Decision making processes for the initiation of enteral feeding in acute inpatients with dysphagia

Miss Rebecca Sexton1, Miss  Melinda  Werder1

1Redland Hospital, Qld Health, Cleveland, Redland , Australia

Introduction:

An assessment of stroke care at Redland Hospital identified that multidisciplinary team (MDT) decision-making and communication regarding the initiation of enteral feeding for stroke and general medical patients presenting with dysphagia was an area for improvement. The literature highlights that enteral feeding decisions should be made collaboratively within the first three days of admission for an acute stroke patient with dysphagia. The consequences of poorly managed dysphagia include malnutrition, dehydration and longer length of stay.

Aims:

  • Investigate existing MDT communication and decision-making practices around initiation of enteral feeding for patients with dysphagia
  • Explore staff perceptions around barriers/enablers of shared decision-making practices for initiation of enteral feeding for patients with dysphagia

Methods:

Retrospective chart audit and staff survey

Results:

  • Patients received enteral feeding in a timely manner
  • No statistically significant difference between stroke and general medical patients across all variables (period receiving active medical treatment, nil by mouth status, enteral feeding commenced/enteral feeding duration)
  • Large variability with meeting formats including 47% of patients with no documented MDT meeting and 18% with no documented meetings at all
  • Staff identified barriers to decision-making including unclear focus of care and patient/family unsure of options.
  • Staff identified opportunities for improvement including timely meeting and clarification of focus of care

Conclusion:

Patients received enteral feeding in a timely manner, however opportunity for improvement of MDT decision-making remains. Recommendations include increased regularity of meetings, developing a proforma to guide these meetings and clear documentation of goals of care.


Biography:

Melinda Werder is a Dietitian who has worked at Redland Hospital for five years.

Rebecca Sexton is a Speech Pathologist who has worked at Redland Hospital for six years.

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