DYSPHAGIA POLICY FOR ADULT LEARNING DISABILITY SERVICES

Transcription

1 INSERT THE NHFT LOGO OF YOUR COMMITTEE IN THE HEADER OF THE FIRST PAGE OF THE DOCUMENT (see Appendix 2 PB001 Policy for the Production and Management of all Policies within NHFT) DYSPHAGIA POLICY FOR ADULT LEARNING DISABILITY SERVICES Policy Details NHFT document reference CLP058/01/06 Version Version Date Ratified 04/03/2014 Ratified by Trust Policy Board Implementation Date 04/03/2014 Responsible Director Director of Operations and Nursing Review Date 04/03/2016 Related Policies & other documents CLP006 Policy for Consent to Examination or Treatment Freedom of Information category Policies 1 of 15 Implementation Date: 04/03/2014

2 QUICK REFERENCE GUIDE Use this policy to find out about Community Dysphagia Services for Adults with Learning. TABLE OF CONTENTS 1. DOCUMENT CONTROL SUMMARY INTRODUCTION PURPOSE DEFINITIONS DUTIES PROCESS Referral 6.2 Assessment 6.3 Management 7. TRAINING Mandatory Training Specific Training not covered by Mandatory Training MONITORING COMPLIANCE WITH THIS DOCUMENT REFERENCES AND BIBLIOGRAPHY RELATED TRUST POLICY... 9 APPENDIX 1 - DYSPHAGIA CAREPATHWAY 10 APPENDIX 2 EQUALITY ANALYSIS REPORT of 15 Implementation Date: 04/03/2014

3 1. DOCUMENT CONTROL SUMMARY Document Title Document Purpose (executive brief) Dysphagia Policy for Adult Learning Services To ensure safe and effective management for service users with actual or suspected dysphagia Status: - New / Update/ Review Areas affected by the policy Policy originators/authors Consultation and Communication with Stakeholders including public and patient group involvement Review Learning Services; all Trust staff who work with people with Learning Emma Willsman Speech and Language Therapists involved in dysphagia management within Learning Services Archiving Arrangements and register of documents Equality Analysis (including Mental Capacity Act 2007) Training Needs Analysis See Section 7 Monitoring Compliance and Effectiveness Meets national criteria with regard to NHSLA - NICE - NSF - Mental Health Act - CQC - Other Further comments to be considered at the time of ratification for this policy (i.e. national policy, commissioning requirements, legislation) If this policy requires Trust Board ratification please provide specific details of requirements The Trust Policy Lead is responsible for the archiving of this policy and will hold archived copies on a central register See Appendix See Section 8 None

4 2. INTRODUCTION This policy describes the management of risk to adults with learning disability who have been identified with actual or potential dysphagia. The term dysphagia is used here to describe eating, drinking and swallowing disorders which are characterised by difficulty in oral preparation for the swallow or in moving a bolus from the mouth to the stomach. Dysphagia may therefore include difficulties in positioning the food in the mouth, difficulties with chewing, sucking or swallowing (RSCLT, 2006). Dysphagia can occur as a result of either a single medical problem, eg stroke, progressive neurological condition, or as a result of: Oropharyngeal structural problems. Motor processing difficulties. Central nervous system disorders. Pharyngo-oesophageal problems. Poor oral health. The psychological effects of institutionalisation. Mental health problems. The effects of medication. Some signs and symptoms of swallowing difficulties or dysphagia include the inability to recognise food, difficulty placing food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent chest infections, unexplained weight loss, gurgly or wet voice after swallowing, regurgitation, and client complaint of swallowing difficulty. (NPSA, 2007) Problems associated with eating and drinking can be life threatening and can lead to poor nutritional status, dehydration and aspiration that can result in chest infections (NPSA, 2004: RCSLT, 2006). Eating, drinking and swallowing difficulties can also lead to choking (airway obstruction). The Trust is committed to treating people with dignity and respect in accordance with the Equality Act 2010 and Human Rights Act Throughout the production of this policy due regard has been given to the elimination of unlawful discrimination, harassment and victimisation (as cited in the Equality Act 2010). Speech and language therapy service delivery is committed to the promotion of independence, choice, inclusion and civil rights. Speech and language therapy service delivery considers communication and eating and drinking needs in the context of a social model of disability (Baker et al, 2010). The social model of disability sees disability as created by social barriers rather than individual impairment (Walmsley, 2001) p of 15 Implementation Date: 04/03/2014

