React Homecare
CC100 – Choking Policy and Procedure
1. Purpose
1.1 To enable React Homecare to deliver services that reduce the risk of choking as part of safe and appropriate care.
1.2 To ensure that there is a framework for the identification and assessment of Service Users with dysphagia or those at risk of choking.
2. Scope
2.1 The following roles may be affected by this policy:
o All staff
2.2 The following service users may be affected by this policy:
o Service Users
2.3 The following stakeholders may be affected by this policy:
o Family
o Advocates
o Commissioners
o External health professionals
o Local Authority
o NHS
3. Objectives
3.1 React Homecare will provide a safe, effective and responsive service to Service Users presenting with eating, drinking or swallowing difficulties and will ensure that assessments are in place that accurately determine the level of dysphagia that they have as well as the associated risks.
3.2 React Homecare will have an individual management plan that is regularly monitored and updated, with Service User involvement to allow the best experience of eating and drinking as possible, whilst keeping risks to a minimum.
4. Policy
4.1 React Homecare recognises that reducing the risk of choking and improving the safety of Service Users who have swallowing, eating and drinking difficulties is an essential part of the safe and appropriate care that meets individual needs and supports their rights.
4.2 React Homecare will ensure that strategies are in place to identify people at risk of choking. This includes access to dental and medical checks.
4.3 React Homecare will ensure that staff are adequately trained to address choking risks, have knowledge of dealing with choking incidents and are able to make a first aid response if the person chokes. All staff will also adhere to this policy and procedure to support the safety and wellbeing of those Service Users with an identified increased risk of choking.
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4.4 React Homecare will ensure that managers understand the importance of escalating concerns to the Service User's GP to obtain Speech and Language Therapist (SLT) and Dietician assessments for those Service Users who have chewing or swallowing difficulties and any special nutritional requirements.
4.5 React Homecare will ensure that all individuals with dysphagia have an individual management Care Plan developed with specialist professionals. This will be regularly monitored and updated with the risks reassessed as the needs of the Service User change.
4.6 In order to improve the safety of adults who have dysphagia or are at risk of choking, accessible information on the assessment and dysphagia management will be made available to Service Users, their carers and families, including advice on the preparation of suitable food and fluids.
4.7 Incident reporting systems must be in place for the accurate recording, reporting and actioning of choking incidents, or potential choking incidents for all people with dysphagia or who are at risk of choking.
4.8 Staff working with Service Users with dysphagia or who are at risk of choking, need to be aware that a change in a Service User’s medication can produce side effects that may worsen their condition. The implications of any such change will be first clarified with a GP and pharmacist.
4.9 Local liaison and care transfer procedures will be in place between React Homecare, the hospital and community services.
5. Procedure
5.1 Assessment Documentation
o Before starting a care service, the assessment documentation will identify if a Service User is at risk. This will be recorded, and the relevant staff informed. Preparations will be put in place before the service starts, such as informing staff of the need for an altered diet
o A risk assessment must be carried out and included in a Care Plan with the appropriate course of action
o Staff must have systems in place to know which Service Users are at high risk of choking
5.2 Risk Assessment Procedure
As part of the risk assessment procedure, an assessment will be made to indicate the risk of choking and whether a referral to a Speech and Language Therapist (SLT) via the GP for swallowing assessment or further discussion with a health professional is required, if this has not already taken place.
Staff must gain consent, wherever possible, before any assessment is undertaken. When a Service User is unable to give informed consent, best interest decisions are made using the guidelines in the Mental Capacity Act and best interest guidance.
A choking risk assessment and reassessment must be undertaken:
o 6-monthly, or every time there is concern about the Service User's swallowing ability or their eating and drinking
o If there has been a significant change in the Service User's level of need which might increase their risk of choking
o If the Service User's choking risk increases as a result of their behaviour
Service Users who exhibit behaviour that may challenge, such as putting nonfood items into their mouth or who swallow non-food items which increases their risk of choking, will have a multidisciplinary team assessment. Clear guidelines must be in place to support the strategies that staff are required to use to manage the risk.
5.3 Medication
When there is an identified choking risk, a review of oral medication will be undertaken and, for all medicines that need to be continued, an alternative dietary route must be considered. Staff will not crush or hide medication (covert medication) without prior approval from the prescriber together with clear, documented authorisation in place. Staff will not hide medication (covert) without the Service User's consent or, where a Service User lacks capacity, without a documented multidisciplinary decision involving the GP. Staff will refer to CM40 - Covert Medication Policy and Procedure at React Homecare for further information.
5.4 Healthcare Professional Input
It is acknowledged that an SLT may not be able to review Service Users swiftly and therefore, whilst awaiting review, Care Workers will maintain a food diary and seek telephone support and advice from the SLT in the first instance.
