Reducing the risk of choking for people with a learning disability: A multi-agency review in Hampshire (11 October 2012)

Summary

This report is aimed at people who are working with those who have a learning disability, in the role of commissioners or providers of services.

It was produced on behalf of the Hampshire Safeguarding Adults Board by a multi-agency group and seeks to understand why people with a learning disability are at greater risk of choking, looking at what can be done locally in Hampshire to improve outcomes for people who are at risk of choking, in any care setting. The report makes a number of recommendations based on common sense and good practice.

Content

Recommendations

1. Adults with a learning disability should be supported to take up annual health checks.
2. Adults with a learning disability should be supported to attend a dentist for regular check ups.
3. Social workers, as part of their annual review of placements, must check that individuals are receiving dental checks.
4. All Primary Care Services in Hampshire are provided with information and web links for the National Patient Safety Agency (NPSA) ‘Ensuring safer practice for adults with learning disabilities who have dysphagia’.
5. Health Commissioners ensure that there is sufficient Speech and Language Therapy resource within the community to respond to requests for  assessment of learning disability clients identified as at risk of choking.
6. The consent of the person with learning disability must be obtained  before any medical investigation or assessment is carried out.
7. All services providing for clients with a learning disability should use an Eating and Drinking Difficulties Screening Tool, which will indicate whether a choking risk exists and a referral to the GP is needed.
8. All services providing for clients with a learning disability, who have a known risk of choking, should use the appropriate documentation in order to ensure the appropriate referrals are made.
9. All Services providing for clients with a learning disability should ensure that they follow the instructions provided by the Speech and Language Therapist following an assessment.
10. All services providing for clients with a learning Disability who are at risk of choking as a result of challenging behaviour or deliberate self- harm, should refer the individual to the Learning Disability Health Team for a formal assessment.
11. If staff or carers identify that someone is at risk of choking from food or other objects in their mouth, a Mental Capacity Act assessment needs to be considered to support appropriate decision making.
12. If clients, as a result of their behaviours and the consequent risk of choking, are prevented from accessing areas within a residential setting then an application should be considered from the care provider to the Supervising Authority (Local Authority) under the Mental Capacity Act Deprivation of Liberty Safeguards.
13. If staff or carers identify that someone is at risk of choking, they must consider a referral to an advocacy organisation for an advocate to support the person with decision making in relation to eating and drinking plans.
14. All carers and staff should be involved in the care planning process for people at risk of choking, particularly those who will be implementing the plan.
15. Staff should be aware of the consequences of not following an agreed eating and drinking care plan.
16. Care plans to support people at high risk of choking should be reviewed at least every 6 months or after any change in the person’s health or care.
17. Staff induction training in all learning disabilities settings should include choking recognition and First Aid treatment of choking.
18. All trainers to increase the emphasis on responding to choking incidents in First Aid training for services that provide care for people with learning disabilities.
19. In line with the NPSA recommendation, regular practices or drills for staff around responding to a choking incident should be carried out as part of First Aid response training.
20. The Group recommend a standard training matrix which should be used by all those providing care for those with a learning disability.
21. The four Hampshire Safeguarding Adults Boards should seek to influence the Department of Health to consider a national data collection about choking deaths in people with a learning disability in order to understand the problem and guide improved practice.
22. All Primary Care Services in Hampshire are sent the NPSA Learning Disability Dysphagia Protocols for GPs.
23. The four Hampshire Safeguarding Adults Boards undertake a communications campaign to raise awareness around the issues of choking.
24. A ‘Health passport’ is developed for every person with a learning disability to ensure that information around health risks including risk of choking is available to be shared between providers, with the person’s consent.
25. All choking incidents involving people with a learning disability should be reported and investigated appropriately.