hard facts to swallow findings of the cavan/ monaghan dysphagia working group pauline ackermann...
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Hard Facts to Swallow
Findings of the Cavan/ Monaghan Dysphagia Working Group
Pauline AckermannSenior Speech and Language Therapist
Gwen RiceDietitian MINDI
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What is Dysphagia?
The process of swallowing is highly complex: preparatory stage, oral stage, pharyngeal stage, oesophageal stage
Thomas (2001) states that dysphagia is a common consequence of many different types of illness or injury resulting in mechanical or neurological impairment of the swallowing process.
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Healthy Ageing- What’s the outcome for this lady if she has Dysphagia?
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Cavan/ Monaghan - North Eastern Area
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Profile of Counties Cavan and Monaghan
Total of 6,498 sq. kilometres. Total population:
2002 344,926 1996 306,155.
+ 38,771 (+12.7%).
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Profile of Counties Cavan and Monaghan
2002 Census:
36,471 people aged 65+, which is a 5% increase on 1996 Census
3,525 people aged 85+ living in this Board, representing a 31% increase since 1996.
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Incidence of Dysphagia
Local Data from Cavan/ MonaghanAcute Hospitals:
12 month period 167 patients admitted with CVA
It is estimated that 45% of thesepatients will have dysphagia
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Incidence of Dysphagia
Over 5 years it is estimated that thisaccounts 375 patients who will have dysphagia as a result of a CVA alone; excluding other conditions such as Parkinson’s Disease, Motor Neuron Disease etc.
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Incidence among older people
Estimates of dysphagia among individuals older that 50 years range from 16 to 22%.
12 to 13% of patients in short-term care hospitals and up to 60% of nursing home occupants have feeding difficulties
Up to 95% of patients with Parkinson’s disease have video fluoroscopic disturbance of deglutition (cited by Thomas, 2001)
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Consequences of no Dysphagia service
Aspiration
Malnutrition
Dehydration
Increased length of hospital stay
Mortality
Vulnerable Patient
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Ambition to Promote Health
Qualified Professional
Diagnosisand
treatment
ADysphagia
Service
BetterPatient
Outcomes
Patient Empowerment
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Health Promotion
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Solution
Dublin Based
Services
ServiceDelivery
InappropriateReferrals
Separate Professionals
NoDysphagia
Service
Formation of the Dysphagia Working Group
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Dysphagia Working Group SurveyCurrent Situation
We Know:
Dysphagia is prevalent in patients with CVA
There is no assessment and treatment services for patients with dysphagia in the Cavan/Monaghan region
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Dysphagia Working Group SurveyCurrent Situation
o Lack of knowledge about nature of dysphagia
Lack of awareness of the impact of dysphagia on patient QOL
Lack of knowledge of the requirements of a dysphagia service
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Dysphagia Questionnaire
Profile of respondent Knowledge of Dysphagia Management of Dysphagia at present:
practice, problems, supports Views, comments, suggestions Separate Questionnaire for Care
Attendants
Two-sided A4 sheet with 13 questions; combination of ticks and comments
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Analysis of Questionnaire
126 completed questionnaires werereturned out of 574
Response rate: 22%.
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Some findings…
Groups represented by respondents
Nursing (Acute)
17%
Medical21%
Nursing (Residential)
21%
Physiotherapy14%
Occupational Therapy
7%
Care attendants
20%
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Problems encountered by medical staff
2
2
1
1
1
5
1
2
3
2
9
1
6
1
1
1
1
3
3
0 1 2 3 4 5 6 7 8 9 10
Feeding diff iculties
Aspiration
Aspiration pneumonia
Choking
Low intake of food
Poor nutrition
? Esophageal w eb
Problem sw allow ing scope
Weight loss
Dehydration
No SLT
Diagnosis by Dr
Inadequate service
Communication problems
Anxiety of patient
Frustration of patient
Lack of follow -up services
No problems
No response
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Current supports for medical staff
8
3
1
1
1
1
1
1
1
1
1
1
2
6
7
0 1 2 3 4 5 6 7 8 9
Dietitian
Medical Assessment
Physiotherapist
Occupational therapist
GPs
Gastroscopes
OPD appts
Referral to CRC
Surgical
NPO
Liquidised food
Radiology
Endoscopy
No supports
No response
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Care attendants
Q3: Do you have any training to help you work with patients with swallowing difficulties?
Yes15%
No85%
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Care attendants
109
32
1
0
2
4
6
8
10
Daily Weekly Monthly Never Varies
Q4b: How often do you come across patients with swallowing difficulties?
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Comments/Suggestions of Dysphagia Service
1
1
1
1
2
2
2
3
3
4
4
4
4
10
10
23
46
Well Wishes!
Reduce the placement of PEG/NG
Funding
High Risk for Patients and Staff
Support Group
"Forgotten Issue" and Poor Service
Inappropriate referral
Under impression that there w as a service
Service Inequality
Videoflouroscopy
Requirement for Community/follow up care
Quality of Life for Patient
Quality of Care to Patient
Protocols/Assessment tools
Multidisciplinary Approach is required
Training and Education
Urgent/Essential Service
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Conclusion
Solution
Separate Professionals
Patient
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Bibliography
Thomas, Briony (2001). Manual of Dietetic Practice – 3rd edition. Blackwell Science Limited.
Cavan/Monaghan Student Induction Pack (2005)
Cavan/ Monaghan Dysphagia Working Group Position Document (unpublished)
North Eastern Health Board (NEHB) High Level Operational Plan 2004