What is the Project?
The Dewsbury Feeding and Swallowing Screen is an observational screening tool for nurses, which assesses the patient’s capabilities with not only fluids but also diet. It identifies life-threatening feeding and swallowing problems in a wide variety of patients who may be in either acute or community settings.
The training package, which accompanies it, provides information via two manuals, on the screening tool itself, with a detailed explanation of each test item and some background information on dysphagia. It includes a DVD showing 12 different swallows - some normal and some abnormal - and also 12 completed screening forms. In this way the DVD and completed screening forms can be used both in training staff how to use the screening tool and also in checking their competence.
What is the aim?
The aim of the screening tool is to identify those patients who have a feeding and swallowing problem as promptly as possible and then to refer them to the Speech and Language Therapist so that they can carry out their expert and detailed assessment which then leads to safe management of this high risk problem.
How has this made a difference?
The Dewsbury Feeding and Swallowing Screen identifies feeding and swallowing difficulties in patients with a wide range of diagnoses. Many professionals are focusing their attention on identifying the presence of dysphagia in stroke patients but patients with dementia, Parkinson’s Disease, those with respiratory illnesses like Chronic Obstructive Pulmonary Disease (COPD) etc are no less at risk than the patient with a stroke from this life-threatening problem.
It can be used with stroke patients but it can also be used with non-stroke patients who currently are much less likely to have a routine dysphagia screen which can lead to many of the well documented risk factors for inadequate management of dysphagia listed below:
- Reduced quality of life (Nguyen et al, 2005)
- Anxiety and distress within the family (Choi-Kwon et al, 2005)
- Poor nutrition and weight loss (Wright et al, 2005)
- Poor health (Hudson et al, 2000)
- Developing respiratory infection (Doggett et al, 2001)
- Aspiration (Smithard et al, 1996)
- Hospital admission or extended hospital stay (Low et al, 2001)
- Choking and death (Marik & Kaplan 2003)
Prompt identification of a feeding and swallowing problem in hospital and community settings will much reduce recurrent chest infections, loss of appetite, poor nutrition, weight loss, aspiration and death. In the community there will be less need for hospital admissions and again reduced death rates. It will also reduce the need for recurring visits by the GP prescribing a number of courses of antibiotics. These antibiotics will never cure the patient who is aspirating. They only treat the symptoms for the time they are being administered. Once the course of antibiotics is finished, the symptoms return because the cause of the chest infection has not been identified and treated. Use of the screening tool not only reduces risk for the patient but will also reduce cost and wasted time for the GP.
The Dewsbury Feeding and Swallowing Screen, with its comprehensive test items and its concentration on both diet and fluids make it a very important tool in identifying this life-threatening problem.
How does it work?
The screening tool is to be used on a patient who falls within a recognised remit, the first time food or drink is given to that patient – on admission to the ward, nursing home, palliative day care centre etc so that professionals will identify a problem promptly. This initial identification of a problem is vital in starting the patient on the “dysphagia pathway”. Once this has occurred, referral to the Speech and Language Therapist takes place immediately which results in a detailed assessment and management plan which is then communicated to all who are involved in the care of the patient.
How did it start and how did it evolve?
The original screening tool was written in 2002. The intention was that it was to be introduced on to the wards at Dewsbury and District Hospital initially but it was always the plan that once it was well established in the acute setting, it would be extended into the community.
In 2003 there were various discussions with nursing managers and ward sisters at the hospital regarding its introduction all of which were met with a great deal of enthusiasm. Prior to trialling it, a “Before” questionnaire was given out to nursing staff to record their experience, skills and confidence in dysphagia and at the end of the trial period an “After” questionnaire was completed to ascertain if there had been changes in practice, skills and confidence as a result of using The Dewsbury Feeding and Swallowing Screen - all of which proved positive.
It was initially introduced on to a ward for elderly patients and then later to medical wards, the medical assessment unit and the stroke rehabilitation unit.
It was at this point, looking at the amount of training which had already been done in the acute setting, it became obvious that a different approach needed to be taken in order to introduce it into the community and indeed beyond the Dewsbury District. This is the reason the accompanying training package evolved so that Speech and Language Therapy did not need to be involved in the training of staff or in overseeing that they were competent to use the screening tool all of which had happened when it had been introduced to the wards at Dewsbury and District Hospital. The training package meant that team leaders, nursing home managers, ward managers at other hospitals etc could introduce The Dewsbury Feeding and Swallowing Screen themselves and this is precisely what has happened since the complete package has been on sale through Medipex Ltd on their website. http://www.ennovations.co.uk/medical-training
What has the impact been?
- It has been in use since May 2003 so a great deal of evidence has been collected on how effective the screening tool has been in the prompt identification of feeding and swallowing problems in a wide variety of patients:-
- Use over time has shown that patients are referred to Speech and Language Therapy quickly, referrals are detailed and accurate and patients are not put “Nil by Mouth” needlessly.
- Nurses have reported that without using the screening tool, they would have missed some of the less obvious symptoms of feeding and swallowing difficulties and would have not referred the patient to Speech and Language Therapy. The patient would therefore have remained untreated. There is clear evidence, therefore, from nursing staff, that risks have been reduced.
- As The Dewsbury Feeding and Swallowing Screen assesses capabilities and safety with both food and drink, not just with drinks as is often the case with a lot of screening tools, nurses have been able to start many patients on modified diet and modified consistency fluids rather than putting them “Nil by Mouth”. They have used the information gained through using the screening tool to make these very basic and common sense decisions which through a seven year period has proved to be very successful. Indeed nurses have reported that this has produced a big change in their practice.
- The screening tool is quick and easy to use even for those with little or no experience of feeding and swallowing problems. Experience over the many years it has been in use has shown that even newly qualified nurses with no experience of feeding and swallowing problems and with no dysphagia training have been able to use the screen successfully.
- Two articles written this year, one in The Nursing Times -The Nursing Times 2010 April 20-26; 106(15) 18-20 - and the other in the Speech and Language Therapy publication, The Bulletin, 27 May 2010, 16-17- have produced a great deal of interest from a wide variety of professionals both within the UK and from abroad.
- The training package, with its manuals and DVD provides all the necessary training and checks of staff competence so that the Speech and Language Therapist need not be involved in either training or evaluation of competence. This has meant a great saving in time and cost for the Adult Speech and Language Therapy department. It has also meant that The Dewsbury Feeding and Swallowing Screen has expanded beyond the Dewsbury District and has sold abroad and across the UK.
For more information on this project please contact:
Mariani Tanton
Clinical Lead Adult Speech and Language Therapy / Dysphagia Specialist
Kirklees Community Healthcare Services
01924 816058
mariani.tanton@kirkleeschs.nhs.uk
