Policy: Compassionate Care Team Ltd recognises that reducing the risk of choking and improving the safety of individuals who have swallowing, eating and drinking difficulties is an essential part of the safe and appropriate care that meets individual needs and supports their rights.
Compassionate Care Team Ltd understands that strategies should be in place to identify people at risk of choking. This includes access to dental and medical checks.
Compassionate Care Team Ltd will ensure that staff are adequately trained to address choking risks, have knowledge of dealing with choking incidents and are able to make a first aid response if the person chokes.
Compassionate Care Team Ltd will ensure that managers understand the importance of escalating concerns to the GP to obtain Speech and Language Therapist (SLT) and Dietitian assessments for those Service Users who have chewing or swallowing difficulties and any special nutritional requirements.
Compassionate Care Team Ltd will ensure that all individuals with dysphagia have an individual management Care Plan developed with specialist professionals. This should be regularly monitored and updated with the risks reassessed as the needs of the Service User change.
All Service Users must have their needs met safely and in line with the agreed person-centred Care Plan. All staff providing care for people should adhere to the Choking Policy and Procedure to support the safety and wellbeing of those people with an identified increased risk of choking.
In order to improve the safety of adults who have dysphagia or are at risk of choking, accessible information on the assessment and dysphagia management should be made available to Service Users, their carers and families, including advice on the preparation of suitable food and fluids.
Incident reporting systems must be in place for the accurate recording, reporting and actioning of choking incidents, or potential choking incidents for all people with dysphagia or who are at risk of choking.
Carers and staff working with Service Users with dysphagia or who are at risk of choking, need to be aware that a change in a Service User’s medication can produce side effects that may worsen their condition. The implications of any such change should be first clarified with a GP and pharmacist.
Local liaison and care transfer protocols should be in place between The Agency, hospital and community Services
Procedure: Assessment Documentation • Before starting a care service, the assessment documentation should identify if a Service User is at risk. This will be recorded, and the relevant staff informed. Preparations will be put in place before the service starts, such as informing staff of the need for an altered diet • A risk assessment must be carried out and included in a Care Plan with the appropriate course of action • Staff must have systems in place to know which Service Users are at high risk of choking
Risk Assessment Procedure As part of the risk assessment procedure, an assessment should be made to indicate the risk of choking and whether a referral to a Speech and Language Therapist (SLT) via the GP for swallowing assessment or further discussion with a health professional is required, if this has not already taken place. Staff must gain consent, wherever possible, before any assessment is undertaken. When a Service User is unable to give informed consent, best interest decisions are made using the guidelines in the Mental Capacity Act and best interest guidance. A Choking risk assessment and reassessment should be undertaken: • 6-monthly, or every time there is concern about the Service User's swallowing ability or their eating and drinking • If there has been a significant change in the Service User‘s level of need which might increase their risk of choking • If the Service User's choking risk increases as a result of their behaviour
Service Users who exhibit behaviour that may challenge, such as putting non-food items into their mouth or who swallow non-food items which increases their risk of choking, should have a multidisciplinary team assessment. Clear guidelines must be in place to support the strategies that staff are required to use to manage the risk.
Medication When there is an identified choking risk, a review of oral medication should be undertaken and, for all medicines that need to be continued, an alternative dietary route should be considered. Staff should not crush or hide medication (covert medication) without prior approval from the prescriber together with clear documented authorisation in place. Staff should not hide medication (covert) without the Service User's consent or, where a Service User lacks capacity, without a documented multidisciplinary decision involving the GP. Staff should refer to the Covert Medication Policy at Compassionate Care Team Ltd.
Healthcare Professional Input It is acknowledged that an SLT may not be able to review Service Users swiftly and therefore, whilst awaiting review, Care Workers should maintain a food diary and seek telephone support and advice from the SLT in the first instance. The SLT, when required, will complete a comprehensive assessment that should investigate potential causes of dysphagia and choking and assess eating, drinking and swallowing skills. Recommendations will then be made to staff which aim to manage and reduce the risk whenever possible and should include: • The Service User's requirements • Safe swallowing management • Assessment of risk from cognitive factors that could compromise the safety of the swallowing process Compassionate Care Team Ltd must ensure that SLT recommendations are followed and recorded in the
Service User's Care Plan. Where a Service User chooses not to follow recommended advice and this is based on an informed decision, this will be respected, recorded and the SLT informed. If a Service User is deemed to lack capacity to make an informed decision, a best interest decision will be made in accordance with the Mental Capacity Act as part of a multidisciplinary decision. Care Plans Where a risk of choking has been identified, the Care Plan must include what the concern is and what needs to be done so that the plan clearly indicates what support should be given to the Service User to eat and drink safely and minimise the risk of choking. The development of individual Care Plans should, wherever possible, involve the Service User and those who provide care. Individual needs and requirements should be accurately documented in the Care Plan. Care Plans should be reviewed in accordance with the care planning policies and procedures. Assessments and decisions must be reviewed following any change or deterioration in health or behaviour. In addition to regular reviews, staff should remain vigilant and responsive to individual needs on a daily basis. Daily records should indicate that the appropriate foods have been given according to advice from an SLT.
