Management of feeding decisions in hospitalised adults with severe oropharyngeal dysphagia.
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.
['McHutchison|Louise|L|', 'Miles|Anna|A|http://orcid.org/0000-0003-3260-5824', 'Spriggs|David|D|', 'Jayathissa|Sisira|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002755:Choice Behavior D000066491:Clinical Decision-Making D003679:Deglutition D003680:Deglutition Disorders D004750:Enteral Nutrition D005248:Feeding Methods D005260:Female D006760:Hospitalization D006801:Humans D007297:Inpatients D008297:Male D008485:Medical Audit D008875:Middle Aged D009520:New Zealand D010348:Patient Care Team D063886:Patient Discharge Summaries D012189:Retrospective Studies D012720:Severity of Illness Index D013997:Time Factors D016896:Treatment Outcome D055815:Young Adult
dysphagia documentation decision-making deglutition disorders enteral feeding shared