Presented by Emily Wechter Speech Pathologist for Disability SPOT September 4 th 2019 This webinar will cover The importance of mealtimes The roles of different professionals in mealtime management ID: 776579
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Slide1
A Multi-Disciplinary Approach to Mealtimes
Presented by Emily Wechter- Speech Pathologist, for Disability SPOTSeptember 4th 2019
Slide2This webinar will cover……
The importance of mealtimesThe roles of different professionals in mealtime managementIntroduction to resources to assist you to support people in the areas of mealtimes e.g. the mealtime management modules
Slide3Acknowledgements
Family and Community Services (2012) The Mealtime Management Modules. Developed by Kelly Anschau and Felicity Burke.Family and Community Services (2016) Mealtime Management: A team approach. Training package developed by the Clinical Practice Support team (Emily Wechter, Lorren Krilich, Kate McDonell, Tess Southcombe, Rebecca Allen, Jamil Masangkay, Agnes Ross, Margaret Balin)
Slide4Goals for mealtimes for people with disabilities:A safe and enjoyable mealtime experienceIncrease or maintain community and social participationIncrease or maintain independence and participationOptimize or improve health and nourishment
Mealtimes- a holistic activity
Slide5Nutrition is a basic human rightEating well promotes good healthMealtimes are important social eventsPeople with disabilities often need support with the activities of mealtimesPeople with disabilities are often dependent on others to meet their nutritional needs and eat safelyWE CAN HELP MAKE MEALTIMES SAFE, ENJOYABLE & ACCESSIBLE
Why are mealtimes important in our roles?
Slide6Mealtimes and the ICF
e.g.
Prader Willi SyndromeDown SyndromeAutismChronic lung diseasePsychiatric IllnessStrokeCerebral PalsyDiabetesObesity
e.g. Low muscle tonePoor motor coordinationCognitive deficitsDifficulties inhibitionDry mouthRespiratory issuesMotor planning impairmentsStructural abnormalitiesPoor dentitionMetabolic issuesDental issuesSmell or taste limitationsDigestion issues/ refluxFussy eating/sensory issues
e.g. ability to sit or transferUsing cutleryUsing a cupDrinkingFeeding yourselfSwallowingChewingBreathing easilyDigestingWeight regulationEating at a normal rateCommunicating preferencesOrdering a mealCooking ShoppingCleaning upBehaving appropriately
e.g. Going out to eat or going to eventsEating when you want toFood choice/varietyMeal planningSocialising at mealtimesComfortable eatingRestrictive practices
e.g. Reliant on other people to eatCarers may have their own ideas about mealtimes and how it should be doneLimited options for eating out – modified diets, accessibility equipmentPeople staringPolicies and procedures of paid carersEmotions of carers or family members
e.g. Cultural considerations
Ageing
Religion
Slide7Who is in a mealtime team and who does what?
Slide8Speech Pathologist
“I want the person to swallow safely and be able to communicate what they like and don’t like”
Slide9Often the “key worker” for development of a mealtime planBrings the plan together based on recommendations from all partiesAssessment of choking or aspiration risks & swallowing ability, VFS (moving x-ray of swallow) etcMonitors the impact of the strategies on swallowing function and safety Compensatory strategies= Food texture & fluid modification, behavioural strategies and environmental changes e.g. pacing & carer educationSkill building= Teaching feeding skills e.g. chewing, transitioning between solids, cup drinkingBasic recommendations around positioning and equipment – if not complex and specialised otherwise bring in othersDoes not make recommendations outside of scope of practice- will just advocate that they are explored e.g. oral care
Speech Pathologist
Slide10Occupational Therapist
“I want the person to sit well when eating and have the right equipment to promote independence”
Slide11Promoting independence and participationPositioning at mealtimes in consultation with SP and teamAssess and prescribe equipment for mealtimes to maximize independence and safetyConsider ecological/environmental assessment- how many environments? What could be inhibiting or facilitating participation?Assess how sensory issues may impact on a person’s independence during mealtimes e.g. vision/hearing impairment, aversion to certain foods/textures/temperatures and reflexes. Provide carer training e.g. using prompt hierarchy to promote independence.
Occupational Therapist
Slide12Physiotherapist
“I want the person to be positioned for a safe and effective swallow and move to the table easily”
Slide13Assess posture, including head and neck position and seating position for a safe and effective swallow Assess muscle tone, strength and mobility as this may affect ability to participate at mealtimes and capacity to move independentlyObserve the person and note if “chesty”, noisy breathing, drooling, gurgling and check if there is a history of reflux and/or respiratory infections- Consult SPAssess the person’s mealtime responses Provide training & instructions for carers
Physiotherapist
Slide14Psychologist and
behaviour support specialist
“I want to reduce any problem behaviours and the impact of mental illness so mealtimes are as positive and enjoyable as possible for everyone”
Slide15Dual rolesAssess behaviours being displayed and risks before, during or after the mealtimesAssess the effect that mental health issues and treatment may be having on the individuals at mealtimesSupport the family and assess the impact of the mealtime disturbances and provide supportSupport a multi-disciplinary approach for fussy eaters – desensitizationRestricted practice strategies that may be inadvertently used or necessaryBehaviour at mealtimes due to traumatic experiencesWrite a behaviour/multi-dis plan or provide strategies and training to all supporting the individual
Psychologist and behaviour support specialist
Slide16Dietitian
“I want the person to eat for optimal health and nourishment”
Slide17Assesses a person’s measurements. This can include weight, height/length, growth, waist circumference, and estimated fat store (skin fold).Looks at the blood test results, and sometimes requests for certain items to be checked through the Doctor.Checks food and medication/supplement interactions, and be aware of the common side effectsEnsures the person’s diet meets their nutritional and fluid requirements (including tube feeding), that also meets the guidelines for their medical condition(s). Recommends a diet that is person and family centred, which takes into consideration their culture/religion, likes and dislikes, different environments, knowledge and skills in food preparation, budget, and other recommendations from other therapists and doctors. If swallowing is an issue, the person will need to be seen by a SP first.
