Pushing the boundaries: SLTAs and Patients with Dysphagia

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

• Short presentation
• Interactive discussion
• Summary

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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

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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

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• 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)

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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

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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

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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

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Interview quotes

• People should be having their swallow assessed
  in AE, not waiting 7,8,9,10,hours on a trolley
  without a drink
• I wish there wasnt a postcode lottery going on
  out there whether a child gets access to a speech
  therapist trained in paediatric dysphagia is a
  lottery

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• It was his second stroke wasnt 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 cant
  swallow, hes 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

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She has quite a healthy cocktail of medication
that she takes daily that she wouldnt have any
access to at all as some of its steroids, some
of its Warfarin. I know shed be going well off
the boil by 48 hours because shed 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,
its only my mum, shes not a person, shes a
patient.
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• Its actually quite frightening feeding
  somebody thats coughing .
• and people avoid feeding people...
• they lose weight you know , just because people
  are avoiding them.

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• 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

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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)

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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

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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

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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)

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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)

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• 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?

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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?

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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

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• IDF
• www.uclan.ac.uk/facs/health/research/groups/strok
  e/recently20completed20projects/dysphagia/htm
• SfH
• www. skillsforhealth.org
• Thank you