5 3. PURPOSE The purpose of this policy is to provide clear guidance to clinicians, professionals and managers operating within Adult Learning Services. This includes the Community Teams for People with Learning (CTPLDs), the Intensive Support Service (ISS) and the Short Term Care service. It is also relevant to other NHFT staff who are concerned that an adult with learning disability may be experiencing dysphagia. The aim is to ensure safe and effective management for service users with actual or suspected dysphagia. The National Patient Safety Agency (NPSA) identifies that swallowing difficulties are more common in people with Learning Disabilities. If not managed safely they can lead to respiratory tract infections, which is a leading cause of early death for people with learning disabilities. One study suggests that respiratory disease was the leading cause of death in 52% of adults with Learning Disabilities compared to 15% of males and 17% of females in the general population (Hollins, et-al, 1998). People with a diagnosis of learning disability are known to be at higher risk of choking than other people. This is due to problems with chewing, difficulty swallowing, behaviours such as bolting food or pica (eating non-food items) and the effects of medication. In the most extreme cases, a piece of food (or non-food item) can obstruct the airway and lead to death. (Hampshire County Council, 2012) Staff will be aware of the need to identify service users who may potentially have dysphagia and to refer to professionals with the relevant skills and training in the diagnosis, assessment and management of dysphagia (NICE guidance, 2006). 4. DEFINITIONS Dysphagia difficulty with the eating, drinking and swallowing process characterised by difficulty in oral preparation for the swallow or in moving a bolus from the mouth to the stomach. Learning (LD) - The government white paper Valuing People defines learning disability as a significantly reduced ability to understand new or complex information and to learn new skills (impaired intelligence IQ less than 70) coupled with a reduced ability to cope independently (impaired social functioning) which started before adulthood, with a lasting effect on development SALT - Speech and Language Therapist NHFT - Northamptonshire Healthcare NHS Foundation Trust 5 of 15 Implementation Date: 04/03/2014

6 CTPLD Community Team for People with Learning ISS Intensive Support Service 5. DUTIES Team managers of CTPLDs, ISS and Short Term Care Services ensuring their staff are aware of dysphagia and can access training as required. Dysphagia Lead for Adult Learning review and update of policy. Speech and Language Therapists within Learning Services to provide dysphagia assessments, advice and management; to provide training on signs of dysphagia, referral processes and management as and when required; to provide person centred training around individuals who are referred with dysphagia. Staff members within CTPLDs, ISS and Short Term Care units to be aware of the signs and symptoms, the referral process and management of dysphagia; to attend training as necessary; to implement dysphagia care plans. 6. PROCESS 6.1. Referral The Speech and Language Therapy Service within the CTPLDs provides dysphagia assessments for adults with learning disability in community settings. Dysphagia assessment and management in acute hospitals is provided by the Adult Speech and Language Therapy Service. Dysphagia services for adults without learning disability are provided by the Adult Speech and Language Therapy Service. Dysphagia services for children (under 18) are provided by the paediatric Speech and Language Therapy Service. Learning disability and paediatric services will work jointly where a young adult with learning disability is transitioning between child and adult services (aged 16-18). Access to dysphagia assessment for adults with learning disability in the community is via the local CTPLD. To meet the CTPLD referral criteria the person must have a learning disability plus a health need which requires specialist intervention. For individuals not already open to the CTPLD, a CTPLD referral form should be completed. Once received by the team secretaries this will be passed to a member of the Speech and Language Therapy (SALT) team. If the individual is already open to the CTPLD, a qualified member of staff will complete an interdisciplinary referral form to Speech and Language Therapy. 6 of 15 Implementation Date: 04/03/2014

7 Please see the LD Dysphagia Care Pathway flow chart in Appendix 1 for further details and timescales. If the referral is not appropriate to the LD SALT Service due to age or lack of learning disability the referral will be passed to the paediatric or adult services. The referrer and referred individual will be informed of this in writing Assessment On receipt of referral the Speech and Language Therapy team member will complete a telephone screening assessment to ascertain the level of risk and priority. Full assessment will then be carried out as necessary. Please see the LD Dysphagia Care Pathway flow chart in Appendix 1 for further details and timescales Management Following assessment, a detailed care plan will be written collaboratively with the individual, other relevant disciplines, carers and relatives. Consent will be sought from the service user before any intervention is implemented or best interests applied (please refer to the Trust Consent Policy for guidance). Treatment/ interventions will be delivered in a person centred context, in ways that support equality and value diversity. Intervention strategies will be tailored to meet the individual s needs, taking into account, for example, their culture and ethnicity, religion, gender, age and disability. Staff in inpatient services and short term care facilities are responsible for ensuring care plans are adhered to and regularly reviewed. If there are any problems or changes with the service user, the Speech and Language Therapist or other relevant professional should be contacted to discuss a change to the care plan. Please see LD Dysphagia Care Pathway flow chart in Appendix 1 for further details. 7. TRAINING 7.1. Mandatory Training There is no mandatory training associated with this policy Specific Training not covered by Mandatory Training Ad hoc training sessions based on an individual s training needs as defined within their annual appraisal or job description. 7 of 15 Implementation Date: 04/03/2014

