Management of feeding decisions in hospitalised adults with severe oropharyngeal dysphagia

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Abstract

Objective

For patients with dysphagia, decisions must be made for provision of nutrition and hydration. This retrospective audit explored feeding decisions for patients with severe oropharyngeal dysphagia.

Methods

Fifty adult inpatients were identified across a 15-month period as requiring a feeding decision due to severe persisting oropharyngeal dysphagia. For each patient, all admissions (previous and subsequent admissions up to and including six months postrecruitment) where dysphagia or dysphagia-related complications were reported in the discharge summary were audited.

Results

A total of 103 admissions were identified with palliation in 22%. Enteral tube feeding (ETF) was initiated in 19% of admissions; and 63% of enteral tube placements failed. Nil-by-mouth with ETF was the final feeding decision in only 8% of admissions, while 43% of admissions led to documented oral feeding despite risk. Dysphagia was documented in only 44% of discharge summaries, with a feeding decision documented in only 34%.

Conclusion

Variation in management and poor documentation in this cohort suggest the need for a Risk Feeding Clinical Guideline.

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