Understanding dysphagia screening, triage, and referral processes in the residential aged care setting.

Abstract

Background: Dysphagia in older persons can lead to preventable incidences of choking, aspiration pneumonia, and malnutrition. In Residential Aged Care Facilities (RACFs), it is therefore important that dysphagia identifications are accurate, timely, and contain sufficient information to be triaged. However, there is currently no published data on Australia’s current dysphagia management practices. Aim(s): The aims of this study are to compare best-practice recommendations on dysphagia screening, referral processes, education to staff, and triage timeframes in RACFs with current Australian practices. Method: A scoping literature review sourced evidence-based recommendations and guidelines. A 23-item survey was disseminated to Speech Pathologists via the SPA national e-newsletter and interest groups obtaining quantitative and qualitative information on current dysphagia practices in RACFs. Result(s): 32 publications were reviewed. Literature highlighted the importance of nursing-led dysphagia screening and early referrals. 65 survey responses were obtained across health sectors and levels of rurality. 80% (n=52) of sites serviced did not have formal dysphagia screening. Referrals that included clinically relevant information were rated as being received half of the time or less by 86% (n=56) respondents. Only 24% (n=16) of respondents had formal referral triage timeframes. Response timeframes for referrals describing aspiration or choking ranged from 1-14 days; 2-30 days without signs of aspiration or choking. 70% (n=46) of Speech Pathologists provided in-services to staff, mostly on an ad-hoc basis. Barriers to quality care were communication with facilities, staff education, and funding. Conclusion: Dysphagia screening, referral, and triage practices across Australian RACFs have marked variations. Emerging literature and survey responses suggest a need for increased screening guidelines, referral protocols, and regular nursing staff education.