Dysphagia management is more complex than other Speech and Language interventions

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Dysphagia management is more complex than other
Speech and Language interventions

• Karen Krawczyk
• Speech and Language Therapist

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Complexity of Dysphagia

• Why ?
• Where ?
• Who ?
• What ?
• How?

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7 Segments of the Wheel
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Roles and Responsibilities
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Risk Management
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Decision Making
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Roles and Responsibilities

• Who does
• WHAT
• to
• WHOM
• and
• WHEN?

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Understanding Roles

• Does everyone understand their role in the
  dysphagia pathway?

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Responsibilities

• Who takes responsibility for oral hygiene?
• Wright 2007
• Do we have a responsibility to train others, If
  so, How?
• Miller, Krawczyk 2003

• Who takes responsibility to place the at risk
  patient Nil By Mouth?
• Newton Shale and Hibberd 2003

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Risk Management

• An appropriate balance between risk and safety
  is desirable
• Wynne-Hartley 1991 cited in Parsloe

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National Patient Safety Agency

• Extrinsic factors
• Access to eating and drinking equipment
• Staffing levels
• Staff adherence to plan
• Family adherence to plan
• Additional Risks
• Quality of life / loss dignity
• Injury / discomfort

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Decision making
Williamson 2002 Judgement and decision making
are seen not only as the least visible yet most
important aspects of practice, but are also the
hardest aspects to quantify and measure.
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Decision Making

• This segment is difficult to separate from
• Roles and responsibilities
• Understanding boundaries and duty of care
• Risk management
• Making a risk assessment
• Understanding
• urgency
• impact
• Training
• Having the knowledge, skills and clinical
  experience

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Maturity ContinuumSteven Covey
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Dysphagia is more complex than other SLT
interventions

• More questions
• More evidence
• More uncertainty
• More Risk
• More People

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References

• Krawczyk K. 2005 Dysphagia combining conflicting
  models? Speech and language Therapy Issues in
  professional Practice chapter 8 p131-154 Whurr
  publishers London
• Wright L. 2007 Practising what we preach. RCSLT
  Bulletin p14-15
• Building a health service fit for the future a
  national framework for service change in the NHS
  in Scotland ("The Kerr Report")Scottish
  Executive, 2005 www.scotland.gov.uk/Resource/Doc/
  924/0012112.pdf
• Newton A, Shale A, Hibberd J Swallowing a risky
  business RCSLT Bulletin 2003 March p6-7
• http//course1.winona.edu/lgray/el620/Chapter6Lead
  /matcont.htm