Regulatory Compliance and Guidance on Dysphagia Management
What you need to know
Dysphagia management in health and social care settings, including where care is delivered at home, is a very complex process. Although it does exist, finding an explicit definition of good practice for regulatory compliance and guidance on dysphagia management may not be clear. This lack of clarity does mean the risk to patients and residents with dysphagia is far higher than it should be. Fortunately it appears that this is changing.
What Guidance is There?
Dysphagia will present as a result of a wide variety of medical conditions related to cognitive and physical disease, disability, and trauma, including cancer, dementia, stroke, and developmental impairment.
All providers of services in the health and social care sector have responsibilities regarding the provision of safe and dignified care, which has the management of dysphagia for patients and residents under their charge implicit in the text. See three CQC regulations below:
Regulation 9 – Person Centred Care
Regulation 12 – Safe Care and Treatment
Regulation 14 – Meeting Nutrition and Hydration Needs
Clear and Robust Systems are Needed
There must be robust systems in place throughout the service, embodied diligently by well trained and competent staff that can identify the onset of a swallowing issue, document accurately, refer in line with local protocols, support a multidisciplinary team that ensures safe management through individualised support and environmental integration, and provide sufficient nutrition and hydration that may need to be modified texturally, as set out in clinical recommendations.
Only when this, rather top line, description of care and safeguarding is implemented into the day-to-day culture of care within a service, can those vulnerable to all aspects of risk associated with dysphagia have a chance of the most important aspect: that the provision of such care will meet the needs of the person.
Is There Guidance Specific to Dysphagia Management?
The general regulatory guidance discussed earlier, does now have a clinical framework in the RCSLT’s document the ‘Eating, Drinking and Swallowing Competency Framework’ (EDS), which you can find out more about HERE.
The EDS sets out accessible competencies for people involved in the care of people exposed to the risks of dysphagia and identifies six knowledge and skills levels that would be required for the different roles provided within a multidisciplinary team.
Regulators Want EDS Implemented
Regulatory guidance of good practice now includes the EDS as central to staff training requirements, with the Care Inspectorate explicitly referencing that evidence of training for competency at Level 2 of the RCSLT framework as a minimum requirement.
Regulatory guidance from elsewhere the UK varies and may not be as explicit to point to the EDS document at this stage, however the EDS provides the clinically validated framework for dysphagia management that will gain this support soon.
Concerned NHS Trusts and health and social care providers are actively looking to implement the EDS to mitigate risk to patients and their business. We know this, because we have supported their journey of implementation; the good news is that those that have strengthened their team’s knowledge in this area have reduced risk and improved lives, by making support far more robust.
In many cases of dysphagia, the profound effect of the underlying medical conditions means that there is a constant and ongoing reliance on others to provide safe care, food, and drink in order to thrive.
Well intentioned support from people that are untrained, or unaware of how catastrophic their actions may be, has been the cause of so many preventable deaths.
It appears from recent fines issued to care providers for such incidents, that there is a desire to weight such penalties to drive change and reduce the recurrence of these tragic and avoidable circumstances.
£1,500,000 and £650,000 fines for single incidents send out a clear message.
There is a clinical framework that identifies the training needs of staff providing care for people with dysphagia and regulators are pointing to this framework as the minimum requirements of staff training.
Oak House Kitchen provides all the training you need to implement EDS and IDDSI across your organisation with online resources that are VALIDATED, ACCESSIBLE and COST-EFFECTIVE.
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