SIPS Project Strategy for an Integrated Preventative pathway for Swallowing difficulties in Care...
-
Upload
morgan-lloyd -
Category
Documents
-
view
217 -
download
2
Transcript of SIPS Project Strategy for an Integrated Preventative pathway for Swallowing difficulties in Care...
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
Thank you !