The SLT, when required, will complete a comprehensive assessment that will investigate potential causes of dysphagia and choking and assess eating, drinking and swallowing skills. Recommendations will then be made to staff which aim to manage and reduce the risk whenever possible and will include:
o The Service User's requirements
o Safe swallowing management
o Assessment of risk from cognitive factors that could compromise the safety of the swallowing process
React Homecare must ensure that SLT recommendations are followed and recorded in the Service User's Care Plan.
Where a Service User chooses not to follow recommended advice and this is based on an informed decision, this will be respected, recorded and the SLT informed. If a Service User is deemed to lack capacity to make an informed decision, a best interest decision will be made in accordance with the Mental Capacity Act as part of a multidisciplinary decision.
5.5
Care Plans
Where a risk of choking has been identified, the Care Plan must include what the concern is and what needs to be done so that the plan clearly indicates what support will be given to the Service User to eat and drink safely and minimise the risk of choking.
The development of individual Care Plans will, wherever possible, involve the Service User and those who provide care. Individual needs and requirements must be accurately documented in the Care Plan.
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Care Plans will be reviewed in accordance with the Care Planning policies and procedures. Assessments and decisions must be reviewed following any change or deterioration in health or behaviour.
In addition to regular reviews, staff will remain vigilant and responsive to individual needs on a daily basis.
Daily records will indicate that the appropriate foods have been given according to advice from the SLT.
5.6 Care Plans Must:
o Give clear information to Care Workers on how to manage the choking risk and make meals safe and enjoyable
o Include recommendations on fluid and food consistencies, recommended position, equipment and the level of assistance required for the Service User
o Include information on the Service User's food and drink preference where applicable. However, it is important to remember that foods need to be given in accordance with food modification and texture advice
o Follow the principles of the Mental Capacity Act, and where decisions are made on behalf of the Service User, they need to be in their best interests
o Ensure that dignity, privacy and respect are maintained at all times
5.7 Mealtimes
Mealtimes will be recognised as an opportunity for reassessing risk in a Service User who has been identified as being at an increased risk of choking. Staff will have the skills to support individuals at risk of choking with their eating and d drinking by:
o Having adequate skills in making mealtimes as safe and pleasurable as possible, including communication at mealtimes
o Ensuring that Service Users are positioned correctly and safely when eating or drinking
o Being able to prepare and present food and drink to the person in a way that follows with their documented recommendations
o Ensuring that any foods brought in match the appropriate consistency
o Being aware of foods with a high choking risk
o Maintaining the Service User's dignity whilst eating and promoting independence as far as possible
o Ensuring that visits are scheduled to allow enough time for eating and drinking so the Service User does not feel rushed
5.8 The presence of staff at mealtimes is critical for observation and to reduce the risk of any unobserved incident of choking. Mealtimes are also a good time to build relations with Service Users and to more fully understand their behaviour, motivations and specific dietary requirements.
5.9 Staff will recognise early, the signs and symptoms that may indicate a risk of choking:
o Coughing during or immediately after eating or drinking
o Wet vocalisation after drinking
o Change of skin colour
o Watering eyes
o Refusal of food before or during a meal
o Increased anxiety when eating or drinking
o Behavioural difficulties when eating or drinking
Care Workers must report to React Homecare immediately if they are concerned that any of the above symptoms are present.
5.10
Modified Diets and Thickened Fluids
o Where diet and fluids are modified on the instruction of the SLT or other specialist healthcare professionals, staff must follow their instructions
o Where fluids are required to be modified, staff must follow the manufacturer's guidance to obtain the correct consistency
o Staff must ensure that prescribed thickener products are kept safely and secured away from Service Users who are at risk of ingesting them. Staff are responsible for maintaining sufficient stock levels of thickener
o Robust procedures will be in place to ensure that all staff are aware when Service Users require a modified diet or fluid consistency, and this must be communicated to all staff involved in the care of the Service User
o React Homecare will follow BDA guidance and the IDDSI framework in accordance with their local dietician and SALT (Speech and Language Therapy) recommendations and staff can refer to the Further Reading section for best practice recommendations
5.11
Transfer of Care
If a Service User is transferred to another health and social care provider for any reason (e.g. hospital admission), eating and drinking needs will be communicated.
5.12
Choking Procedure
o Choking can happen at any time, to anyone and therefore any member of the team at React Homecare, regardless of role, must understand how to recognise a choking event and know how to respond
o If choking occurs, all staff must follow the public advice accessible via the NHS Website or the Resuscitation Council Website
o If the person's airway is still blocked after trying back blows and abdominal thrusts, the member of staff must summon help immediately by calling 999 and follow the advice of the emergency services whilst waiting for the ambulance to arrive
o When safe to do so, the choking episode/incident will be reported on an accident/incident form and documented in the Care Plan in accordance with AB19 - Record Keeping Policy and Procedure The frequency and severity of events will be monitored and strategies in the Care Plan will be reviewed
o All choking incidents (whether there are serious consequences or not) must be reported
5.13
Training and Education
Every member of staff, regardless of role, will have a public level of awareness for recognising a choking event and knowing how to respond. It is recommended that practice scenarios and drills take place to maintain that awareness and the responsiveness of everyone.
