Health care professionals working in geriatric care environments are finding a growing number of medically complex residents requiring assistance with feeding and swallowing safely," said Lori Sampson-Baum, MA, CCC-SLP, assistant director of Speech Pathology and Audiology Services at Gouverneur Diagnostic and Treatment Center and Nursing Facility in New York City. "Assisting residents to feed safely helps them to enjoy the act of eating, thereby enhancing the quality of their lives."
This is the guiding principle behind the Safe Feeding Program that Sampson-Baum began developing in 1998. The primary goal of the program is to educate and train nurses, certified nursing assistants, patient care technicians and family members on how to feed elderly individuals safely.
Improving residents' quality of life by enhancing their pleasure of eating while maintaining adequate nutrition and hydration is the program objective.
"By educating caregivers on safe feeding, the risks of decreased oral intake, coughing, choking, aspiration, pneumonia and other complications associated with improper feeding may diminish," Sampson-Baum told ADVANCE.
"Feeding safely is of primary importance when working with patients and residents who live in a long-term skilled facility. This is especially true when assisting those who suffer from progressive illnesses, such as dementia," she said. "For those who have feeding and swallowing difficulties, all viable strategies to continue oral feeding should be explored by the interdisciplinary care team before any artificial means of nutrition and hydration are implemented. The Safe Feeding Program is one such option."
The Safe Feeding Program encompasses three phases:
educating and training the nursing staff,
successfully completing a competency checklist, and
orienting and training new staff.
In phase 1, definitions and descriptions of dysphagia are provided, signs and symptoms of swallowing disorders are identified, and potential negative outcomes of unsafe feeding are discussed.
Sampson-Baum teaches caregivers that signs of swallow dysfunction may include excessive mouth movement during chewing, delayed swallow response, holding food or liquids in the mouth, food spilling out of the mouth, pocketing of food, refusal to eat, a noticeable wet vocal quality after or during the meal, and sudden temperature spikes.
In addition, the nursing staff views a videotape. Instructional role-play activities are used, easy-to-understand handouts are provided, and pre- and post-course quizzes are administered. Successful completion of this initial phase requires a score of 100 percent on the post-quiz.
Phase 2 involves administering a competency assessment in the form of a checklist. Staff members must be competent in all of the targeted areas before they are able to receive a certificate of course completion.
Items assessed on the checklist are: addressing the resident by name, making certain the resident is alert and responsive enough to eat, sitting and feeding the resident at eye level, conversing with the resident, and checking that the name on the diet order slip matches the name on the resident identification bracelet and the diet order written in the medical record.
"We make rounds and do spot-checking to make sure that the feeding strategies learned in the classroom are being properly carried on in the units," Sampson-Baum said. "Any problems identified are immediately addressed with the feeder."
The third phase of the program was designed to ensure that all of the new nursing staff members receive training on safe feeding techniques. A safe feeding workshop is part of the new employee orientation program, which is linked with the Nursing Education Department. The new nursing staff members also are observed feeding residents and must pass the competency assessment.
In addition, the Safe Feeding Program is provided to family members who assist feeding their loved ones. This adaptation of the program focuses on the dos and don'ts of feeding. Tray line workers and dietary aides are trained on safe techniques for delivering the meals through inservicing and demonstrations.
Recently, two new dimensions were added to the program. Caregivers now are trained on how to apply a variety of seasonings and condiments in order to enhance food flavors and to possibly increase oral intake. Condiments such as ketchup, mustard, salt, pepper, sugar, mayonnaise, salad dressing, and prepackaged Chinese and Spanish seasonings (given the cultural make-up of the residents) are provided at mealtime.
In conjunction with the Food and Nutrition Department, a condiment station was set up on each unit.
"We have been monitoring the reaction of the residents to this new service," Sampson-Baum said. "It is our hypothesis that enhancing the taste of food results in increasing oral intake in our residents for whom poor oral intake is of concern. Initial feedback from the residents and the staff has been very positive."
Additionally, the nurses have been trained in the strategy of alternating hot and cold and sweet and sour food and drinks to allow for differentiating flavors and temperatures.
"We are investigating if this method of feeding has any correlation with oral intake," she said.
It is important for speech language pathologists to foster a working relationship with the nursing staff. This will convey to the nursing staff that the speech pathologist is not there to critique their feeding performance but to help improve their feeding skills.
Since the program began at Gouverneur, the nurses have reported feeling more confident with feeding residents. They also found the classes to be interesting and informative.
For more information contact:
Lori Sampson-Baum, Gouverneur Diagnostic & Treatment Center & Nursing Facility, 227 Madison St., New York, NY 10002; 212-238-8451; e-mail: firstname.lastname@example.org
Nicole Klimas is on staff at ADVANCE.