Dysphagia / stroke swallowing problems (assess within 4 hours) (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Any patient with a new onset swallowing difficulty should be referred to a Speech & Language Therapist for assessment Hospital admission should be considered. All patients will have a Dysphagia Management Plan which will provide information and advice to patients, their families and other health professionals The local policy for the management of dysphagia should be referred to if no SLT is available.

The aim of intervention is to minimise complications and to establish a method of feeding that is acceptable to the patient and which allows for adequate intake while minimising the risk of aspiration and choking. Every patient should be regularly reviewed.  This is necessary to monitor improvements and change of management requirements.  Refer to Multi-Disciplinary Care Pathway and Protocols for further information.

For information or advice, please contact Speech and Language Therapy (01463 705424) or Stroke Coordinator (01463 704086)

To determine if swallowing is a problem

  • All patients should be screened for swallow problems within 4hours of admission.
  • This should be done using the Water Swallow Test (see Box 2) and the outcome recorded in the patients notes.
  • The screening will be carried out by an appropriately trained health care professional
  • An appropriately trained staff member will have recently been trained in the procedure by a Speech and Language Therapist or be competent in swallow screening.

Note: Training is delivered by an SLT or by working through the Swallow Safely Interactive Learning Pack

Screening Procedure for Swallowing

  1. Refer to Stroke & TIA Swallow Screening Assessment form (NHS Highland Intranet access required)
  2. Typically, Screening Procedure should include:
    • Initial observations level of consciousness
    • Observations of the degree of postural control
  3. If patient is able to co-operate and be supported in an upright position:
    • Further observations of oral hygiene
    • Observations of control of oral secretions
    • Then, if appropriate, a water swallow test
  4. Patients failing the water swallow test should be referred to SLT for a full bedside assessment.
  5. Medics and pharmacist should be contacted for medication review / alternative route prescribing
  6. Record result and time of the swallow screen in the patient's record

If difficulties observed with swallowing an initial assessment is required by SLT

  • An initial assessment will ideally be carried out within 24 hrs of receipt of referral and no longer than 48hrs
  • Assessment results and recommendations will be documented
  • A Management Plan will be drawn up in consultation with the patient and the multi-disciplinary team
  • The plan will be in an agreed format and be kept by patient bedside.

Management Recommendations by SLT for safe swallowing

  • Following initial assessment recommendations will typically include:
    - Nil by mouth
    - Postural adjustments
    - Consistency adjustments
    - Strategies for safer swallowing
    - Specific exercises
    - Advice & Education
  • Ward staff will be responsible for implementing recommendations and for monitoring
  • If nutritional risk identified refer to protocol for Management of Nutrition.

Further Assessment

  • Video Fluoroscopy or Nasendoscopy may be carried out at Raigmore Hospital, at the discretion of SLT
  • Referrals / Enquiries should be made to Raigmore SLT Dept: Tel: 01463 705424 or to the local community hospital SLT Dept

Follow up of transfer of care

  • Patients will be reviewed regularly and the management plan will be updated as appropriate
  • All Dysphagia Management Plans should be sent with the patient when transferred to another Care Setting
  • The management plan should be transferred to appropriate staff who should ensure compliance
  • For further information refer to Pathway and Protocol for AHPs.

Refer to dietitian

Refer to Protocol for Management of Nutrition

Editorial Information

Last reviewed: 31/12/2021

Next review date: 31/12/2024

Author(s): Stroke and Rehab Department .

Approved By: TAM subgroup of ADTC

Reviewer name(s): L Campbell, Stroke Co-ordinator.

Document Id: TAM397