Care Plans Must: • Give clear information to Care Workers on how to manage the choking risk and make meals safe and enjoyable • Include recommendations on fluid and food consistencies, recommended position, equipment and the level of assistance required for the Service User • Include information on the Service User's food and drink preference where applicable. However, it is important to remember that foods need to be given in accordance with food modification and texture advice • Follow the principles of the Mental Capacity Act, and where decisions are made on behalf of the Service User, they need to be in the their best interests • Ensure that dignity, privacy and respect are maintained at all times
The Dining Experience Meal times should be recognised as an opportunity for reassessing risk in a Service User who has been identified as being at an increased risk of choking. Staff should have the skills to support individuals at risk of choking with their eating and drinking including: • Having adequate skills in making mealtimes as safe and pleasurable as possible, including communication at mealtimes • Ensuring that Service Users are positioned correctly and safely when eating or drinking • Being able to prepare and present food and drink to the person in a way that follows with their documented recommendations • Ensuring that any foods brought in match the appropriate consistency • Being aware of foods with a high choking risk • Maintaining the Service User's dignity whilst eating and promoting independence as far as possible
The presence of staff at mealtimes is critical for observation and to reduce the risk of any unobserved incident of choking. Mealtimes are also a good time to build relations with Service Users and to more fully understand their behaviour, motivations and specific dietary requirements. Staff should recognise early, the signs and symptoms that may indicate a risk of choking: • Coughing during or immediately after eating or drinking • Wet vocalisation after drinking • Change of skin colour • Watering eyes • Refusal of food before or during a meal • Increased anxiety when eating or drinking • Behavioural difficulties when eating or drinking Care Workers must report to The Agency immediately if they are concerned that any of the above symptoms are present.
Modified Diets and Thickened Fluids • Where diet and fluids are modified on the instruction of the SLT or other specialist healthcare professionals, staff should follow their instructions • Where fluids are required to be modified, staff must follow the manufacturer's guidance to obtain the correct consistency • Staff must ensure that prescribed thickener products are kept safely and secured away from Service Users who are at risk of ingesting them. Staff are responsible for maintaining sufficient stock levels of thickener • Robust procedures should be in place to ensure that all staff are aware when Service Users require a modified diet or fluid consistency and this must be communicated to all staff involved in the care of the Service User • Compassionate Care Team Ltd will follow BDA guidance and the IDDSI framework in accordance with their local dietitian and SALT (Speech and Language Therapy) recommendations and staff can refer to the Further Reading section for best practice recommendations
Transfer of Care If a Service User is transferred to another health/social care provider for any reason (e.g. hospital admission), eating and drinking needs should be communicated.
Choking Procedure • Choking can happen at any time to anyone and therefore any member of the Compassionate Care Team Ltd team, regardless of role, must understand how to recognise a choking event and know how to respond • If choking occurs, all staff should follow the public advice accessible via the NHS Website or the Resuscitation Council Website • If the person's airway is still blocked after trying back blows and abdominal thrusts, the member of staff must summon help immediately by calling 999 and follow the advice of the emergency services whilst waiting for the ambulance to arrive • When safe to do so, the choking episode/incident will be reported on an accident/incident form and documented in the Care Plan in accordance with the Record Keeping Policy and Procedure. The frequency and severity of events will be monitored and strategies in the Care Plan will be reviewed • All choking incidents (whether there are serious consequences or not) must be reported
Training and Education Every member of staff, regardless of role, should have a public level of awareness for recognising a choking event and knowing how to respond. It is recommended that practice scenarios and drills take place to maintain that awareness and the responsiveness of everyone In order to safely meet the needs of Service Users in relation to choking, Care Workers must have knowledge and competence in the following: • Recognition and assessment of risk and delivery of safe care in line with the agreed Care Plan • Understand the individualised support needed to reduce their risk of choking when eating or drinking and provide the required support to promote the Service User's safety • It is the responsibility of Compassionate Care Team Ltd to ensure that all staff are trained to meet the needs of Service Users who may present with a risk of choking • Staff must be familiar with this choking policy • Staff should be aware that chronic symptoms of dysphagia include chest infections, malnutrition and dehydration • Relevant staff must be able to identify and manage Service Users at choking risk/with dysphagia and ensure appropriate management • Staff supporting Service Users identified as at risk of choking must have the first aid training to be able to provide emergency aid response to choking. They should also have access to the latest resuscitation guidance • Being involved in the Care Plan process for people at risk of choking wherever possible • Being aware of the consequences of not following an agreed eating and drinking plan • Completing a Choking Risk Assessment any time a new or increased risk of choking is identified • Identifying support services and the referral process
Audit and Review • All incidents, accidents and near misses occurring again • The Registered Manager or delegated other will assess the knowledge of staff in the event of a choking episode to provide assurance that, in the event of an emergency response, staff are competent and current with practice • Care Plans and risk assessment audits will include the risk of choking. Any identified themes and trends will be addressed and changes in practice embedded • The Registered Manager will seek feedback and support from the SLT in relation to ongoing quality improvement