Authors (including presenting author) :
Chan YH (1)(2), Leung CK (1), Mak LS (1), Au SM (1)
Affiliation :
(1) Geriatric Medical Unit, Grantham Hospital, (2) Tuberculosis and Chest Medical Unit, Grantham Hospital
Introduction :
Dysphagia or difficulty swallowing is a common problem in the elderly. If dysphagia is not detected early and treated, it can cause life-threatening complications aspiration pneumonia. A nurse-speech therapist (ST) collaboration program has been implemented in Geriatric medical unit (GMU) , Grantham Hospital (GH) to early detected patients with swallowing problem since 2005.
Objectives :
To report on the Nurse-Speech Therapist collaboration in early detection of dysphagia
Methodology :
Retrospective study of patients in GMU, GH from Oct 2007 to Oct 2018.
The effectiveness of Nurse ST collaboration pre-feeding screening program
Result & Outcome :
Two Tiers Pre-feeding screening tools
There are 3 exclusive criteria to perform Pre-feeding assessment, Tube feeding, speech therapist assessed already in other hospital and Patient was Nil per oral (NPO).
All GMU Patients (not fall in exclusive criteria) are subjected to a Swallowing assessment part A by nurse on admission. 4 assessment items included consciousness level, tongue movement, coughing and voice. Patient was allowed to eat with caution when passed in Part A. (First row of Diagram 1) Patient would then be further assessed by Swallowing Assessment Part B (Oximeter monitoring with thicken liquid trial) if Patient failed in the Part A screening whose was noted, (Second row of Diagram 1) 1. Stupor consciousness or
2. Limited or sluggish tongue movement or
3. Weak cough or
4. Weak or hoarse voice. All patients would be referred to ST assessment after Form B assessment or clinically indicated, refer to “Referral criteria for ST assessment on swallowing in GH” regardless Part A A total of 12785 patients admitted to GMU during this period 9628 (75.3%) patients were assessed by Part A. 8895 (92.4%) patients passed the Part A Swallowing assessment, and allowed eat with caution. (3819 Passed patients refer ST after physician assessment, 1041 27% patients required thickener with liquids.) 701 (7.3%) patients failed in Part A Swallowing assessment subsequently proceed to Part B swallowing assessment. 313 patients passed Part B assessment with ST referred, 55(17%) required thickener with liquid. 388 patients failed Part B with ST referred and 266(61%) required thickener with liquid. 32 (0.3%) patients Failed in Part A screening, required to be kept NPO and referred physicians/+/-ST for assessment and management. 28 cases seen by ST and 22 (87%) patients required thickener with liquid. 16 cases developed aspiration pneumonia during this period.
Co-location with:
