Improving communication of safe eating and drinking in dysphagia management: a cyclic approach to improving healthcare.

Abstract

Background: In response to adverse choking events across the state’s hospital networks, Safer Care Victoria developed their best practice guidance for Communicating Safe Eating and Drinking in 2020. A gap analysis was completed within the Monash Health speech pathology department, and following this, a dysphagia clinical guideline and minimum documentation standards were developed to inform speech pathology management of dysphagia. A working party was established to implement these guidelines. Method: A retrospective audit of current documentation was completed. Education of minimum standards and expectations were communicated to all speech pathologists. The working party collaborated with ground staff to identify behaviour change strategies which included amending site meeting agendas, documentation reviews, and updating the speech pathology power form on the electronic medical record (EMR). A postimplementation audit was completed, and results were fed back to the department – areas of improvement were identified and celebrated, and areas of improvement were communicated, and expectations established. These areas will become the focus of the next annual audit. Results: The post-implementation audit revealed improvements in all target areas; 44% increase in the number of specific plans documented, 41% increase in documentation of supervision, 11% increase in adding dysphagia alerts/problems and 22% increase in documentation of specifics from a swallow exam e.g. consistencies and amount trialed as well as feeding method. The audit additionally revealed areas for improvement which included documentation of a clinical handover, documentation of use of interpreters and completing a bulbar assessment or documenting rationale for why an assessment was not completed. Conclusion: Communication of clinical risk in dysphagia management remains critical to mitigate adverse outcomes. In 2025, we will review our new areas for improvement and new targets will be set by the department to support the ongoing standardisation of dysphagia documentation. The standardisation of documentation and strategies can improve communication of safe eating and drinking, minimise clinical risk and improve patient safety outcomes.