Executive Director of Nursing and Operations. Fiona Johnstone Speech and Language Therapist

Executive Policy Title Policy Reference Number Lead Officer Author(s) Ratified By Policy for the Multi-disciplinary management of eating, drinking and swallowing difficulties (Dysphagia) NTW(C)26 Executive Director of Nursing and Operations Fiona Johnstone Speech and Language Therapist Trust-wide Policy Group Date Ratified April 2015 Implementation date May 2015 Date of full implementation May 2015 Review date April 2018 Version Number V03 Review and Amendment Log Version Type of change Date V03 Review Apr 15 Description of change All sections updated highlighted in blue Updated standard appendices A, B, and C This policy supersedes: Reference Number Title NTW(C)26 V02.7 Dysphagia Policy

Management of Dysphagia Section Contents Page No: 1 Introduction 1 2 Purpose 1 3 Duties and Accountabilities 3 4 Quality Assurance 6 5 Resource Requirements 6 6 Safety and Legal Issues 8 7 Consent 9 8 Identification of Stakeholders 11 9 Implementation 11 10 Equality Impact Assessment 11 11 Standard Key Performance Indicators 12 12 Monitoring Compliance 12 13 Training 12 14 Fair Blame 12 15 Associated Documentation 13 Standard appendices attached to policy A Equality and Diversity Impact Assessment 14 B Training and Communication Checklist 16 C Audit and Monitoring Tool 18 D Policy Notification Record Sheet - click here

Appendix No: Appendices listed separate to policy Management of Dysphagia = MoD Description Issue Date Issued Review date Appendix 1 MoD in Children with a Learning Disability (Newcastle) 1 May 15 Apr 18 Appendix 2 Appendix 3 Appendix 4 MoD in Adults with a Learning Disability in Community (Newcastle and Sunderland) MoD in Adults with Acquired Brain Injury (Walkergate Park) MoD in Inpatient areas excluding adult with acquired brain injury 1 May 15 Apr 18 1 May 15 Apr 18 1 May 15 Apr 18 Practice Guidance Note listed separate to policy PGN No: Description Issue Date Issued Review date DP-PGN-01 Speech and Language Therapists LD-Dysphagia referral checklist 2 Oct 16 Apr 17 Appendix 1 Eating and Drinking Checklist for people with LD 1 Oct 13 Apr 17 Appendix 2 Impact Assessment 1 Oct 13 Apr 17

1 INTRODUCTION 1.1 Northumberland Tyne and Wear NHS Foundation Trust (The Trust/NTW) is committed to providing the highest standards of healthcare for all service users. This policy is intended to ensure the high standards of care maintained by the Trust. 1.2 Whilst the clinical process may differ depending on the service user group and the setting in which they receive their care, the core principles are the same (see separate appendices for specific service user services Section 2.8). The key objective is to ensure the safety of individuals who have eating, drinking and swallowing disorders. 2 PURPOSE 2.1 NTW is committed to providing the highest standards of care to all service users. As part of that care, staff must be able to recognise and care for a service user who has swallowing difficulties, from a sudden onset or as part of a long-term problem. 2.2 This policy provides clinical guidance to ensure the health and safety of service users with dysphagia of NTW inpatient wards and NTW Sunderland and Newcastle Community Team LD). 2.3 Some service users with dysphagia are supported in the residential settings by NTW staff. In these cases, NTW staff should work within the framework of this protocol. The NTW staff should be instrumental in identifying dysphagia and referring to appropriate community agencies. 2.4 Disruption of swallowing can have serious effects impacting on physical health, with complications such as malnutrition, pulmonary aspiration (fluid or food going into the lungs), and the emotional and psychological problems associated with not being able to eat normally. If not recognised and managed correctly, dysphagia can be fatal. 2.5 The term dysphagia is used to refer to eating, drinking and swallowing problems arising from a wide range of acquired and congenital causes. These problems include: orophanyngeal structural problems, motor processing difficulties, problems arising from the effects of medication, neurological disorders, phanyngooesophageal problems, poor oral health, mental health problems and psychological conditions (includes information from NPSA 2006) 1

