Pilot of a Charter to Improve Management of Medicines and Oral Care for Residents with Dysphagia in Care Homes

Abstract

Research in care homes has demonstrated that medication management practices in patients with dysphagia and those receiving medicines covertly may be inappropriate, illegal, and potentially cause harm. This paper presents the results of a feasibility study piloting a resident and healthcare professional best practice charter to improve such practices in care home residents with dysphagia. A charter was developed through a multi-professional expert panel, implemented in one care home, and then piloted in 22 homes in England, Wales, and Northern Ireland. A website was setup and developed iteratively to support the process. Care home staff and residents provided initial feedback on the implementation process and on perceived outcomes six months post implementation. A total of 16 (88.9%) out of 18 respondents from nine homes for six months reported a positive response to the charter. More than 80% of responses regarding the implementation process, impact on staff confidence, and perceived usefulness of the charter were positive. Perceived effectiveness and usefulness could, however, be further improved especially the perceived effect on frequency of medication review, which is reliant on external stakeholder involvement. The charter and supporting website were well received with respondents believing that it was useful, staff showing more confidence, and residents having enhanced care. Approaches to enhancing the charter’s effectiveness were identified.

Dysphagia and Oral Health in Older People

“…Aspiration may be seen following video-fluoroscopy or fiberoptic endoscopic evaluation of swallowing (FEES), but not all people aspirating develop pneumonia [4,33,34]. The diagnosis of aspiration pneumonia is often misdiagnosed with community-acquired pneumonia.…”

“…Swallowing problems, as well as poor oral hygiene, may lead to respiratory infections such as aspiration pneumonia by aspirating gram-negative living microorganisms in the oral cavity [33]. Therefore, improving oral care is essential to reduce the risk of pneumonia [34].…”

Factors that affect health‐care workers’ practices of medication administration to aged care residents with swallowing difficulties: An Australia‐wide survey study

“…Receiving advice from other health‐care professionals was seen as an important support by all respondents. Interventions that have focused on improving multidisciplinary care of patients with swallowing difficulties have proven to have a positive impact on the care of these patients 30,31 . Doctors, speech pathologists and pharmacists, in particular, were the main professionals that health‐care workers relied on for advice.…”

Risk of an Adverse Event in Individuals Who Aspirate: A Review of Current Literature on Host Defenses and Individual Differences

“…When aspiration occurs, individuals with reduced pulmonary function, with respiratory disease, or who are currently smoking have an increased risk of decompensation (Bock et al, 2017;Langmore et al, 1998Langmore et al, , 2002. The risk of an adverse event in individuals with poor pulmonary function is further increased when there is reduced exercise tolerance and poor nutritional status (Abe et al, 2011;Burtin et al, 2009;Kayambu et al, 2013;Morris et al, 2018).…”