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

• 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

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

• 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.

• 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.

• 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

• 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 Protocol for Management of Nutrition