Doing Your Part in Swallowing Safety

Doing Your Part in Swallowing Safety

Speech therapy evaluates: Chewing, swallowing strength Timing of the swallow Left over food in the mouth Signs of difficulty swallowing Coughing Wet voice Complaint of food getting stuck Speech therapy determines: Functional dysphagia diagnosis Diet recommendations Swallowing strategies

Dysphagia is any difficulty getting food from the mouth to the stomach. It can be a problem chewing, swallowing, or moving food through the esophagus/food tube. Who has dysphagia? More than HALF of nursing home residents. But then why don t they cough all the time? Most people with dysphagia DO NOT COUGH when food, liquid enters the airway This is SILENT ASPIRATION Residents with silent aspiration are at HIGH risk to develop pneumonia

NORMAL SWALLOW: Airway is clear after the swallow SILENT ASPIRATION: Drink in airway, patient does not cough

Liquid enters the airway. This is ASPIRATION.

UNCHEWED FOOD: Patient is at high choking risk LEFTOVER FOOD: Stuck in throat after the swallow

Food hovers above the airway before the swallow. Large bites of food risk blocking the airway.

Our responsibility: To provide the diet as ordered in the medical chart. Residents with thin liquid dysphagia have difficulty Controlling liquid in their mouth Swallowing quickly Thickened liquids move more slowly than thin liquids A slower swallow needs slower moving liquids

We MUST provide the diet as ordered. It is NOT okay to: Give a resident a cookie if they are on puree Give a resident thin coffee if they are on nectar It is NOT allowed to give the resident food or drink that is NOT PRESCRIBED in their orders. Legally: We are BOUND to provide the ordered diet. Giving food that is NOT ordered by the doctor can result in CHOKING, PNEUMONIA, and even DEATH.

Choking deaths were a result of: NEGLECT & NEGLIGENCE IN FACILITIES Providing incorrect food items Not providing recommended supervision These deaths were PREVENTABLE. What happened as a response to these deaths? Involved staff was fired State fined the facilities One facility additionally fined by federal government $10,000 THE STATE IS FOCUSED ON HOW FACILITIES ARE PREVENTING FUTURE ACCIDENTS

1. Feb. 2012, resident chokes on a PB&J sandwich Resident was supposed to eat under supervision Staff failed to supervise the resident when left unattended with the sandwich Resident found unresponsive, CPR unsuccessful, and died at hospital 2. March 2012, resident chokes on a marshmallow Resident was on a ground diet Visitor asked the nurse if the resident could have one, and the nurse allowed it. The resident ate 2 and choked. Resident was revived but died 2 days later in hospital 3. April 2012, resident chokes on a meatball Resident was on soft, cut up food and was supposed to eat under supervision Resident ordered takeout directly to his room Ate without supervision, meatballs were not cut up Resident choked, CPR unsuccessful, died at hospital 4. April 2012, resident chokes on ham Resident was on ground meat, needed assistance while eating Kitchen staff gave resident regular ham Nursing staff cut it into ½ bites and fed it to resident Resident began choking, Heimlich unsuccessful Died at facility before ambulance arrived

If you feel that a resident is doing better, Talk with nursing or speech therapy about a swallowing re-evaluation. DO NOT try something off the diet and then refer to speech: This makes you responsible for not following the doctor s orders, and you are responsible if there is a choking incident. Follow the recommended swallowing strategies or aspiration precautions These recommendations IMPROVE EATING SAFETY for all residents.

If coughing or choking at meal, diet downgrade should be done No doctor s order required for a downgrade Pending a swallow screen, this is the SAFEST precaution when someone is at risk If you think there is a problem, PROVIDE CONSTANT SUPERVISION until swallow screen

What YOU Do Makes a Difference

Make sure that the diet served matches the diet list provided on the food cart NEVER ask the Kitchen for a different consistency other than what is ordered by the doctor Apple diet levels are: Puree (no chewing required) Dysphagia (some chewing required) Mech soft (more chewing required) Regular (most chewing required) There is NO cut up diet; if it is recommended to cut up food, this should be performed on the floor by nursing staff

Most beverages come pre-thickened Water Juices Milk Some drinks (coffee, tea) must be thickened by nursing staff Nectar is as thick as tomato juice (thick) Honey is as thick as honey (thicker) Pudding is spoon-thick (thickest) Jello and ice cream are LIQUIDS Someone on thickened liquids SHOULD NOT HAVE EITHER unless specifically stated in the doctor s orders Magic Cups are available to replace ice cream for residents on thickened liquids

Put in resident s dentures Use adhesive to keep in place Eating in a chair or wheelchair is best If eating in bed, put bed up as high as it will go Add or remove pillows for best positioning as Make sure resident is not leaning to one side

STOP feeding the resident if: they can t stay awake Medications can cause this to happen during a meal they are keeping food in their mouth they are coughing If coughing during eating, DO NOT GIVE ANYTHING TO EAT OR DRINK UNTIL THE COUGHING STOPS. INFORM NURSING WHEN A RESIDENT IS COUGHING DURING THE MEAL

Bite size amounts of food should be given It should take 20 minutes to feed a resident, no faster. If it takes over 20 minutes, talk to nursing or your facility speech therapist. Be sure their mouth is empty before giving another bite. When recommended by speech, give a drink after swallowing each bite of food. This is sometimes referred to as alternating food and liquid.

Clear resident s mouth of leftover food Mouth care may be needed Keep resident upright at least 30 minutes Longer may be recommended THANK YOU for understanding the importance of FOLLOWING THE RECOMMENDED DIET and IMPROVING EATING SAFETY. These practices keeps your residents, and your workplace, safe.