2.6 Implications of dysphagia 2.6.1 If not managed properly, swallowing problems can lead to: Malnutrition Dehydration Poor oral health Poor healing of wounds Increased fatigue Decreased concentration Reduced development and growth Increased risk of social isolation Reduced quality of life Distress Choking Chest infections/pneumonia Premature death 2.7 Aims of a multidisciplinary approach to managing eating, drinking and swallowing difficulties service are: To provide a comprehensive, evidence based and responsive service to people presenting with swallowing disorders, including taking a central role in the promotion of health and well-being To assess, diagnose, request and interpret diagnostic tests, to refer to other agencies as appropriate, provide a management plan and to discharge To be a first point of contact for patient care, including single assessment (where indicated.) To facilitate intervention by the multi-disciplinary team extending and improving collaboration with other professions and services To engage in MDT discussion and decision making, along with service users, carers and families as appropriate, regarding quality of life, service user wishes and Best Interest Decisions in complex risk management cases. This includes when a service user is risk feeding (unsafe on all oral consistencies), end of life or risk feeding protocols where appropriate To take an active role in strategic planning and policy development for services to clients presenting with swallowing disorders To provide training and education for, professionals and carers involved in the care of clients with dysphagia To develop and apply the best available research evidence and evaluative thinking in all areas of practice 2

2.8 Nutrition is a vitally important aspect of our lives. Nursing staff have an important role to play to ensure that food provided is nutritious and well presented, as well as the appropriate consistency and that service users find eating/drinking safe as well as an enjoyable and pleasant experience. 2.9 It is important that service users with known swallowing difficulties and/or those with known behaviours that could affect the safety of the swallowing process, receive appropriate management for their difficulties to reduce the risk of complications. This includes being offered the recommended texture modified diet/consistency to reduce the possible risks. 2.10 This policy applies to all staff employed by or working in the Trust. The policy will apply wherever care is given; this may be hospital premises, NTW residential settings, the client s home, or another designated area. 2.11 The policy for the Multi-disciplinary management of eating, drinking and swallowing difficulties (Dysphagia) includes the following appendices relating to specific service areas - Management of Dysphagia in Children with a Learning Disability (Newcastle) Management of Dysphagia in Adults with a Learning Disability in Community (Sunderland and Newcastle) Management of Dysphagia in Adults with Acquired Brain Injury (Walkergate Park) Management of Dysphagia in individuals on inpatient wards (excluding acquired brain injury) 3. Duties and Accountabilities 3.1 The Senior Management Team are accountable to the Trust Board for ensuring the Trust-wide compliance with Policy. 3.2 Group, Directorate, Service and Corporate managers are responsible for the application and compliance of staff within their services with the Policy. 3.3 Inpatient/Residential Service Managers: Managers are responsible for staff, within their areas of responsibility, having an awareness of recognising and managing service users who are at risk of dysphagia and choking Referring the service user to the appropriate member(s) of the Multi- Disciplinary Team (MDT) for further assessment and advice Reporting choking incidents using the Trust s Safeguard Incident Reporting System and investigates, involving the multidisciplinary team 3

3.4 Inpatient/Residential Services Clinical Staff It is the responsibility of clinical staff to be aware of service users who may be at risk of eating and drinking difficulties by completing a risk assessment and taking appropriate action to reduce the risks whilst meeting the nutritional and hydration needs of the individual Referring the service user to the appropriate member(s) of the MDT for further assessment and advice Reporting of choking/ eating and drinking incidents and contributing to the investigation of incidents 3.5 Dysphagia Qualified Practitioner (Dysphagia Trained Speech and Language Therapists and/or dysphagia trained nurses) When required, these Dysphagia Qualified Practitioner will complete a comprehensive assessment of a service user s eating, drinking and swallowing skills and advise staff on the service user s requirements and safe swallowing management They will also assess the risk from any cognitive factors that could compromise the safety of the swallowing process 3.6 Dietitian They will provide training for clinical and non-clinical staff as identified o They will refer the service user to the appropriate member(s) of the MDT for further assessment and advice If the completed nutrition screening tool indicates, a referral to dietetics is made and the Dietitian will assess, advise and monitor the individual s diet, in order to meet nutritional needs They will refer the service user to the appropriate member(s) of the MDT for further assessment and advice as required 3.7 Physical Health Nurse The Physical Health nurse will advise about the impact of any physical health difficulties on swallowing, eating and drinking and provide specific and supporting information in relation to the service user s medical treatment They will refer the service user to the appropriate member(s) of the MDT for further assessment and advice as required 4

