Dysphagia is a frequent complication after acute stroke. Published studies have shown that up to 50% of conscious acute stroke patients are found to have swallowing problems, less than half of whom have feeding precautions taken. (Smithard et al 1997)
As the importance of dysphagia management in reducing complications and consequently length of stay (Ellul et al 1997) has been increasingly recognised, and with a faster rate of throughput in the acute sector, referrals to speech and language therapists (SALT’s) have risen exponentially (Ellul et al 94, White et al 93).
Many organisations have developed programmes to improve collaborative working between SLTs and nurses. The aim of these schemes has been to reinforce and extend the role of nurses and other healthcare professionals in screening and managing routine cases. By enabling non-specialist staff to screen and manage the more persistent dysphagia cases, practitioners with higher dysphagia management competence can be used in a more consultative role for the more complex and long-term cases (Davies2002). There is currently, however, no national guidance on developing these programmes, nor on the roles, responsibilities and competencies of the respective professions, leading to considerable variation of practice across the UK.
Development of a competency-based inter-professional consensus on the identification and management of swallowing difficulties, with essential support mechanisms in situ, would facilitate interdisciplinary working and avail the patient of 24 hour monitoring of their swallow function which together with appropriate management would improve the nutritional and psychological status of the patient and thereby facilitate their engagement with the rehabilitation process.
Jane Williams (Portsmouth)
Sue Pownall (Sheffield)
Clare Fuller (Wales)
Mary Heritage (Derby)
Department of Health, National Patient’s Safety Agency, National Stroke Nursing Forum, NHS Modernisation Agency Changing Workforce Programme, North and East Yorkshire Workforce Development Confederation, North Lincolnshire and South Yorkshire Workforce Development Confederation.
Boaden E.E., Davies S.R., Storey L. and Watkins C.L; 2006; Inter-professional Dysphagia Framework on behalf of the National Dysphagia Competence Steering Group.
To develop a framework of competences for practitioners involved in the identification and management of patients with swallowing difficulties. This framework will inform strategies for developing the skills, knowledge and ability of healthcare professionals in the identification and management of swallowing difficulties.
Plan of Investigation
Literature review relating to the identification and management of swallowing difficulties.
Phase 1: Stakeholder interviews scoping existing mechanisms, models of care, clinical and research knowledge, education, training, providers of training and education and characteristics and issues relevant to non-, pre- and post-registered staff. Information will be utilised to construct a survey instrument for exploring issues further and quantification of issues and requirements.
Phase 2: Staff User Survey identifying the range of models of care, working practices, levels of competency/skills required for dysphagia assessment and management, existing training and education (formal and informal) to inform competency framework design. The survey will be sent to clinicians/practitioners and educationalists working in dysphagia-relevant areas in England.
Phase 3: Stakeholder/Expert Focus groups to validate the proposed competency framework, which has been developed from information gained in Phases 1 & 2, to identify issues for implementation, education and training.
The project team will collate all information and produce a revised Competency Framework.
Phase 4: The dysphagia competence framework is being field tested in Portsmouth, Sheffield, Wales and Derby in Stroke, ALD, Mental Health, Paediatric Head and Neck client groups.
During the process of developing the role competencies, draft competencies have been developed in collaboration with Skills for Health, the Sector Skills Council which will be field tested at 10 sites with the client groups; Falls and Stroke, Paediatrics, Mental Health and ALD. They will then be included in the sites of National Workforce Competencies that cover the health workforce.