Is it Hard to Swallow?
NICE QS stipulates that patients with PD should have a point of contact with specialist services to facilitate continuity of care, information sharing, advice and support. This contact also ensures patients needs are proactively reviewed and addressed.
PwP are 1.5 times more likely to be admitted to hospital.
Because there are no guidelines for swallowing screening as there are in Stroke services, there were no formal swallowing screens performed by nursing staff, all patients, if identified were referred to SALT. Patient satisfaction around NCEPODs work showed that patients felt their swallowing problem management was of poor quality.
As can be seen only 7 formal referrals were made to PDNS, although through visiting wards more of these patients were identified and reviewed. I used July as the study month to pick up the formal referrals due to service provision at this time (holidays).
NCEPOD also looked at referral letters but unfortunately there was NO evidence of any referrals and all patients were admitted via A&E. As there was nobody accompanying patients information was gathered by telephone predominantly from family and meds checked via repeat prescriptions by EAU doctors.
As poor swallowing can also effect medication, NCEPOD included a tool to gather missed medication of which 80% missed medication was due to swallowing issues.
From all 19 patients, 15 were discharged alive, 4 who died were all in complex stage half of which had pre-existing swallowing difficulties which were correctly identified on admission. 1 out of 4 had missed admission assessment.
We have designed a passport for all PD patients in which information on their motor and non-motor problems can be recorded and should be taken to all appointments with MDT including GP visits.
SALT and PDNS to provide education on swallowing assessment and SALT to provide training which will be rolled out throughout trust but to start on EAU. A poster has been placed in admission areas asking staff to make a e referral to PDNS to provide continuity if care and improve outcomes.
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