3.8 Estates and Facilities staff for inpatients Estates and Facilities staff will ensure that appropriate meals are available for service user s with swallowing difficulties in the appropriate textures, including snacks and finger foods They will ensure that additional items recommended by Dysphagia Qualified Practitioner, and dietetics, are ordered The Dysphagia Practitioner would liaise with the person who orders meals/snacks for the ward to ensure the appropriate food consistencies were ordered for service users 3.9 Pharmacy Will ensure that an appropriate range (different stages and flavours) of pre-thickened drinks, thickener and liquid medications are available and easily accessible within inpatient services within the Trust. Will provide pharmaceutical advice on presentations/formulations of medicines for people with dysphagia and prescription of thickeners Will provide access to advice and information about medicines which may increase the risk of dysphagia 3.10 Physiotherapist The Physiotherapist will assess, advise and monitor the service user s posture, seating and chest care, in order to meet nutritional needs and dysphagia management. They will refer the service user to the appropriate member(s) of the MDT for further assessment and advice 3.11 Occupational Therapist The Occupational therapist will assess, advise and monitor the service user s daily living skills around mealtimes and snacks, including utensil use and appropriateness, in order to meet nutritional needs and swallowing problems. They will refer the service user to the appropriate member(s) of the MDT for further assessment and advice 3.12 Medic Medics will assess overall health needs of the service user and continue to monitor 5

They will prescribe thickener when needed, and refer the service user for further assessments as required, for example, for videofluoroscopy, to gastroenterology. They will also consider medication use and review within the MDT in consideration of swallowing difficulties following assessment and advice from Speech and Language Therapist (Dysphagia Qualified Practitioner) They will refer the service user to the appropriate member(s) of the MDT for further assessment and advice 4 QUALITY ASSURANCE 4.1 All Dysphagia Qualified Practitioners will be registered Speech and Language Therapists or Qualified Nurses who have undertaken further dysphagia training. 4.2 There is a minimum requirement of a post-graduate dysphagia course or equivalent training with supervision from a competent Dysphagia Qualified Practitioner prior to working independently with dysphagic clients. 4.3 Advanced skills training are required prior to working with more complex cases. This may be achieved through a recognised course, e.g. MSc, Advanced Practitioner Courses or Portfolio of relevant and up to date CPD activity. 4.4 Dysphagia Qualified Practitioners are required to provide evidence of Continuing Professional Development in relation to dysphagia management via further training courses, special interest groups, knowledge and evaluation of recent research and peer review. Evidence of this will be demonstrated in Personal Development Plans and Continuing Professional Development Logs. 4.5 Clinicians in the process of training in Dysphagia should be working under the direct supervision of a competent Dysphagia Practitioner. New Graduates/Post Graduates with introductory dysphagia knowledge should work under the direct supervision of a competent Dysphagia Qualified Practitioner to gain their next stage of competence. 4.6 Students may take part in observation as part of assessment with prior client/carer consent, under direct supervision of a competent Dysphagia Qualified Practitioner. 5 RESOURCE REQUIREMENTS 5.1 Medical notes for service users should be available when seen in the acute setting. A brief summary of background and medical history is necessary for an outpatient/community referral. If the service user is known to NTW, such information should be available on RiO for reviewing by the Dysphagia Qualified Practitioner. 5.2 Relevant testing materials should be available, to include food/fluids and clinical supplies 6

