1. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Taking dysphagia management out of the classroom: A ward based feeding and swallowing training project Becky Blagdon, Morag Bixley, Natalie Forknall, Leonie Bird, Gill Hood & Katherine Murphy Northamptonshire Healthcare NHS Foundation Trust De Montfort University, Leicester becky.blagdon@nhft.nhs.uk

2. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Dysphagia training in hospital settings RCP National Clinical Guideline for Stroke 3 rd Ed. (2008) “Staff and carers responsible for the care of patients disabled by stroke should be trained in the recognition and management of swallowing difficulties”. RCSLT Clinical Guidelines (2005) “The Speech and Language Therapist will instigate training for carers and care staff to whom the responsibility for supporting eating and drinking has been delegated, in order to increase their awareness and understanding of eating and drinking difficulties including behavioural problems”.

3. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project 51% of Hospital Trusts are fully compliant with “Meeting the nutritional needs of patients” (Outcome 5) Care Quality Commission Report Dignity and Nutrition Inspection Programme (2011)

4. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Traditional training for ward staff at NGH Dysphagia link nurse (DLN) training Qualified3 x year All wards Swallow screening trainingQualified12 x year Stroke wards only Post-registration nursing NGH in-house preceptorship Qualified6 x year Healthcare assistant NGH in-house training Unqualified2 x year

5. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Problems identified Problems on the wardsIncrease in poor feeding practices observed and reported on the ward. Problems with trainingDeclining numbers of staff attending the training sessions arranged by SLT: 199910-15 attending 2010+1-4 attending Declining numbers of DLN contacts being carried out: 19991 x week 2010+1 x 4 months

6. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project But….. The Nursing Staff wanted more training

7. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project An alternative training solution? Protected mealtimes introduced at Northampton General Hospital. Better feeding practices on wards with a greater SLT presence. Difficulty releasing staff from wards. Need to increase accessibility of training for diversity of NHS staff. Service links with SLT Department at De Montfort University, Leicester. Ward based feeding and swallowing training project

8. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Nursing questionnaires (5) Research design: Repeated measures design Ward based feeding and swallowing training project pilot study Feeding observation checklist (5) Day 1 Baseline 1

9. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Research design: Repeated measures design Ward based feeding and swallowing training project pilot study Day 1 Baseline 1 8 training days Ward Based Training Day 10 Baseline 2 Day 20 Baseline 3

10. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Baseline: Pilot study observational checklist

11. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project 1. Do you know what dysphagia is? 2. What factors would indicate dysphagia? 3. What would you do if you think someone has dysphagia? 4.Do you know the consistencies of fluids used in this hospital? 5.Do you know the diet options for dysphagic patients in this hospital? 6.What are the consequences of poor oral hygiene? 7.Have you ever attended any dysphagia training? If so, what? 8.Who are the DLNs for your ward? 9.Have you had any feeding training? If so, what? 10.What factors are important to consider when feeding? Baseline: Pilot study nursing questionnaire 11.What happens when swallowing problems are not managed properly?

12. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Training: Pilot study training checklist Dysphagia 1. Oral Stage 2. Pharyngeal Stage 3. Indicators to dysphagia 4. What to do if you suspect someone has problems 5. Dentures and managing diet Hygiene 1. Good oral hygiene Feeding 1. Importance of positioning/alertness/head position etc. 2. Pace of feeding/not talking etc. 3. Consistencies of fluid 4. Diet options Other points

13. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project Pilot study results: Nursing questionnaire Difference between mean scores

14. Pilot study results: Observational checklist Original pilot study version Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project

15. Pilot study results: Observational checklist Getting patients ready for feeding 1. Is the patient sitting in an upright position? 2. Is the patient getting support if needed? 3. Are the dentures in place if needed? 4. Are appropriate utensils/equipment available? 5. Is the feeder positioned appropriately? Hygiene 1. Is oral hygiene good? Enhancing Nutrition 1. Has the patient got access to a drink of the recommended consistency? 2. Is the patient’s food of the recommended consistency? 3. If being fed:Is the feeder pacing the feeding appropriately? Are they focusing on the patient? Other observations: Adapted version

16. Pilot study results: Adapted training checklist Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project

17. Pilot study conclusion Positive difference in the means of the nursing questionnaires between baselines. Subjective improvement in feeding practices on the ward. Improved relationships and communication with nursing staff. SLT team building and improved morale.

18. Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project The future SLT service continuing to roll out the project throughout the hospital and extend to Kettering General Hospital. Analysis of mealtime observational data. Aiming to publish the research. Considering effect on referral rates to service. Traditional training continuing alongside ward based project.

19. “ This improved awareness should have positive effects on: patient safety, patient experience, hydration, nutrition and reduced risk of choking and aspiration pneumonia.” Royal College of Speech and Language Therapists Clinical Guidelines by Consensus for SLTs (2005) Taking dysphagia management out of the classroom: A ward based feeding & swallowing training project

20. References Boaden, E. Davis, S. Storey L. and Watkins (2006) Interprofessional Dysphagia Framework. www.uclan.aca.uk/facs/health/nursing/research/groups/stroke www.uclan.aca.uk/facs/health/nursing/research/groups/stroke Care Quality Commission (2011) Dignity and Nutrition Inspection Programme: National Overview Royal College of Physicians (1998) Clinical Guideline in Stroke. 3 rd Edition. Royal College of Speech and Language Therapists (2005) Clinical Guidelines by Consensus for SLTs.