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In order to safely meet the needs of Service Users in relation to choking, staff must have knowledge and competence in the following:
o Recognition and assessment of risk and delivery of safe care in line with the agreed Care Plan
o Understand the individualised support needed to reduce their risk of choking when eating or drinking and provide the required support to promote the Service User's safety
o It is the responsibility of React Homecare to ensure that all staff are trained to meet the needs of Service Users who may present with a risk of choking
o Staff must be familiar with this choking policy
o Staff will be aware that chronic symptoms of dysphagia include chest infections, malnutrition and dehydration
o Relevant staff must be able to identify and manage Service Users at risk of choking or with dysphagia and ensure appropriate management
o Staff supporting Service Users identified as at risk of choking must have the first aid training to be able to provide emergency aid response to choking. They will also have access to the latest resuscitation guidance
o Being involved in the Care Plan process for people at risk of choking wherever possible
o Being aware of the consequences of not following an agreed eating and drinking plan
o Completing a Choking Risk Assessment any time a new or increased risk of choking is identified
o Identifying support services and the referral process
5.14 Audit and Review
o All incidents, accidents and near misses will be reviewed by the Registered Manager and investigated as necessary. The Registered Manager will discuss any choking events with staff and review associated risk assessments and Care Plans to ensure that they remain robust and aim to reduce the risk of events occurring again
o The Registered Manager or delegated other will assess the knowledge of staff in the event of a choking episode to provide assurance that, in the event of an emergency response, staff are competent and current with practice
o Care Plans and risk assessment audits will include the risk of choking. Any identified themes and trends will be addressed and changes in practice embedded
o The Registered Manager will seek feedback and support from the SLT in relation to ongoing quality improvement
6. Definitions
6.1 Choking
o The inability to breathe because the trachea is blocked, constricted or swollen shut
6.2 Dysphagia
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o A medical term used to refer to difficulty and discomfort in swallowing. It is a serious problem that can lead to malnutrition, dehydration, choking and aspiration pneumonia
6.3 Aspiration
o The inhalation of food/drink particles into lungs
6.4 Speech and Language Therapist (SLT)
o A health professional who provides life-improving treatment, support and care for children and adults who have difficulties with communication, eating, drinking or swallowing
6.5 Nutritional Requirement
o The amount of nutrients needed to maintain health and reduce the risk of diet-related diseases
6.6 The Mental Capacity Act 2005
o Primary legislation designed to support and enhance the lives of people who are assessed as not having capacity to make decisions themselves
7. Key Facts – Professionals
Professionals providing this service should be aware of the following:
Reducing the risk of choking and improving the safety of individuals who have swallowing, eating and drinking difficulties is an essential part of safe and appropriate care that meets individual needs and supports their rights
To reduce the risk of aspiration and choking whilst meeting the nutrition and hydration needs of Service Users, a Choking Risk Assessment will be undertaken, and the recommended action followed
Where Service Users are identified as at risk of choking, a Care Plan will clearly indicate what support will be given to the Service User to eat and drink safely and minimise the risk of choking
Staff will be aware of Service Users at high risk of choking and understand the individualised support needed to reduce their risk of choking when eating or drinking, including keeping records indicating the appropriate foods and drinks according to advice from health professionals
Any choking incident (whether there are serious consequences or not) will be reported
The involvement of external professionals, such as Speech and Language Therapists (SLTs), is paramount in the support of individuals identified as at risk of choking
8. Key Facts – People affected by the Service
People affected by this service should be aware of the following:
You will have your choking risks assessed to ensure that the risk of choking when eating and drinking is reduced and that your individual nutrition and hydration needs are met
To reduce the risk of choking whilst meeting your nutrition and hydration needs, a Choking Risk Assessment will be undertaken, and the recommended action followed
Where you are identified as at risk of choking, a Care Plan will clearly indicate what support you must be given to eat and drink safely and minimise the risk of choking
Care and support surrounding you as a person at risk of choking is an essential part of safe and appropriate care that meets your individual needs and supports your rights
Any choking incident (whether there are serious consequences or not) will be reported
9. Outstanding Practice
To be ‘outstanding’ in this policy area you could provide evidence that:
The local SLT team reports excellent relationships with the service and reports that the service clearly follows their advice
Staff are clear on the issues surrounding choking, have received training and are confident in their own knowledge to manage situations when they arise
People using services report that staff are extremely knowledgeable and act in a clear, decisive and effective way when dealing with a choking incident
Documentation surrounding choking is very clear and updated regularly, whilst the service is highly transparent in the management of choking incidents
Date Policy Reviewed
20th July 2017
20th December 2018
20th December 2019
19th October 2020
5th January 2021
29.11.24
Signature of Reviewer
D Woolley
D Woolley
D Woolley
D Woolley
D Woolley
C Elllis
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