5.3 A more experienced dysphagia practitioner will be available for second opinions/support for therapists with less experience 5.4 Compliance of ward staff/ community staff in assessment and following care plans is vital to ensure the needs of the service users are met and to ensure risks are kept to a minimum as well as eating/drinking being an enjoyable and pleasant experience. 5.5 Access to Videofluoroscopy Clinics would either be through Service Level Agreement (SLA) or on a cost per case basis depending on the service agreements and requirements. 5.6 Access to high quality video playing equipment to facilitate reading of VFSS and FEES examination tapes 5.7 Adapted utensils assessment for adapted utensils may be carried out by Occupational Therapists (see Section 3.11) for in-patients and community as well as dysphagia qualified practitioners. 5.7.1 An item may be trialled for appropriate use and then purchased for the service user. Details of the item should be recorded in the service user s notes and disseminated to staff and carers for future reference and purchasing. 5.8 Dysphagia posters/information information regarding swallowing problems, signs and symptoms to look for, high risk foods, high risk behaviours, making mealtimes safe and different food and drink consistencies are available. 5.9 Thickener from pharmacy see section 3.9 for further information relating to inpatients. In the community, the dysphagia qualified practitioner will contact the GP to request thickener for service users as required. 5.10 Modified texture meals see section 3.8 for Estates and Facilities information. National descriptors are used for meal ordering and preparing appropriate meals on wards and in the community. 5.11 Mealtime plans - care plans will be completed on RiO for NTW inpatient service users. Specific mealtime plans will be completed for other staff, carers, families in the Community. The content of these plans will be discussed with key people and disseminated to other staff, carers, family members as well as those in the MDT. 5.12 E-learning Awareness training on dysphagia will be available via E-learning and is recommended training for all in-patient registered nurses and non-registered staff. See Section 13 Training, as well as Appendix B Communication and Training Checklist including Needs Analysis. 7

6 SAFETY AND LEGAL ISSUES 6.1 The Dysphagia Qualified Practitioner must ensure that recommendations follow good practice and maximise the safety of the service user with all food and drink. 6.2 Health and Safety Guidelines in specific environments should be followed at all times, particularly regarding prevention of cross infection by the Dysphagia Qualified Practitioner. (a) Immunisation Dysphagia qualified professionals working with service users with dysphagia are advised to undergo immunisation for Hepatitis B Individuals are personally responsible for ensuring that their boosters are kept up to date. This can be done through the Occupational Health Department Team Prevent. (b) Infection Control Dysphagia qualified professionals need to follow the Trust s Infection, Prevention and Control Policy, NTW(C)23 (i) (ii) (i) (ii) Sterilisation and storage of equipment should adhere to the above policy to avoid cross infection of both patients and staff involved in the clinic. Staff must wear disposable gloves and other appropriate protective clothing (e.g. aprons, glasses) during oral examination. Staff must adhere to the Trust s policy NTW(C)23 Infection, Prevention and Control, practice guidance note IPC-PGN- 04.1-Hand Hygiene and use of alcohol hand rub for cleaning hands before and after seeing a patient. Staff must be aware and comply with the Trust s policy NTW(C)23 Infection, Prevention and Control, practice guidance note IPC-PGN-21, Management of MRSA in Hospitals. Related reading: Trust policy NTW(C)23, Infection, Prevention and Control (c) Food Handling Staff must be aware of and adhere to the Trust s policy NTW(O)53 Food Hygiene regarding storage and transportation of food and drink. 8

(d) Staff must be aware of and adhere to the following policies and practice guidance notes: NTW(O)27 - Nutrition Policy NTW(O)53 - Food Hygiene Policy NTW(O)70 - Catering Service Policy NTW(C)17 Medicine Policy, practice guidance note: o UHM-PGN-26 - Dietary Products NTW(C)29 Trust Standard for the Assessment and Management of Physical Health (e) Cardiac Pulmonary Resuscitation Staff are responsible for attending regular CPR training. This is available through the Trust and should be renewed annually 6.3 If recommendations are not being followed, the Dysphagia Qualified Practitioner should clearly state this in the client s notes and discuss the reasons with the service user and team members, as appropriate. It will be necessary to also raise the issue(s) with ward managers/team leads. 6.4 Further discussion would be required regarding further input for the service user by the Dysphagia Qualified Practitioner. If recommendations continue not to be followed, the clinician may need to complete a Safeguarding alert. 7 CONSENT 7.1 Clinicians should refer to the Trust s policy, NTW(C)05 Consent to Examination or Treatment. 7.2 (a) General Client consent should be sought in line with DOH guidance www.doh.gov.uk/consent Consent should be sought prior to assessment in all cases and resought with any significant changes in treatment / management For consent to be valid, it must be given voluntarily by an appropriately informed person who has the capacity to consent to the intervention in question. Consent must be given voluntarily and freely. The individual needs to understand, in broad terms, the nature and purpose of the procedure. It is advisable to inform the individual of any material or significant risks in the proposed treatment, any alternatives to it and the risks incurred in doing nothing 9

