Louise McHutchison

Hutt Valley DHB, Wellington, NZ

BIOGRAPHY

Louise is a speech language therapist working at Hutt Valley DHB.As a part of post gradaute student with University of Auckland Louise undertook research into current practices with feeding of patients at risk of aspiration. This guideline has been developed as a result and will be implemented at Hutt Valley DHB and probably nationally.







ABSTRACT

New Zealand Risk Feeding Guideline for Adults with Severe Oro-Pharyngeal Dysphagia

Louise McHutchison1, 2, Anna Miles1, David Spriggs3, Sisira Jayathissa2
1 Speech Science, The University of Auckland, Auckland, New Zealand
2 Lower Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
3 Auckland Hospital, Auckland District Health Board, Auckland, New Zealand

For patients with chronic dysphagia, decisions need to be made about the provision of nutrition & hydration. ‘Risk feeding’, where someone continues to eat & drink despite risk, may be necessary when tube feeding is not in a patient’s best interests or is not medically possible. There is emerging interest in risk feeding pathways internationally. This presentation introduces the New Zealand Risk Feeding Guideline.

This guideline supports health professionals working with patients & whānau where risk feeding is considered. The guideline was developed by a multi-disciplinary working group, received support from an national advisory group & received endorsement from New Zealand Speech-language Therapists Association, Dietitians New Zealand, Hospice New Zealand & Spectrum Care. In developing the guideline, a clinical audit of 50 patients involved in complex feeding decisions was completed. Twenty-nine staff members, three patients & three whānau were interviewed (Miles et al., 2016). The audit found convoluted, lengthy decision-making with failed enteral feeding trials commonplace. There were frequent omissions in transfer information. Interviewed staff described limited education & organizational policy. Communication amongst staff & between staff, patients & whānau was considered a major factor in the success of risk feeding decisions. Staff described risk feeding as complex & stressful, whilst patients & whānau at times appeared unaware of decisions or their consequences. Keeping patient & whānau at the centre of all decisions was deemed critical by all.

This guideline provides explicit evidence-based statements to support consistent interprofessional practice. Key themes include: ASSESSMENT, COMMUNICATION, MANAGEMENT PLANS & DOCUMENTATION. For each theme, there is further guidance including links to resources.

Risk feeding is a common issue in New Zealand hospitals. Decision-making is ethically complex & causes stress amongst staff, patients & whānau. Shared decision-making involving supportive, informed interprofessional teams is essential. These New Zealand-specific guidelines are now available for national use.