoms or a number of non-urgent symptoms- therapist’s discretion)

Comments……………………………………………………………………………………………………………………………………………………………………………………… Action: Assess within 2 working days (urgent) Assess within 10 working days of receipt of referral Signed…………………………………………….... Speech and Language Therapist


Appendix 3 LEaD (Leadership, Education & Development) Training Needs Analysis

If there are any training implications in your policy, please complete the form below and make an appointment with the LEAD department (Louise Hartland, Strategic Education Lead or Sharon Gomez, Essential Training Lead on 02380 774091) before the policy goes through the Trust policy approval process.

Training Programme

Frequency Course Length Delivery Method Trainer(s) Recording Attendance

Strategic & Operational Responsibility

Specialist level dysphagia practice (for SLTs). See Appendix iv for list of approved courses/ frameworks

Once, if relevant to job description and qualification not obtained during previous employment.

Variable, dependent on requirements of external training centre and time required by individual SLT to achieve competency in practice.

Attendance on approved course plus supervised clinical practice and/or successful completion of recognised competency framework

Specialist and consultant level dysphagia practitioners within Southern Health NHS Foundation Trust (SHFT) plus external training centre where appropriate.

Specialist and consultant level dysphagia practitioners within SHFT plus external training centre where appropriate.

SLT named as Clinical Supervisor (must be a Specialist/Consultant level dysphagia practitioner)

Directorate Division Target Audience

MH/LD

Adult Mental Health

Learning Disability Services

SLTs who will be required to work with dysphagia as part of their job description but do not have recognised qualifications/competencies in working with dysphagia on commencement of employment with SHFT

Older Persons Mental Health

SLTs who will be required to work with dysphagia as part of their job description but do not have recognised qualifications/competencies in working with dysphagia on commencement of employment with SHFT

Specialised Services

TQtwentyone

ICS

Adults

Children’s Services

Specialist Services

Corporate Services

All (Workforce & Development, Finance & Estates, Commercial)


Appendix 4

Dysphagia Competency

This form is to be signed off to confirm the competence of a Speech and Language

Therapist’s Dysphagia practice. According to the Southern Health Dysphagia

policy it is mandatory that each Therapist practising within Dysphagia

demonstrates their competence.

Therapist ……………………………………………………

Clinical Supervisor………. ………………………………………..

Therapist’s date of employment within trust: ……………………………

I declare that the above named Therapist is deemed to be competent to practice

Dysphagia. Their competence has been confirmed alongside:

(please tick the appropriate framework or training)

The Inter-Professional Dysphagia Competence Framework to at least a

Specialist Dysphagia Practitioner

Royal College of Speech and Language Therapists Dysphagia training and

competence framework to at least a level C (Specialist level Dysphagia

Practitioner)

Manchester Metropolitan University Post Basic Dysphagia Course

Post registration Dysphagia course (Quest)

Other RCSLT registered or quality assured Dysphagia course

o Please specify course name ……………………………………………

Signed Therapist:………………………………………………… ………… Date:…………………

Signed Clinical Supervisor:…………………………………………….. Date:………………..

A copy of this from is to be held within the Therapist’s personal files and once

signed the recording section within LEAD is to be completed.


Appendix v

Southern Health NHS Foundation Trust: Equality Impact Analysis Screening Tool

Equality Impact Assessment (or ‘Equality Analysis’) is a process of systematically analysing a new or existing policy/practice or service to identify what impact or likely impact it will have on protected groups. It involves using equality information, and the results of engagement with protected groups and others, to understand the actual effect or the potential effect of your functions, policies or decisions. The form is a written record that demonstrates that you have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by equality law. For guidance and support in completing this form please contact a member of the Equality and Diversity team

Name of policy/service/project/plan:

Dysphagia Policy

Policy Number:

SH CP 130

Department:

Speech and Language Therapy

Lead officer for assessment:

Ian Gosling, Speech and Language Therapist

Date Assessment Carried Out:

1.7.2015

1. Identify the aims of the policy and how it is implemented.

Key questions Answers / Notes

Briefly describe purpose of the policy including

How the policy is delivered and by whom

Intended outcomes

Dysphagia is a condition which can have extremely severe consequences. This policy outlines the roles and responsibilities of clinical staff working with people whilst they eat and drink. The policy provides a clear framework of action for Trust staff to follow when working with the management of dysphagia.