It is the responsibility of the Dysphagia qualified professional, working within the multidisciplinary team, to ensure this Translation services will be sought, as appropriate, where the service user/service user s relatives have English as a second language 7.3 (b) Where the client is unable to consent: Parents, relatives or members of the healthcare team cannot consent on behalf of an adult who is unable to give consent for him or herself When an individual is unable to give consent a key principle is that of the person s best interests. Best interests are not confined to best medical interests. Case law has established that other factors, which may need to be taken into account, include the service user s values and preferences when competent, relationships with relatives or carers, spiritual or religious beliefs, for example. It is good practice for the healthcare team to involve those close to the service user in order to find out the service user s values and preferences before loss of capacity Consideration should be given to obtaining consent in writing where there is judged to be significant risk to the service user. See the Trust s NTW(O)05, Consent to Examination or Treatment Policy 7.4 (c) Adults capable of giving consent who have communication difficulties: Verbal consent can be gained from the service user prior to assessment, treatment and management. Where there are significant communication difficulties, every attempt will be made to inform the service user non-verbally about these procedures, using alternative/augmentative strategies e.g. photographs, symbols, signing Verbal consent is acceptable as for any other aspect of Speech and Language Therapy with this group. If the service user has severe language and communication impairment (either expressive or receptive) consent may be sought via non- verbal communication methods (see above) How consent has been given should be clearly documented in service user s notes on RiO Where the service user lacks the ability to consent to a particular course of treatment this should be clearly documented. In these cases a multi-disciplinary team decision may be made, in consultation with the family/carers/advocate, about the service users best interests 10

Wherever possible it is good practice through the use of non-verbal methods, to gain as much information from the client as to their wishes and preferences in relation to a particular treatment 7.5 (d) Video and photographic consent: This should be sought in accordance with the Trust s NTW(O)45, Visual Imaging and Audio; NTW(O)05, Consent to Examination or Treatment policies, regarding consent for clinical photography and conventional or digital video recordings 7.6 Consent agreement and discussions must be documented in the service user s notes on RiO. Written and signed consent forms should be uploaded onto RiO and copies given to the service user and carer s as appropriate. This also applies for MCA forms. 8 IDENTIFICATION OF STAKEHOLDERS 8.1 This is an existing policy under review which has been circulated to the following for a four week Trust wide consultation period: Corporate Decisions Team Local Negotiating Committee Consultant Psychiatrists Community Services Care Group Specialist Service Inpatient Care Group Psychological Services Clinical Governance and Medical Directorate Safeguarding Trust Allied Health Professions Service Steering Group Finance, IM&T, Estates and Performance Staff-side Trust Pharmacy Workforce Communications 9 IMPLEMENTATION 9.1 This policy will meet the target date of 12 months from the date of ratification to be implemented across the Trust. If this target date cannot be met, then the Physical Health Group will be responsible for developing an action plan. 10 EQUALITY IMPACT ASSESSMENT 10.1 In conjunction with the Trust s Equality and Diversity Officer this policy has undergone an Equality and Diversity Impact Assessment which has taken into account all human rights in relation to disability, ethnicity, age and gender. 11

