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Pushing the boundaries: SLTAs and Patients with Dysphagia

Pushing the boundaries: SLTAs and Patients with Dysphagia. Elizabeth Boaden Head of Adult Speech and Language Therapy Services Central Lancashire NHS. Pushing the boundaries. Format. Short presentation Interactive discussion Summary. Background.

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Pushing the boundaries: SLTAs and Patients with Dysphagia

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  1. Pushing the boundaries: SLTAs and Patients with Dysphagia Elizabeth Boaden Head of Adult Speech and Language Therapy Services Central Lancashire NHS

  2. Pushing the boundaries

  3. Format • Short presentation • Interactive discussion • Summary

  4. Background • no national inter-professional approach to competence frameworks • no inter-professional consensus • no endorsement from professional bodies • no role definition/responsibility • no definition of competence against which people can be assessed • no requisite body of knowledge • no common language

  5. Dysphagia competence frameworks A number of frameworks had been developed using a range of approaches: • Local - to meet local need • National - to meet government guidelines • Profession specific competencies • Staff (grades/groups) specific

  6. Perhaps the most dangerous assumption in the professions is that being qualified implies that one is competent. (Eraut: Learning in Health and Social Care 2003)

  7. Remit… Identify: • levels of dysphagia competence regardless of profession/qualifications • underpinning knowledge and skills • competencies pertinent to all dysphagia client groups • competencies based on professional consensus • user/carer views

  8. No remit to… • Identify which professional groups should perform at each level • Promote specific assessments or therapeutic approaches • Specify intervention/management options • Dictate service delivery or training models • Recommend training courses

  9. IDF: Phases of development • Phase 1: Review of literature 20 semi-structured interviews Staff User Survey Instrument (SUSI) • Phase 2: Disseminated SUSI developed draft competences (SfH) • Phase 3: Consultation Stage (76 charities,expert advisors) • Phase 4: Modified competences Developed role descriptors • Phase 5: Field Testing (competences (SfH)/ IDF) • Phase 6: Professional endorsement

  10. Interview quotes ‘People should be having their swallow assessed in A&E, not waiting 7,8,9,10,hours on a trolley without a drink’ ‘I wish there wasn’t a postcode lottery going on out there whether a child gets access to a speech therapist trained in paediatric dysphagia is a lottery’

  11. ‘It was his second stroke wasn’t it and he had difficulty swallowing, erm, he came in and they kept giving him drinks and giving him things to eat and I kept on saying ,’but my dad can’t swallow, he’s aspirating’ and in the end he got aspiration and and he died as a result of --- . That was on the death certificate --- Nobody listened, they carried on giving him diet and fluids even though he was coughing and he was blue, carried on doing that for four days’

  12. ‘She has quite a healthy cocktail of medication that she takes daily that she wouldn’t have any access to at all as some of it’s steroids, some of it’s Warfarin. I know she’d be going well off the boil by 48 hours because she’d be withdrawing from her Prozac and God knows what else at the same time…… but I think that no-one else would probably consider that in a hospital environment, it’s only my mum, she’s not a person, she’s a patient.’

  13. ‘It’s actually quite frightening feeding somebody that’s coughing ……. and people avoid feeding people…... they lose weight you know , just because people are avoiding them.’

  14. Phase 1: Staff User Survey Instrument (SUSI) • Phase 2: Disseminated SUSI developed draft competences (SfH) • Phase 3: Consultation Stage (76 charities,expert advisors) • Phase 4: Modified competences Developed role descriptors • Phase 5: Field Testing (competences (SfH)/ IDF) • Phase 6: Professional endorsement

  15. IDF 6. Endorsement from professional bodies: • NHS Changing Workforce Development Programme (DH) • National Patient Safety Agency (NPSA) • Skills for Health • Users, carers, consumer organisations • Royal College of Physicians (RCP) • Royal College of Speech and Language Therapists (RCSLT) • Royal College of Nursing (RCN) • British Dietetic Association (BDA)

  16. SfH competences Development of SfH competences: • Dys 1 – Undertake protocol-guided swallowing assessments • Dys 2 – Undertake a comprehensive dysphagia assessment • Dys 3 – Undertake a specialist dysphagia assessment • Dys 4 – Develop a dysphagia care plan

  17. IDF role descriptors • Awareness: Aware of the presenting signs and symptoms of dysphagia and refer • Assistant: Contributes to the implementation and review of dysphagia management plan • Foundation: Implements protocol-guided assessment and management • Specialist: Undertakes comprehensive assessment and management • Consultant: Undertakes expert assessment and management of complex or co-existing difficulties with a responsibility for policy development and/or consultative opinions

  18. Patient pathway: Where does the SLTA fit? • Patient ill/unconscious • Ambulance call (Aw) • Ambulance journey (Aw) • Medical assessment unit (F) • (Acute medical ward) (Aw) (F) • Stroke Unit (Aw) (As) (F) (S) • Rehabilitation unit (Aw) (As) (F) (S) • Intermediate care (Aw) (As) (F) (S) • Day Hospital (Aw) (As) (F) (S) • Home (As) /Nursing home (F)

  19. Patient pathway: Where does the SLTA fit? • Child not eating in school (Aw) (As) (F) • Volunteer (Aw) (As) • Teacher (Aw) (As) (F) • Parents (Aw) (As) • GP (Aw) • Consultant (Aw) (F) • Speech & Language Therapist (S) (C) • Videofluoroscopy (S) (C) • Parents, carers, school (Aw) (As) (F)

  20. How many people work within a service that provides a service to dysphagic individuals? • How many people work with dysphagic individuals? • What client group do you work with? • Preschool • Paediatrics • ALD • Adults • What location do you work in? • How many people are familiar with the IDF?

  21. SLTA role in dysphagia:Implementation of IDF • Which level most describes your role? • Identify the competencies that you feel you have. • Identify the competencies that require further training. • Identify level of training required by different people/professionals in your team • Discussion within your team regarding appropriate implementation/training • Identified the role in your job description & KSF? • How can you use the IDF to support you in your role?

  22. Summary • Consensus document • Defines the competencies (skills and under-pinning knowledge) required to work in dysphagia at different levels according to job description • Linked to the SfH competence units • Linked to KSF • Not prescriptive: Allows local implementation • Allows extension of role according to job requirements • Allows development of an inter-professional dysphagia service

  23. IDF www.uclan.ac.uk/facs/health/research/groups/stroke/recently%20completed%20projects/dysphagia/htm SfH www. skillsforhealth.org Thank you

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