1. SIPS Project Strategy for an Integrated Preventative pathway for Swallowing difficulties in Care Homes Eleanor Stout Mary Heritage Derbyshire Community Health Services NHS Trust & Pat Betts

2. Dysphagia: swallowing difficulty caused by: stroke progressive neurological conditions dementia

3. Dysphagia in Care Homes – the Quality issues Late identification: risks not understood: Dehydration, weight loss, poor nutrition, chest infections, pneumonia, increased confusion, choking. Distress Unplanned hospital admission – urgent swallow assessment. On discharge – poor transfer of information

4. Dysphagia in Care Homes – Workforce issues SLT - specialist assessment Dysphagia trained nurses (DTN) Lack of awareness amongst other staff Occasionally ‘dysphagia panic’

5. SIPS project - Aims early identification of dysphagia, prevention of health deterioration, proactive care planning, avoidance of hospital admission

6. Patients with the most complex needs access a specialist assessment Patients with identified symptoms of dysphagia are assessed by a DTN in their own setting All residents in care homes are supported by staff that have good nutrition and dysphagia awareness

7. SIPS project 14 nursing homes and 1 residential home were provided with: –assessment training for DTNs –awareness training for any staff –a named SLT for specialist assessment or consultation.

8. Assessment training for DTNs

9. Awareness training for any staff Chart to show increase in scores

10. SIPS - a named Speech and Language Therapist (SLT) for specialist assessment or consultation Direct collaboration DTN and SLT when problem identified Support for DTN post training course Easy access for referral Identification for urgent assessment

11. SIPS - Impact on timing of assessment

12. SIPS - Timing of assessment

13. SIPS – impact on admissions

14. SIPS impact of assessments

15. Patient experience – Mrs S Admitted to Care Home from acute hospital Progressive physical condition Fork mashable diet and normal fluids

16. Patient experience Mrs S Grade 3 pressure sores – difficult to position Temperature with green sputum (consistent with a chest infection) Anxious, with fear of choking GP visit - Antibiotics prescribed DTN assessment – 24 hr trial before readmission.

17. Patient Experience Mrs S DTN: Care Plan: –Syrup thick fluids and soft diet –Family informed ‘Do Not Attempt Resus’. –‘Right Care’ management plan Recovery after 3 days of antibiotics No further chest infections to date Now enjoying pureed diet and thickened drinks No referral to SLT.

18. Impact of DTN role on Mrs S’ care Without DTN training: Mrs S would have been admitted If waited for SLT assessment - ?4 weeks Poor quality of life Increased distress Compromised nutrition, hydration and pressure areas

19. DTN reflections More aware of residents coughing More aware of diet, fluids, positioning Assessing continually Able to sort out problems ‘in house’ Whole team more aware ‘Next day’ assessment

20. SIPS project – impact summary more timely assessment, positive impacts on well being up to 50% reduction in hospital admissions amongst a group of high risk patients

21. Economic Impact Cost of training 20 nurses£5,500 If each DTN completes 7 assessments 140 residents will benefit.. If 57% of these have reduced aspiration risk 80 people with reduced risk of aspiration If 30% of these avoid one admission in Year 1. Saving 24 hospital admissions is £75,504 2 avoided admissions exceed the cost of training 20 nurses.

22. SIPS Next steps ‘Partnership with Care Homes’ in CQUIN 12-13 Business case to extend this project Learning Beyond Registration funding Integrated Dysphagia Pathway a further 180 DTNs to be trained 2 DTNs per Nursing Home Build the evidence base re cost benefits

23. Thank you ! mary.heritage@dchs.nhs.uk