The Trust undertakes to improve the working experience of staff and to ensure everyone is treated in a fair and consistent manner. 11 STANDARD/KEY PERFORMANCE INDICATORS 11.1 The Healthcare Commission and the Mental Health Act Commission require assurance and information relating to the management of dysphagia within the Trust. Information maybe considered by the NHS Litigation Authority. Key performance indicators within service specifications maybe outlined relating to the use of dysphagia. It is therefore required that records/procedures must be maintained as specified within the dysphagia policy. 12 MONITORING AND COMPLIANCE see Appendix C 12.1 To monitor all Dysphagia qualified practitioners are registered SALT or Nurse 12.2 To ensure clinician has successfully completed an accredited postgraduate training programme within Dysphagia or recognised training course to be able to work unsupervised. 12.3 To ensure that CPD is in accordance with profressional body. 13 TRAINING See Appendix B 13.1 Awareness training on dysphagia will be available via E-learning and is recommended training for all in-patient registered nurses and non-registered staff. Further training will be provided by Dysphagia Trained Practitioners alongside members of the MDT as needs arise, focussing on more specific issues related to specific client groups and areas within The Trust. 13.2 The Trust will ensure that all identified staff has access to appropriate levels of training, and it is the responsibility of each Director to ensure staff attend. 13.3 Levels of training are identified in the training needs analysis (see Appendix B of policy) and are included within the Essential Training Guide which forms part of NTW(HR)09 Staff Appraisal Policy. 13.4 All Trust staff are recommended to complete E-learning awareness training with a focus on signs and symptoms of dysphagia and what to do if these are observed. 14 FAIR BLAME 14.1 The Trust is committed to developing an open learning culture. It has endorsed the view that, wherever possible, disciplinary action will not be taken against members of staff who report near misses and adverse incidents, although there may be clearly defined occasions where disciplinary action will be taken. 12

15 ASSOCIATED DOCUMENTATION 1. Clinical Guidelines in Dysphagia Management 2003 RCSLT 2. Communicating Quality 3 RCSLT. Professional Standards for Speech and Language Therapists 2006 3. Hickman, J, and Jenner, L, 1997 ALD and dysphagia: issues and practice, Speech and Language Therapy in Practice, Autumn 8-11 4. Langmore, S.E., 1999 Issues in the Management of Dysphagia. Folia Phoniatrica et Logopaedia, 51, 220-230 5. The Ionising Radiation (Medical Exposure) Regulations 2000 6. Protocol for VFSS and FEES, Sunderland Speech and Language Therapy Service 2004 7. Reference Guide to Consent for Examination or Treatment www.doh.gov.uk/consent 8. Ten Key Roles for Allied Health Professionals, Department of Health 9. Trust policies in relation to: NTW(C)04 - Safeguarding Children Policy NTW(O)05 Consent to Examination of Treatment Policy NTW(O)27 Nutrition Policy NTW(O)45 Visual imaging and Audio Policy NTW(O)53 Food Hygiene Policy NTW(O)70 - Catering Service Policy NTW(C)17 Medicine Policy, practice guidance note: o UHM-PGN-26 - Dietary Products NTW(C)29 Trust Standard for the Assessment and Management of Physical Health 13

Appendix A Equality Analysis Screening Toolkit Names of Individuals involved in Review Date of Initial Screening Review Date Fiona Johnstone November 2014 March 2018 Service Area / Directorate Policy to be analysed NTW(C)26 Dysphagia Policy Is this policy new or existing? Existing with new training requirements What are the intended outcomes of this work? Include outline of objectives and function aims Ensuring safe working practise Who will be affected? e.g. staff, service users, carers, wider public etc. Staff and Service Users Protected Characteristics under the Equality Act 2010. The following characteristics have protection under the Act and therefore require further analysis of the potential impact that the policy may have upon them Disability Sex Race Age Gender reassignment (including transgender) Sexual orientation. Religion or belief Marriage and Civil Partnership Pregnancy and maternity Yes positive impact to ensure safe drinking and eating Yes positive impact to ensure safe drinking and eating Carers Other identified groups No How have you engaged stakeholders in gathering evidence or testing the evidence available? Through standard policy process procedures How have you engaged stakeholders in testing the policy or programme proposals? Through standard policy process procedures 14

For each engagement activity, please state who was involved, how and when they were engaged, and the key outputs: Appropriate policy review by author/team Summary of Analysis Considering the evidence and engagement activity you listed above, please summarise the impact of your work. Consider whether the evidence shows potential for differential impact, if so state whether adverse or positive and for which groups. How you will mitigate any negative impacts. How you will include certain protected groups in services or expand their participation in public life. Positive impact to ensure safe eating and drinking for service users across NTW Now consider and detail below how the proposals impact on elimination of discrimination, harassment and victimisation, advance the equality of opportunity and promote good relations between groups. Where there is evidence, address each protected characteristic Eliminate discrimination, harassment and victimisation Advance equality of opportunity Promote good relations between groups What is the overall impact? Addressing the impact on equalities Ensuring safe working practise From the outcome of this Screening, have negative impacts been identified for any protected characteristics as defined by the Equality Act 2010? If yes, has a Full Impact Assessment been recommended? If not, why not? Manager s signature: Fiona Johnstone Date: April 2015 15

