Abstract
Introduction
Dysphagia affects a large proportion of patients in hospitals and the community. Poor management of dysphagia results in aspiration pneumonia, malnutrition, and poor quality of life. Management, as recommended by Speech and Language Therapists (SALT), with the strongest evidence base for reducing aspiration pneumonias, is diet modification such as thickened fluids (Rosenvinge S, Starke I. Age and Ageing. 2005;34(6):587-593). Safe management of dysphagia is important discharge, as such this study focused on patients being discharged with fluid thickeners.
Method
We assessed current rates fluid thickeners being correctly prescribed on discharge medications by analysing data sets of patients discharged by the inpatient SALT from January to February 2022; including rejected referrals, deceased patients and discharges without fluid thickeners (n=223). 26 data sets were further analysed, after applying inclusion and exclusion criteria. Data was collected on whether thickeners were prescribed as inpatient, on discharge alongside analysis of nursing notes and SALT plans.
Results
Overall, 69.2% (n=18) of patients had thickeners correctly prescribed on discharge. Of the remaining 30.7% (n=8) without thickeners prescribed on discharge, 87.5% (n=7) of these were also not prescribed as inpatient. Whereas only 9.01% (n=1) of cases had thickeners prescribed inpatient but missed on discharge. 92.31% (n=24) of nursing notes included SALT recommendations and noted that thickeners were being given.
Conclusion
Results highlighted that the burden of administrating thickeners in hospital fell upon the nursing staff who used a communal stock of fluid thickener, regardless of inpatient prescription. A recommendation put forward to doctors, and to be included in SALT plans is to prescribe thickeners on inpatient charts, to reduce chances of missed prescriptions on discharge. Similarly, including SALT recommendations in discharge summaries will aid correct prescribing for patients in their future admissions. Further education and dissemination of the importance of dysphagia management will also be beneficial
Comments
Thickeners
definitely an area of under-recognised risk. Thank you for highlighting, we need to ensure that the whole team appreciate the importance of thickeners and that they are identified and included in discharge summaries (and appropriately asked about on admission)