Enhancing the Quality of Care for Old-Aged Home Residents with Dysphagia Through a Community Speech Therapy Pilot Project in the Ho
ng Kong East RegionSpeech Therapy Department
Ruttonjee and Tang Shiu Kin Hospitals
Candy Ngan (Speech Therapist i/c)
Rita Wong (Speech Therapist)
Christina Chan (Speech Therapist)
Jamy Wong (Clerk)
BackgroundProblems encountered at out-patient ST clinic Patient: frail elderly, chair-/bed-bound
with transport problem OAH staff: inadequate knowledge on risks
prevention and swallowing management
Speech Therapist: face with poor carry-over, poor compliance and
high default rate
Extent of problems
A) 24% of out-patient speech therapy referrals are OAH residents
(Survey: by ST Department, RHTSK, from Oct, 2000 - March, 2001)
Extent of problemsB) 8.5% (119) OAH residents require non-
oral feeding
9.1% (128) OAH residents (on oral feeding) were reported to have swallowing difficulties
(Questionnaire Survey to 14 OAHs in HKE region)
Extent of problemsC) Average time spent for transportation by
NEATS
= 168 minutes
(Survey: 1 - 28 February, 2001 in ST Clinic, RHTSK)
CST Pilot Project Community Speech Therapy (CST) service
for HKE commenced in May, 2001
Aim: enhance service quality and outcomes to OAH residents with swallowing
problems
Preparation Work Liaison work with
- CGAT, HKE
- OAH in-charges
- Medical and Geriatric teams of other hospitals in HKE through our CGAT
- Speech Therapy Department of PYNEH/TWEH/WCHH
- Finance Department
Preparation Work Educational materials Risk identification and swallowing
management protocol Service guidelines Referral guidelines
Programmes Education
Educational Talks Practical training
On-site consultation Swallowing Assessment Intervention Swallowing management guidelines Carer Education
CST Coverage 11 Old Aged Homes
(6 PNHs and 5 C&AHs)
under CGAT coverage 1692 residential places Inclusion criteria:
- Patients of the 11 OAHs
- Medical referral required
Present Progress (April, 2005 to March, 2006)
Manpower: 0.2 speech therapist FTE Total new attendance: 160 Total attendance: 558 No. of residents who had completed
swallowing intervention by ST in April, 2005 to March, 2006 = 137
Outcomes
Education
2 major education programs
Train-the-trainer Dysphagia Management Enhancement Prog
ram
Swallowing Management Refresher
Course
2002 2005
OutcomesEducation- satisfactory results from post-talk questionnaire survey
- increase the level of awareness, risk identification and swallowing management skills
" 現時的 nursing home, 極需要這種訓練給予員工 ,讓員工 對吞嚥困難之長者護理有深刻認識 ;但各員工因無時間 往上課 .現在有此機會 ,極為珍惜 ."
" 現時一課內容很實際與本院內之長者之需求協助有密 切關係 ,直接幫助到現時部份老人家之需 . "
" 經過 29-5-2001 這一課 ,實在得益很多 ,有錄影帶播出 ,對 課程內容更加深入理解 ,下次講座也希望會帶帶播影 . "
Swallowing Outcomes
Mode of feeding4/2005 to 3/2006
Oral → Oral67%
Oral → Non-oral8%
Non-oral → Oral4%
Non-oral → Non-oral21%
Swallowing Outcomes – Change in diet to sustain oral feedingApril, 2005 to March, 2006
Upgrade33%
No Change36%
Downgrade todysphagia diet
31%
Escort hours and NEATS cost saved in 2001 (pilot project—1/2 year)
C&AH staff PNH staff
Escort time saved
160 hours
390 hours
NEATS cost saved
N/A
HK$ 37,720
Cost of CST (W.Y. Leung, 2004)
Cost per patient treated:
Cost of CST service < Cost in OPD, ST
($556.2) ($893.5)
Service Evaluation OPD CST
Demand of frail elderly, bed-bound residents with dysphagia
Escort problem No need to escort to the hospitals
Cost-effectiveness- limited time and resources- Caseload
One resident,
One OAH
-at least 3-5 patients per OAH visit
- recruit 2-3 OAHs within close geographical region
Staff quality-high turnover rate of OAH’s staff- language barrier
The escort staff might not be the one who cares the residents
Difficult to carry-over the swallowing recommendations
Could provide on-site education and hands-on practical experience for the front-line staff.
Know the staff quality of the OAH
tailor-made the mode of education to them
Swallowing compliance Not know the compliance of the residents in OAH
Know the compliance of the residents in OAH- good? - poor?
Service Evaluation
Any Policy to enhance the swallowing compliance?
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