Date post: | 11-Jan-2016 |
Category: |
Documents |
Upload: | morgan-lloyd |
View: | 217 times |
Download: | 2 times |
SIPS ProjectStrategy for an IntegratedPreventative pathway for
Swallowing difficulties in Care Homes
Eleanor StoutMary Heritage
Derbyshire Community Health Services NHS Trust
& Pat Betts
Dysphagia: swallowing difficulty
caused by:
• stroke
• progressive neurological conditions
• dementia
Dysphagia in Care Homes – the Quality issues
• Late identification: risks not understood:• Dehydration, weight loss, poor nutrition, chest
infections, pneumonia, increased confusion, choking.
• Distress• Unplanned hospital admission – urgent swallow
assessment.• On discharge – poor transfer of information
Dysphagia in Care Homes – Workforce issues
• SLT - specialist assessment• Dysphagia trained nurses (DTN)• Lack of awareness amongst other staff• Occasionally ‘dysphagia panic’
SIPS project - Aims
• early identification of dysphagia, • prevention of health deterioration, • proactive care planning, • avoidance of hospital admission
Patients with
the most complex
needs access a specialist assessment
Patients with identified symptoms of dysphagia are assessed by a DTN
in their own setting
All residents in care homes are supported by staff that have good nutrition and dysphagia awareness
SIPS project
14 nursing homes and 1 residential home were provided with:– assessment training for DTNs– awareness training for any staff – a named SLT for specialist assessment or
consultation.
Assessment training for DTNs
29
55
18
17
0
10
20
30
40
50
60
70
80
2011 2012
Number of Certificated and Trainee DTNs practising in Derbyshire Care Homes 1st May 2011 / 2012
Trainee DTNs
Certificated DTNs
Awareness training for any staff
• Chart to show increase in scores
0
20
40
60
80
100
120
140
Identifying 5signs of
swallowingdifficulties
Knowing soft isnot blended
Soft is Jacketpotato and fishpaste sandwich
Knowing 8-10recommended
no of drinks
Encouragingperson to holdbeaker/spoon
Bad Strategy touse Spout
Bad Strategy totip head back
Pre Training out of 95
Post Training out of136
SIPS - a named Speech and Language Therapist (SLT) for specialist assessment or consultation
• Direct collaboration DTN and SLT when problem identified
• Support for DTN post training course• Easy access for referral• Identification for urgent assessment
SIPS - Impact on timing of assessment
Number of requests for rapid response SLT assessment
0
1
2
3
4
5
6
7
Baseline Impact
SIPS - Timing of assessment
No residents waiting more than 1 week for assessment
0
2
4
6
8
10
12
14
Baseline Impact
SIPS – impact on admissions
No of hospital SLT episodes for residents with dysphagia from the homes where DTNs were trained
0
10
20
30
40
50
60
01 Jul 2010 - 31 Dec 2010 01 Jul 2011 - 31 Dec 2011
No of hospital SLT episodesrelated to dysphagia inresidents from the Homes withDTNs
SIPS impact of assessments
DTN Assessments
40
1
31
DTN Assessmentsrecommending actions toprevent aspiration
Confirmed avoided admission
DTN assessmentsrecommending actions toimprove quality of life
Patient experience – Mrs S
• Admitted to Care Home from acute hospital
• Progressive physical condition• Fork mashable diet and normal fluids
Patient experience Mrs S
• Grade 3 pressure sores – difficult to position
• Temperature with green sputum (consistent with a chest infection)
• Anxious, with fear of choking
• GP visit - Antibiotics prescribed
• DTN assessment – 24 hr trial before readmission.
Patient Experience Mrs S
DTN: Care Plan:– Syrup thick fluids and soft diet– Family informed ‘Do Not Attempt Resus’.– ‘Right Care’ management plan
Recovery after 3 days of antibiotics
No further chest infections to date
Now enjoying pureed diet and thickened drinks
No referral to SLT.
Impact of DTN roleon Mrs S’ care
Without DTN training:
• Mrs S would have been admitted
• If waited for SLT assessment - ?4 weeks
• Poor quality of life
• Increased distress
• Compromised nutrition, hydration and pressure areas
DTN reflections
• More aware of residents coughing
• More aware of diet, fluids, positioning
• Assessing continually
• Able to sort out problems ‘in house’
• Whole team more aware
• ‘Next day’ assessment
SIPS project – impact summary
• more timely assessment, • positive impacts on well being• up to 50% reduction in hospital admissions
amongst a group of high risk patients
Economic Impact
Cost of training 20 nurses £5,500
If each DTN completes 7 assessments
140 residents will benefit..
If 57% of these have reduced aspiration risk
80 people with reduced risk of aspiration
If 30% of these avoid one admission in Year 1.
Saving 24 hospital admissions is £75,504
2 avoided admissions exceed the cost of
training 20 nurses.
SIPS Next steps
• ‘Partnership with Care Homes’ in CQUIN 12-13 • Business case to extend this project• Learning Beyond Registration funding• Integrated Dysphagia Pathway• a further 180 DTNs to be trained• 2 DTNs per Nursing Home • Build the evidence base re cost benefits