Learning Disability: Choking
In recent years there have been preventable deaths of adults with a learning disability in Hampshire. All died from choking and all were known to have dysphagia. All had eating and drinking guidelines in place which were not being followed accurately. As a result we want to highlight this risk to GPs. There is a key role for clinicians undertaking Annual Health Checks (AHC) to identify patients at risk of choking.
The Hampshire Safeguarding Adults Board found dysphagia, poor oral health, behaviours, pica (eating non-food items), medication and deliberate self-harm as reasons people with LDs choked in Hampshire. To read the full report click here.
So what do you need to do?
Always consider the patient's choking risk - at the AHC as well as opportunistically.
Flag the patient record if you get information suggesting they have dysphagia or receive details from the community LD team about dysphagia.
At each consultation, ask the following three questions of carers:
1. Are you aware the patient is at increased risk of choking and aspiration and has specific speech and language recommendations for eating and drinking?
2. Are you and your team following these eating and drinking guidelines given for the patient?
3. Has there been a change in the patient’s ability to eat and drink?
If the answer to the first two is NO, please discuss with the carers the need to follow the recommendations.
A useful flow chart for managing dysphagia in LD patients for GPs is listed in Appendix 4, page 44 of the review document .
If a choking risk is identified surgeries should contact their local Learning Disability Health Team in the first instance.
These can be found on this page.
We need to raise the awareness of the choking risk for all carers and staff. Where there is a recognised swallow risk a clear plan needs to exist, with review and reassessment should the individual's circumstances change, e.g. following addition of a new medication that could alter this.
Another important step is to ensure that oral health is maintained and GPs can encourage LD patients to attend dental appointments.
Providing support and ensuring information about choking and swallowing is available to carers is vital. The Hampshire SLT LD team often signpost people to Help Stop Choking Website. There is advice for patients, professionals and carers in written and video format and it comes highly recommended.