Roles and responsibilities

The Medical Practitioner (Senior Doctor/Registrar/GP) is responsible for:

• Ensuring that a referral is made to SLT.
• Ensuring that anticipatory care plans are completed when needed.
• Ensuring that eating and drinking with acknowledged risk guidelines are included in the discharge summary.
• Responsible for completing capacity assessments, as required.
• Making the ultimate decision once the individual is clinically discussed with the MDT and options shared with the individual and family and clearly documenting the decision in the medical notes/GP records.
• Responsible for considering an escalation plan should the individual become unwell as a result of eating and drinking with acknowledged risk.

The Speech and Language Therapist (SLT) is responsible for:

• Conducting a detailed assessment of swallow and make safer swallowing recommendations where possible.
• Facilitating information gathering to contribute towards the completion of a capacity assessment if required.
• Ensuring eating and drinking with acknowledged risk documentation is in place where required.
• Educating the individual, family and carers.
• Informing dietetic colleagues if concerned about an individual’s nutrition and hydration status.
• Discussing the findings of the assessment with the MDT.
• Informing the physiotherapist if required to assist with chest maintenance.
• Liaising with other SLTs re: on-going care.

The Psychologist is responsible for:

• Assisting with capacity assessment.

The Physiotherapist is responsible for:

• Physiotherapy have a role in the management of respiratory health which may or may not follow the aspiration of food or fluids. In the process of respiratory management, the physiotherapist may identify the presence or suspicion of food or fluid in the airway. As such they can play a key role in the early identification of patients where aspiration may be a risk.
• Where there is ongoing involvement with patients with an acknowledged risk, physiotherapists will highlight if any significant changes have been observed.
• Physiotherapists provide specialist advice and interventions regarding positioning in a bed or chair and make recommendations which can reduce the risk of aspiration.

The Occupational Therapist is responsible for:

• Eating and drinking assessments and recommendations for equipment as necessary.
• Assistance with optimal positioning.

The Dietitian is responsible for:

• Support the individual to optimise their nutritional intake.
• Evaluate candidacy of the person for alternative nutrition and hydration options.
• Support other members of the MDT regarding the development and implementation of the individual’s nutrition and hydration care plan.
• Support palliative care regarding eating and drinking at the end of life.

The nurse is responsible for:

• Identify issues around eating and drinking and initiate referral to SLT.
• Ensuring the eating and drinking with acknowledged risk pathway is adhered to, supported and facilitated within the ward environment.
• Ensuring robust oral care.
• Ensuring eating and drinking with acknowledged risk information is transferred to nursing home or care facility on discharge.
• Ensuring appropriate food and drink is ordered/provided in line with SLT recommendations and the person’s wishes.
• Referring the individual to SLT if status changes.

The community nurse is responsible for:

• Highlighting if any concerns regarding eating and drinking with acknowledged risk pathway in community environment.
• Referring the individual to SLT if status changes.
• Community Nurses will develop and review advanced care plans (ACPs).
• Inputting to palliative and end of life care.

The Advanced Nurse Practitioner (ANP) is responsible for:

• Identifying issues around eating and drinking and initiate referral to SLT.
• Ensuring that anticipatory care plans are completed when needed.
• Ensuring the eating and drinking with acknowledged risk pathway is adhered to, supported and facilitated within the ward environment.
• Contribute to gathering information for a capacity assessment.
• Monitor person’s medical status for signs of adverse effects of aspiration.

Palliative care/Hospice are responsible for:

• Ensuring the eating and drinking with acknowledged risk pathway is in place and to facilitate implementation.
• Referring individuals for whom eating and drinking with acknowledged risk is appropriate.
• Referring the individual to SLT if status changes.
• Providing support and education for family and carers around changes to appetite and nutritional requirements at end of life.