DYS1 Undertake protocol-guided swallow screening / assessments

Overview

This standard is about the initial screening and/or assessment of individuals who present with difficulties swallowing liquids (including saliva) and solids. It covers recognition and identification of swallowing difficulties and implementation of protocol-guided actions. The practitioner will refer individuals with swallowing difficulties for a comprehensive dysphagia assessment using processes, and within timescales, specified in local protocols. It is essential that the potential risks presented by the problems associated with dysphagia are recognised and action taken with the appropriate degree of urgency. This standard is for practitioners who are not specialists in dysphagia, but who have appropriate training and responsibility for identifying individuals with swallowing difficulties. This includes practitioners who work across primary and secondary health care, social services and education. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. local policies which affect your work practice in relation to working with individuals who may require a basic swallow screen/assessment
2. your responsibilities under the current European, national and local legislation and policies on your actions within the care environment
3. the policies and guidance which clarify your scope of practice
4. the impact of ethical issues on your role and the service you provide
5. the scope of your practice and level of competence in relation to the screening/assessment of swallowing difficulties
6. the importance of applying standard precautions and health and safety measures, and the potential consequences of poor practice
7. legislation and legal processes relating to consent
8. the principles of valid consent, including implied consent and expressed consent
9. the process and timing for obtaining valid consent
10. the relevant national and organisational policies and guidelines on consent, including methods to be used to achieve consent where the individual is not able to give their informed consent
11. the organisational policy and practices with regard to the keeping and sharing of clinical records, recording information and maintaining confidentiality
12. how to adapt communication styles in ways which are appropriate to different people e.g. age, culture, language or communication difficulties
13. the ways in which carers should be involved in communication in order to deliver the most effective outcome for the individual
14. the basic anatomy and physiology of swallowing including:
1. anatomical structures involved in the swallowing process
2. physiology of normal swallowing
3. development of swallow function
4. effects of aging on swallowing
15. the main clinical causes of dysphagia
16. the sorts of issues and risk that can arise with dysphagia
17. the importance of following swallow screening/ assessment protocols exactly as specified, and the potential effects of not doing so
18. how the environment may affect the individual’s swallow function
19. how an individual’s medical and physical state may impact on their ability to swallow, in terms of:
1. sensory impairment
2. loss of bodily function
3. loss of cognition
20. the psychological and emotional impact of swallowing and/or feeding difficulties on the individual and their carers
21. how the support required by the individual affects the assessment outcome
22. the actions you should take if adverse issues and risks emerge as a result of the assessment process
23. acute signs of aspiration
24. the sorts of secondary difficulties e.g. compromised nutrition and hydration, difficulties swallowing medicines, that can arise in individuals suffering from dysphagia and how to recognise their emergence
25. nutritional risk, nutritional screening procedures, and the actions you should take in response to different screening outcomes
26. the role of other health and social care practitioners and how they can contribute to the assessment, treatment and care of individuals with dysphagia
27. referral processes within the multi-disciplinary team
28. local services, agencies and community resources that may be relevant to the types of individuals with whom you work, and how to access these
29. local protocols for the subsequent actions which may be necessary given different outcomes
30. the information that should be recorded and the importance of doing this contemporaneously
31. organisational record keeping practices and procedures in relation to protocol-guided swallow screen/assessments.

Performance Criteria

You must be able to do the following:

1. identify individuals for protocol-guided swallow screening/assessment according to national and local criteria
2. establish any specific requirements which will need to be taken into account during the protocol-guided swallow screening/assessment from available information
3. obtain further information if the initial data is insufficient for safe and effective screening/assessment to be undertaken
4. confirm arrangements for the protocol-guided swallow screening/assessment with the individual, the carers they specify, and relevant members of the care team
5. ensure the environment is as conducive as possible to effective swallow screening/assessment
6. apply standard precautions for infection control any other relevant health and safety measures
7. explain the screening/assessment process and any potential outcomes to the individual and carers
8. obtain the valid consent of the individual for the screening/assessment and the information which may be passed to others
9. conduct the protocol-guided swallow screening/assessment according to locally agreed protocols using standardised documentation
10. provide the individual with sufficient time, support and encouragement to contribute to their swallow screening/assessment
11. stop the swallow screening/assessment if any adverse situation occurs
12. seek assistance from an appropriate person as soon as possible when there are any problems with the protocol-guided swallow screening/assessment
13. carry out nutritional screening according to local guidelines
14. evaluate all information from the protocol-guided screening/assessment to identify potential outcomes
15. agree the actions to be taken with the individual and carers based on the results of the swallow screening/assessment
16. provide accurate and prompt feedback to members of the care team to ensure effective care management
17. keep accurate, complete and legible records of the protocol-guided swallow screening/assessment using the appropriate documentation

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning