DYSPHAGIA AND QUALITY OF LIFE STUDY DAY

On 6th July 2017 we held a study day on Dysphagia and Quality of Life, if you were unable to attend or simply would like to refresh your memory you can view all the session videos here as well as download any of the resources.

This study day and now course is designed to enhance your knowledge and practical skills in enhancing the quality of life for patients with dysphagia.

It is aimed at all health care professionals, primarily aimed at Speech & Language Therapists who see adults with dysphagia in their day-to-day practice.

Sessions of the study day

View each session from the day below alongside a summary video.

Access your CPD Personal Reflection Sheet here






Dr Ben Hanson, Senior Lecturer in Engineering University College London


The first talk of the day demonstrated how academia links to clinical practice - how lab based science is applicable to people and has clinical relevance. Rheology, the relationship between pressure and force, can be used to design texture modification strategies and products and contribute to standardisation of these. Thickening agents are of daily use to speech and language therapists and other health professionals; however this talk gave the underpinning engineering knowledge of why they work and how we can control the movement of a bolus and therefore the swallowing process. ‘Apparent viscosity’ was the focus of the presentation- dysphagia products have high apparent viscosity (appear thick but require little force to swallow e.g. mousse) which means the bolus is easier to control and has a slower motion. Studies at University College London have found that individuals perceive level of thickness differently- therefore healthcare professionals may perceive the different stages differently too.


Take Home Message:

There is a wide range of ways of classifying and measuring rheology in practice, from lab work using rheometry, to visual or verbal descriptors such as our current UK National Descriptors, however we need to find a simple, cost-effective standardised way of measuring viscosity that can be used in the clinical world rather than a lab setting.


  • Sensory and rheology: How important are they to thickened drinks and texture modified food?
     
    Dr Ben Hanson, Senior Lecturer in Engineering University College London

Dr Ben Hanson, Senior Lecturer in Engineering University College London


Dr Hanson’s second talk followed on the theme of finding a standardised way of measuring viscosity by outlining the process of development of the International Dysphagia Diet Standardisation Initiative (IDDSI). The aim of IDDSI’s board of directors is to develop a culturally sensitive, age-span framework of terminology and descriptors for texture and fluid modification. Following a systematic review of all thickeners, rheology and dysphagia papers the board looked to find reliable measures of stimulus but found very little consensus. Therefore the IDDSI framework pyramid was developed. The texture modification of food maps clearly to the UK descriptors and explanation was given to how the fluid modification now takes account of naturally thick fluids meaning some changes in terminology for UK health care professionals. The IDDSI flow test was outlined with practical demonstrations in the breaks. The fork test was highlighted by attendees as a top tip of the day- the gap between fork prongs is always approx. 4mm, the size that minced food should be, helpful for use in training other professionals, carers and patients.


Take Home Message:

Both IDDSI and Nestlé Health Science are committed to providing training resources and examples of best practice.


  • IDDSI framework and detailed descriptors: Progress to date
     
    Dr Ben Hanson, Senior Lecturer in Engineering University College London


Dharinee Hansjee, Head of Speech and Language Therapy Lewisham and Greenwich NHS Trust


Dharinee Hansjee, specialist advisor for CQC, outlined the process of completing an inspection to give attendees an insight into how the 5 key domains apply to Speech and language therapy- in particular hydration and nutrition. Dharinee provided examples of the policies or procedures that should be in place to ensure a successful CQC inspection and of course ideal patient care. She also outlined the ways CQC try to gather data through patient and carer observation and interview. Interestingly Dharinee is part of an advisory group for medicines management and dysphagia, and they have developed a care home charter for swallowing and medicines.


Take Home Message:

Good communication and information sharing will lead to better patient care. The patient should be at the centre of decisions and treated as an individual with risk managed appropriate.


  • Sharing best practices: Nutrition and hydration: CQC standards
     
    Dharinee Hansjee, Head of Speech and Language Therapy Lewisham and Greenwich NHS Trust

Rosalyn Davis Dental Program Manager 1000 Lives Improvement, Public Health Wales


Rosalyn’s talk continued the day’s theme of dignity and quality of life. Practical advice was given on how to manage patients with dysphagia who will have reduced oral hygiene due limited self-cleaning within the mouth, particularly relevant due to the link between periodontal disease and systemic disease. There is a large evidence base linking poor oral health and dysphagia that requires ventilation, however all studies have the same solution; remove plaque. Hard hitting case studies from the Francis Report (2013) were provided followed by tips such as ensuring 5000ppm fluoride toothpastes are used for adults with dysphagia using a smear on a dry brush, brushing dentures with soap and water twice a day to avoid abrasion and build-up of plaque and reminding patients with dysphagia that they should inform their dentists of their respective condition. Rosalyn outlined her work on the Welsh Government Programme for oral care and copies of the protocol were provided to attendees.


Take Home Message:

Mouth care risk assessments and care plans should be in place for all patient’s with dysphagia to help reduce the risk of aspiration pneumonia and it is the job of the healthcare professional to ensure these are delivered properly and not as a tick-box exercise.


  • Oral care/oral hygiene protocol
     
    Rosalyn Davis Dental Program Manager 1000 Lives Improvement, Public Health Wales

Alison Smith, Prescribing Support Dietitian Chiltern and Aylesbury Vale Clinical Commissioning Groups


Do we know how much thickener our patients are getting prescribed? Is it enough? These questions spurred reflection for all attendees, as the evidence showed that our patients are not always being prescribed with enough thickening agents. This talk focused on the process of switching from one thickener to another in a CCG and also additional MDT guidance for specific patient groups. Alison reiterated that gum based thickeners are more palatable and actually cost effective; she gave the timeline of her year long project to change to Resource® ThickenUp™ Clear (a gum based thickener) in her area. She inspired attendees to do the same and how they could switch to this product by working with their local acute trust, community trust and CCG. Advice was also given on how to communicate prescribing guidelines to GPs by keeping it-short, sharp and 1 side of A4 paper! The second part of the talk explored how liquid medications do not meet fluid texture recommendations so working with pharmacists is essential. How to meet requirements for those with diabetes and dysphagia in the event of hypoglycaemia in the form of hypo-boxes and glucose syrup was also given as a top tip.


Take Home Message:

MDT collaboration can help instigate change and help other staff members develop their understanding of dysphagia. However, one off training sessions are rarely able to embed change in practice and we should be working with pharmacists and care homes to ensure medications are managed correctly.


  • Sharing best practices: The safe and effective use of thickeners within a CCG
     
    Alison Smith, Prescribing Support Dietitian Chiltern and Aylesbury Vale Clinical Commissioning Groups

Debbie Begent Adult Speech and Language Therapy Service Manager Buckinghamshire Healthcare NHS Trust


Debbie reminded SLTs that the focus should not just be on aspiration but on quality of life and that the implications of making a patient nil by mouth (NBM). She outlined the palliative comfort feeding guidelines developed at Buckinghamshire Healthcare NHS Trust- tailor made care plans for feeding an individual. Following these guidelines a care home can put patients on thickened fluids before assessment to keep their swallow? As safe and comfortable as possible. NBM should only be used when necessary. These were challenging topics for discussion and case studies were used to show how the guidelines can be used in practice and how risk and quality of life can be balanced.


Take Home Message:

Healthcare Professionals need to be more mindful of how seriously and profoundly changes in eating can affect an individual. Could risk be balanced more with quality of life?


  • Quality of life, including risk feeding
     
    Debbie Begent Adult Speech and Language Therapy Service Manager Buckinghamshire Healthcare NHS Trust