2. Consideration of available data, research and information

Monitoring data and other information involves using equality information, and the results of engagement with protected groups and others, to understand the actual effect or the potential effect of your functions, policies or decisions. It can help you to identify practical steps to tackle any negative effects or discrimination, to advance equality and to foster good relations. Please consider the availability of the following as potential sources:

Demographic data and other statistics, including census findings

Recent research findings (local and national)

Results from consultation or engagement you have undertaken

Service user monitoring data

Information from relevant groups or agencies, for example trade unions and voluntary/community organisations

Analysis of records of enquiries about your service, or complaints or compliments about them

Recommendations of external inspections or audit reports

Key questions

Data, research and information that you can refer to

2.1 What is the equalities profile of the team delivering the service/policy?

This policy is relevant to any staff

2.2 What equalities training have staff received? Mandatory training 2.3 What is the equalities profile of service users? This policy is relevant to all

service users. 2.4 What other data do you have in terms of service users or

staff? (e.g results of customer satisfaction surveys, consultation findings). Are there any gaps?

National data for service user groups can be obtained from the document “RCSLT resource manual for commissioning and planning services for SLCN – dysphagia” © RCSLT 2009 (literature synthesis updated 2014)

2.5 What internal engagement or consultation has been undertaken as part of this EIA and with whom? What were the results? Service users/carers/Staff

Please see table on who has been consulted

2.6 What external engagement or consultation has been undertaken as part of this EIA and with whom? What were the results? General Public/Commissioners/Local Authority/Voluntary Organisations

Any issues that have a negative impact will be addressed immediately by policy amendment or action by the relevant staff


In the table below, please describe how the proposals will have a positive impact on service users or staff. Please also record any potential negative impact on equality of opportunity for the target: In the case of negative impact, please indicate any measures planned to mitigate against this:

Positive impact (including examples of what the policy/service has done to promote equality)

Negative Impact Action Plan to address negative impact

Actions to overcome problem/barrier

Resources required

Responsibility Target date

Age Applies to all patients

No adverse or potentially adverse impacts have been assessed for this protected characteristic

Disability

Assessment of the patient nutritional and Hydration needs starts with the patient’s first contact with the service and it is the responsibility of all staff involved in the admission process, to ensure that all assessments are completed and reviewed regularly and actions are

Service users with learning disabilities or mental health conditions may find it difficult to understand the process and reasons for the assessment and actions. The Trust will respond to requests to provide information in the most appropriate format


highlighted and dealt with

Gender Reassignment

No adverse or potentially adverse impact have been assessed for this characteristic

Marriage and Civil Partnership


Pregnancy and Maternity

Trust staff will liaise with appropriate services for advice

No adverse or potentially adverse impact have be assessed for this characteristic

Race Staff are available at the bed-side in all clinical areas to discuss face-to-face issues with patients, relatives and visitors Special diets can be catered for during patients’ stay

Language barriers and/or ethnicity may make it difficult for service users/clients to understand The Trust will respond to requests to provide information in the most appropriate format

Religion or Belief

The Trust will adopt the Equality Delivery System with a focus on: Better health outcomes for all Improved

Mitigation: The Trust will respond to requests and provide information in the most appropriate format


patient access and experience

Sex


Sexual Orientation



Sign Off and Publishing Once you have completed this form, it needs to be ‘approved’ by your Divisional Director or their nominated officer. Following this sign off, send a copy to the Equality and Diversity Team who will publish it on the Trust website. Keep a copy for your own records.

Name:

Designation:

Signature:

Date:

Dysphagia (Swallowing Disorder) Policy · July 2015 DYSPHAGIA (SWALLOWING DISORDER) POLICY ... DoH...

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Transcript of Dysphagia (Swallowing Disorder) Policy · July 2015 DYSPHAGIA (SWALLOWING DISORDER) POLICY ... DoH...