Dysphagia Management

January, 2017

While our pharmacist colleagues have targeted the over-crushing of medications in aged-care facilities with their aptly titled book, “Don’t Rush to Crush”, we as Speech Pathologists have identified a concerning trend of our own.

As an Australia-wide company, our team has had the opportunity to observe the practises and cultures that have developed across a large number of RACFs. It has been clear in many locations that diet and fluid modifications are often being decided and prescribed by registered nurses, enrolled nurses and, in some cases, personal care workers and catering staff.

So why are our staff so quick to give them thick (fluids)?

Don’t Be So Quick to Give Them Thick!

The Queensland Health Department recommends within a health facility (including residential aged care facilities) that only medical officers and Speech Pathologists prescribe thickened fluids. This recommendation is for all prescription of thickened fluids, even in the immediate and initial stages.

Why is it that we find that most RNs believe that ‘downgrading’ residents to thickened or thicker fluids is appropriate or acceptable practice? After some candid discussions with senior nursing staff and clinical management teams, it appears the answer is quite simple: they don’t know what else to do.

There are no current guidelines for nursing staff to follow once a concern has been identified and unfortunately most do not have access to immediate speech pathology intervention. While many metropolitan hospitals have had access to prompt, on-call speech pathology services, historically our aged care facilities may have been waiting for days, weeks or even months for an assessment. In these cases, nursing staff have felt that they had to provide some sort of solution or management while awaiting speech pathology intervention, and therefore chose what they felt was the safest and best alternative: thickening fluids.

After discussing the reasoning for this trend, it appeared that most RNs and clinical staff shared the same assumption: Thicker is better and thicker is safer.

But thickened fluids are not the best or safest option for many residents.

We then asked “What is the reason nurses are turning to thickened fluids?” Again, a trend appeared: prevention. The assumption was that thickened fluids would help in the prevention of aspiration pneumonia.

However, without a proper assessment and diagnosis (which require either a medical officer or a speech pathologist), an appropriate management plan cannot be initiated.

Quick Dysphagia Facts:

  1. Did you know that some residents may have a higher risk of aspiration on thicker fluids? Therefore providing thickened fluids may increase the risk of developing aspiration pneumonia in some residents.
  2. Did you know that the aspiration of food and fluids is not the single most contributing factor to aspiration pneumonia? Good oral health is the single most important factor for the prevention of aspiration pneumonia. It is also a factor that is within the scope of the nursing practice to assess and manage.
  3. If nurses should not be prescribing thickened fluids, what should they do?  It is outside of the nursing scope of practice to conduct a swallowing assessment or to diagnose dysphagia. However, nurses are very well equipped to assess the situation in which the problem has been identified.

With this in mind, we have created a resource to assist RNs and other clinical staff with decision making when someone has been identified as having difficulties with fluids. This will assist nursing staff to ensure residents are at the lowest risk possible while awaiting speech pathology intervention and in order to comply with the Queensland Health Department’s stance on prescription of thickened fluids.

To obtain your copy of this tool, please contact us.

Dietitians Australia

Don’t let your residents or budget experience the side effects of malnutrition or dysphagia.
Call us on 1300 850 246 or email and request a call back.

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