8 8. MONITORING COMPLIANCE WITH THIS DOCUMENT The table below outlines the Trust s monitoring arrangements for this document. The Trust reserves the right to commission additional work or change the monitoring arrangements to meet organisational needs. Aspect of compliance or effectiveness being monitored Duties Referral process and timescale Completion of telephone screen Waiting times Care plans Method of monitoring Individual responsible for the monitoring Monitoring frequency To be addressed by the monitoring activities below. Audit of 8 cases 2 from each CTPLD selected at random SALT Dysphagia Lead for LD Annually Group or committee who receive the findings or report Group or committee or individual responsible for completing any actions Where a lack of compliance is found, the identified group, committee or individual will identify required actions, allocate responsible leads, target completion dates and ensure an assurance report is represented showing how any gaps have been addressed. 9. REFERENCES AND BIBLIOGRAPHY Baker V, et al. (2010) Adults with learning disabilities (ALD) Royal College of Speech and Language Therapists Position Paper. RCSLT: London Department of Health (2001), Valuing People: A New Strategy for Learning for the 21 st Century Hampshire County Council Adult Services Department (2012) Reducing the risk of choking for people with a learning disability, A multi-agency review in Hampshire Hollins et al, (1998) Mortality in people with learning disability: risks, causes, and death certification findings in London. Developmental Medicine and Child Neurology, 40, p NICE guidance, Feb Nutrition Support in Adults. NPSA, Understanding the patient safety issues for people with learning disabilities. NPSA, 2007, Problems Swallowing? Resources for Healthcare Staff RCSLT, Communicating Quality 3. 8 of 15 Implementation Date: 04/03/2014

9 Walmsley, J. (2001). Normalisation, Emancipatory Research and Inclusive Research in Learning. and Society,16, RELATED TRUST POLICY CLP006 Policy for Consent to Examination or Treatment 9 of 15 Implementation Date: 04/03/2014

10 APPENDIX 1 LD DYSPHAGIA CARE PATHWAY Referral received by CTPLD team secretaries re dysphagia Secretary aims to pass to SALT within one working day SALT will try to establish appropriateness to CTPLD by LD, age, Epex Not appropriate Refer to paediatric or adult services if no LD Appropriate SALT will aim to make a screening telephone call within two working days Emergency Advise to go to hospital Priority Will be seen by CTPLD SALT within 10 working days Low Priority Will be seen by CTPLD SALT within working days Eating and Drinking Assessment 10 of 15 Implementation Date: 04/03/2014

11 Eating and Drinking Assessment Discussion with the person/carer about the nature/frequency of the difficulty Observations Instrumental assessment cervical auscultation/ pulse oximetry Past history Current medical status chest infections/uti Request a medical history from the GP SALT will repeat assessment at different meals or in different settings as appropriate May include onward referral to videofluoroscopy, occupational therapist, physiotherapist or dietician No intervention needed Report to referrer and discharge Plan of Care Aim person to eat and drink safely and pleasurably Interim eating and drinking guidelines will be issued Formal report and guidelines/ care plan will be produced that may include:- o Advice on food and drink consistencies o Positioning o Pacing o Communication o Strategies/manoeuvres o Environment o Therapeutic exercises programme o o Desensitisation programme Training of carers and report to referrer and GP, e.g request for thickener 11 of 15 Implementation Date: 04/03/2014

12 Evaluate outcome of management Repeat observation and discussion with carers Not Achieved Outcome Achieved Stable for 2 months Not meeting nutrition/hydration needs or at high risk of aspiration Discussion re alternative feeding If carers not following plan consider safeguarding process Discharge Report Give information on how to rerefer Comment Card 12 of 15 Implementation Date: 04/03/2014