Dietitian
Slide18“I want the person to have all their medications, have good chest health, have good oral care and be assisted appropriately”
Nurse
Slide19Nursing assessments (issues identified e.g. gagging/vomiting regularly; difficulties managing saliva; noisy breathing; frequent chest infections; consider medications)Documentation and monitoring of e.g. weight, dehydration, elimination.Development of Care Plans e.g. Bowel Management PlanEvaluation- treatments are modified to reach best outcomesReferral to other professionals e.g Clinicians, GP, Specialists, Dentist. Has a role in overseeing and monitoring healthy eating & drinking practices and overseeing the implementation of therapy plans.Nurse can deliver education to families, carers and support staff e.g. medication administration via gastrostomy-PEG tube.
Nurse
Slide20Dentist
“I want the person’s teeth and mouth to be clean and a good oral care plan in place”
Slide21Dentist
Assessment and management of gum disease, tooth decay, dental erosionOral care strategies Adaptations for disabilities e.g. difficulties managing thin fluids, positioning, oral aversion, nil by mouth, reliance on others for oral careDry mouth, excess secretionsImpact on behaviour e.g. can’t communicate painOral hygienist may also develop an oral care plan and provide carer training
Slide22As a team we work together We should all know the strategies that the team members are recommending and come up with a coordinated mealtime plan and support the person and carers to implement itYou CAN’T make decisions and changes to recommendations outside of your scope of practice
Role boundaries
Slide23Resources to guide us:
The Mealtime Management Moduleshttp://ngolearning.com.au/mealtime-management/
Slide24Format of MMMs
E-learning/self directed learning toolTakes approximately 2 ½ hours to complete13 sections or modules with combination of written information, links and videos as well as mini quizzes to test knowledgeCase study which puts it all togetherAssessment at the endLinks to resources including an appraisal which can be used by workplaces to assess the transfer of knowledge into practice.
Slide25What is covered
Why mealtimes are important and what they involve
Frameworks policies and procedures we follow around mealtimes including ICF and Evidence Based practice- links to the resources within the program
Who is in a mealtime team and what do they do
Considering personal factors in mealtime management e.g. considering culture
Identifying signs and difficulties at mealtimes- e.g. signs of swallowing difficulties
What to consider in a mealtime assessment
Slide26What is covered
Importance of nutrition and enteral nutrition
Positioning, sensory processing and medication
Oral care
Developing mealtime management plans
Ethical decision making e.g. informed consent, duty of care issues
Best Practice Tips
Slide27Resource shelf
Slide28Particularly useful tools and resources
The Nutrition and Swallowing Risk Checklist
Mealtime management plan templates
https://www.facs.nsw.gov.au/__data/assets/pdf_file/0007/590704/111-N-and-S-tools-and-templates-accessible.pdf
Nutrition and swallowing guidelines
https://www.facs.nsw.gov.au/download?file=590702
Mealtime Management for Nurses Practice Package
https://www.facs.nsw.gov.au/download?file=301784
Slide29Developed by Family and Community Services/ Ageing Disability and Home CareNutrition and Swallowing issues were identified as a big concern in residential facilities in 1997 Lead to development of policies and procedure including the checklistStill a concern!Free to use and available on the internet - can be given to caregivers or completed by clinicians
The Nutrition and Swallowing Risk Checklist
Slide30The Nutrition and Swallowing Risk Checklist
Preliminary information e.g. personal info , BMI,24 yes/no questions looking at common risks or activity & participation limitationsSummary page at end to document actions for areas identified as an issue (i.e. answered “yes”)
Slide31Mealtime management plans
Holistic way to document your strategies for a safe and comfortable mealtime which encourages independence and participationCan be completed jointly by everyone on the team (remember to maintain your scope)Additional template called “my eating and drinking profile” meant for support workers to complete
Slide32Slide33Slide34Nutrition and Swallowing guidelines
Comprehensive written resource
Aimed at disability support workers but a good overall summary of mealtime strategies, considerations
etc
across mealtime activities
Also could be given to carers as easy to read handouts for certain goals/strategies related to mealtimes
Slide35Slide36Slide37Mealtime Management for Nurses Practice Guide
Based on the practice guide for therapists but now housed under FACS website for Nurses
More “professional” version of N&S guidelines
Covers:
Identifying and managing nutrition risks
Screening, assessing and managing dysphagia
Enteral nutrition- decision making and management
Readings, resources and links
Slide38Slide39Questions