Appendix B Communication and Training Check list for policies Key Questions for the accountable committees designing, reviewing or agreeing a new Trust policy Is this a new policy with new training requirements or a change to an existing policy? Existing with additional training requirements from previous policy If it is a change to an existing policy are there changes to the existing model of training delivery? If yes specify below Required competencies for working in dysphagia as laid out in clinical guidelines & recognised training courses. Agreement made at MDT planning workshops in January 2014 regarding training needs. Are the awareness/training needs required to deliver the changes by law, national or local standards or best practice? Please give specific evidence that identifies the training need, e.g. National Guidance, CQC, NHSLA etc. Please identify the risks if training does not occur Please specify which staff groups need to undertake this awareness/training. Please be specific. It may well be the case that certain groups will require different levels e.g. staff group A requires awareness and staff group B requires training. Is there a staff group that should be prioritised for this training / awareness? Please outline how the training will be delivered. Include who will deliver it and by what method. The following may be useful to consider: Team brief/e bulletin of summary Management cascade Newsletter/leaflets/payslip attachment Focus groups for those concerned Local Induction Training Awareness sessions for those affected by the new policy Local demonstrations of techniques/equipment with reference documentation Staff Handbook Summary for easy reference Taught Session E Learning Please identify a link person who will liaise with the training department to arrange details for the Trust Training Prospectus, Administration needs etc. Awareness training considered best practise Ensure staff working in the management of dysphagia have the required competencies and access to supervision Risks of not having the training: See Section 2 & 4.2 of the policy E-learning awareness training from National Skills Academy Awareness and adherence to policy which mirrors clinical guidelines Team brief to raise awareness of the policy Ensure clinicians working with dysphagia receive their own copy through management cascade E-learning or taught session in situ Awareness training already on e-learning: 000dysphagia:nutrition & hydration National Skills Academy 16

Appendix B continued Staff/Professional Group Type of training Duration of Training Frequency of Training In-patient/residential ward LD community staff e-learning 000dysphagia:nutrition & hydration National Skills Academy 20 minutes Bi-annually Copy of completed form to be sent to: Training and Development Department, St. Nicholas Hospital Should any advice be required, please contact:- 0191 245 6770 (internal 56770) 17

Statement Monitoring Tool Appendix C The Trust is working towards effective clinical governance and governance systems. To demonstrate effective care delivery and compliance, policy authors are required to include how monitoring of this policy is linked to auditable standards/key performance indicators will be undertaken using this framework. NTW(C)26 Management of Dysphagia - Monitoring Framework Auditable Standard/Key Performance Indicators Frequency/Method/Person Responsible Where results and any Associate Action Plan will be reported to, implemented and monitored; (this will usually be via the relevant Governance Group). 1. All Dysphagia Qualified Practioners will be a registered SALT or Nurse Registration to profession will be checked on recruitment by appointing officers. Record made on departmental register by manager Departmental register checked and updated annually by manager Annual Report to Physical Health Group 2. To work unsupervised in dysphagia management, the clinician should have successfully completed an accredited postgraduate training programme in dysphagia, or recognised training course Departmental register will be updated either on recruitment by manager or on completion of training by supervising dysphagia qualified clinician Departmental register checked and updated annually by manager Annual Report to Physical Health Group 3. CPD is in accordance with professional bodies Regular clinical supervision by supervising dysphagia qualified clinician Departmental register will be updated by supervising dysphagia qualified clinician Departmental register checked and updated annually by supervising dysphagia qualified clinician Annual Report to Physical Health Group The Author(s) of each policy is required to complete this monitoring template and ensure that these results are taken to the appropriate Quality and Performance Governance Group in line with the frequency set out. 18