13 APPENDIX 2 EQUALITY ANALYSIS REPORT Equality Analysis Report Name of function: Dysphagia Policy for Adult Learning Services Date: Assessing officers: Emma Willsman Description of policy including the aims and objectives of proposed: (service review/resign, strategy, procedure, project, programme, budget, or work being undertaken): Policy to ensure safe and effective management for adults with learning disability who have actual or suspected dysphagia Evidence and Impact provide details data community, service data, workforce information and data relating specific protected groups. Include details consultation and engagement with protected groups. Evidence base: NHFT Equality Information Report August 2012 Northampton County Council :Northamptonshire Results: 2011 Census Data Summary Corby Daventry East Northants Kettering Northampton South Northants Wellingborough Northants England 53,400 72,100 76,600 82, ,200 79,400 72, ,400 49,449, ,100 77,700 86,800 93, ,100 85,200 75, ,900 53,012,500 % rise 14.4% 7.8% 13.3% 13.7% 9.2% 7.3% 4.0% 9.8% 7.2% Ethnicity: 85.7% (White) and 14.3% (BME )- 1.75% (dual heritage); 4.01% (Asian); 2.5%(Black including British, African and Caribbean) ; 0.85 % (Chinese) ; 6.05 % (white other EEA, polish, Gypsy & Traveller) Gender: 49.6% males; 50.4% females (including 1% transgender) Disabled people: 19% (including 3.5 % < aged under 18) Faith communities: 71% Christian; 29% minority faith: (includes Hindu, Muslim, Sikh, atheists, nonbelief) Sexual orientation (gay, lesbian or bisexual): 5-7% (Stonewall estimate) Service Information: provide any relevant service data or information to inform the Equality Analysis including service user feedback, external consultation and engagements or research. 13 of 15 Implementation Date: 04/03/2014

14 Equality Analysis Report Name of function: Dysphagia Policy for Adult Learning Services Date: Protected Groups STAGE 3: Consider the effect of our actions on people in terms (Equality Act 2010) of their protected status? The law requires us to take active steps to consider the need to: Eliminate unlawful discrimination, harassment and victimisation. Advance equality of opportunity Foster good relations with people with and with protected characteristic Age Gender (male, female and transsexual, inclu. Pregnancy and maternity) Gender reassignment Sexual Orientation (incl. Marriage & civil partnerships Race Identify the specific adverse impacts that may occur due to this policy, project or strategy on different groups of people. Provide an explanation for your given response. Eating, drinking and swallowing difficulties can occur at any age and can affect people with learning disability throughout their lifespan. This policy covers services for people aged 18 and over and for those undergoing transition from child to adult services. The service does not exclude people on the basis of their age apart from where there are other specialist services more appropriate to their needs (i.e. paediatric SALT service). The policy is likely to have a positive impact on people with learning disability as our service provides a specialist service for people with LD and we work closely with other disciplines to provide an integrated, holistic approach. People with physical or sensory disabilities are not excluded from our services. Eating and drinking needs are considered within a social model of disability. This policy is unlikely to negatively impact on these groups. People who are male, female, transsexual, pregnant or new mothers would not be excluded from the service or treated adversely. This policy is unlikely to negatively impact on this group. People who are undergoing/ have undergone gender reassignment would not be excluded from our service or treated adversely. People would not be excluded from the service or treated adversely on grounds of sexual orientation or type of relationship they are in. The policy is unlikely to negatively impact on people of a particular race or ethnicity. People would not be excluded from the service or treated adversely for reasons of race or ethnicity. Staff are mindful of different beliefs for example around health and disability, food and drink preferences and linguistic differences. Religion or Belief This policy is unlikely to negatively impact on someone because of 14 of 15 Implementation Date: 04/03/2014

15 Equality Analysis Report Name of function: Dysphagia Policy for Adult Learning Services Date: (including non belief) their religion or beliefs. A person would not be excluded from the service due to their religion or beliefs. Staff are mindful of different beliefs for example around health and disability, food and drink preferences. Equality Analysis outcome: Having considered the potential or actual effect of your project, policy etc, what changes will take place? The impact of the policy is likely to be positive for all protected groups. The SALT team and CTPLDs work in a person centred way, aiming to treat people as individuals and be mindful of all aspects of their identity such as age, disability, gender, sexual orientation, race, religion and beliefs. Action Plan Issue to be addressed Action Who Date to be completed NFA NFA Ratification a completed copy of the Equality Analysis form must be sent to Equality and Inclusion Officer to be approved. Approving Officers Tendai Ndongwe Date of completion: February of 15 Implementation Date: 04/03/2014