Choking and Aspiration Supplemental Reading Materials

Transcription

1 Choking and Aspiration Supplemental Reading Materials (Word Count: Minutes) The Supplementary Reading Materials for this training program consists of the following documents: Dining Assistive Devices Low-Risk Foods for At-Risk Residents Motivating Residents to be Independent Diners OBRA Regulations Copyright 2010 by Long-Term Care Learning Center

2 Assistive devices (or adaptive devices) can be important tools for residents. If your facility would like to acquire these devices, they can be found at your local medical supply store or at a medical supply retailer on-line. Angled Utensil Angled utensils have handles that bend to the right or left. Some types are flexible and can be bent to meet the resident s needs Residents with limited flexibility in their hands can use angled utensils. They make it easier to get food to their mouths. They also help people with limited wrist or arm movement. Clothing protector A clothing protector is a smock or apron that may have a pocket along the bottom to catch spilled food. If the clothing protector does not have a pocket, you can turn the bottom edge. Clothing protectors help to protect a resident s clothes from spills and also facilitate clean up once the meal is finished.

3 Cups with lids Cutout cups Cups with lids keep liquids from flowing too quickly. Some cups with lids have openings for straws. Cutout cups have a notch that fits comfortably around the nose as the resident drinks. Cups with lids allow residents with physical limitations to drink without spilling and to better control speed of liquids entering the mouth. Cutout cups are ideal for the resident who is unable to extend the neck.

4 Flexible straws Flexible straws are plastic straws that come in varying lengths and can bend in many different directions. Flexible straws help residents who are unable to drink from a cup or glass. They can be placed in non-tip containers to prevent spilling. Non-slip mat Rocker Knife A non-slip mat is made from material with a gripping surface. Place it under a plate or bowl. A rocker knife is designed for one-handed use. It cuts food by rocking back and forth rather than sawing. The non-slip mat prevents movement of the dishes and reduces the incidences of spills. Since rocker knives only require the use of one hand to cut food, residents with paralysis on one side now have the ability to cut food independently.

5 Special cups for people with arthritis Cups for residents with arthritis have enlarged handles designed so that a resident can slip his or her hand through and hold the cup without having to grasp the handle. Cups designed for residents with gripping issues are textured or contoured so that a resident can easily grasp it. Cups designed for residents with arthritis allow them to hold their cups more securely and drink independently. Weighted Handle Utensil Weighted handle utensils have six to eight ounces of extra weight in the handle. Weighted handle utensils enable residents with hand tremors to have more control over their utensils.

6 Built-up Handle Utensil Built-up handle utensils have sleeves that enlarge the grip surface making them easier to hold. Built-up handle utensils enable residents with limited gripping ability to hold utensils. Plate guard Scoop dish A plate guard attaches to the edge of the plate to provide a surface to push food against. A scoop dish is higher and curved on one side to assist in getting food onto the utensil. Plate guards are helpful for residents who have difficulty getting food on the utensil. Scoop dishes make it easier for the resident to get food onto the utensil.

7 Motivating Residents to be Independent Diners Determine the cause of eating problems, e.g., arthritis, tremors, dementia, poor dental health, poor vision, or lack of endurance. Plan your actions to meet the specific needs of each resident. Include finger foods or foods that are easy to eat with a fork or spoon. Avoid foods that are difficult or messy to eat such as spaghetti, sauces, or barbeque. Keep the eating area well lit and free from distractions to encourage concentration on eating. Seat residents in a comfortable chair of appropriate height. Chairs should have arms and a cushioned seat. Obtain assistive devices such as weighted or built up handle utensils, plate guards, and non-spill cups and have them readily available. Consult an occupational therapist for information about assistive devices and how to obtain them. Place all needed items within the resident s reach. Use non-slip placemats to fix utensils on the table. Describe food and its location on the plate for residents with visual impairment. Provide one dish at a time for residents who are easily distracted or overwhelmed by large amounts of food. Comment on the food as you serve it This smells very good. Provide verbal cues, one step at a time. Allow time for the resident to respond. Use modeling and tactile cues for residents who do not respond to verbal cuing. Allow adequate time for the resident to finish the meal. Praise the resident s efforts and accomplishments. Talk with other staff members about what works for each resident. Document successful techniques in the resident s service plan. AND REMEMBER that residents who are at risk for choking and aspiration always need close supervision when dining. Copyright 2010 by Long-Term Care Learning Center

8 Injury Prevention for Older Adults Preventing Choking and Aspiration Low-Risk Foods for At-Risk Residents 2004 Harrington Software Associates, Inc Wilson Road Warrenton, VA (540) Directions: Use these suggestions to pick low-risk foods for frail older adults or for people with missing teeth or dentures to reduce the risk of choking. Frail Older Adults Meats (cut or cubed into small pieces) Finger sandwiches with firm fillings like cream cheese Toast (plain or cinnamon) Toasted bagel with cheese spread Bread and butter Eggs (deviled or hard-cooked) Cheese (strips, wedges, or dips) Mixed cereals Crackers Soft-cooked carrots, celery, cauliflower Fresh apple slices, bananas, berries, seedless grapes Dried fruits Pound cake Cookies People with Missing Teeth or Dentures Cream soups Ground or chopped meats Baked fish Soft-cooked eggs Soft-cooked vegetables and fruits Oatmeal French toast Pancakes or waffles Pasta Cottage cheese Ice cream (no nuts) Custards Puddings Adapted from information in Feeding the Frail Elderly by Mildred O. Hogstel and Nell B. Robinson. (1995). Journal of Gerontological Nursing, 15(3).

9 Injury Prevention for Older Adults Preventing Choking and Aspiration Resource Omnibus Budget Reconciliation Act of 1987 (OBRA) Regulations 2004 Harrington Software Associates, Inc Wilson Road Warrenton, VA (540) The following regulations have been summarized from 42 CFR Ch. IV ( Edition), published by the Health Care Financing Administration. They relate to issues associated with preventing choking and aspiration in nursing facilities Resident rights. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. Facilities must protect and promote the rights of each resident. Facilities must immediately inform the resident, the resident s physician, and the resident s legal representative or interested family member when there is an accident involving the resident which results in injury and has the potential for requiring physician intervention Resident behavior and facility practices. Residents have the right to be free from any physical or chemical restraints imposed for the purpose of discipline or convenience and not required to treat the resident s medical symptoms Resident assessment. Facilities must conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident s cognitive, nutritional, and dental status Quality of care. Facilities must ensure that a resident s abilities in activities do not diminish unless circumstances of the individual s clinical condition demonstrate that diminution was unavoidable. This includes a resident s ability to eat. Facilities must ensure that a resident who is able to eat enough alone or with assistance is not fed by nasogastric tube unless the resident s clinical condition demonstrates that the use of a nasogastric tube was unavoidable. Facilities must provide appropriate treatment and services to residents being fed by nasogastric tubes to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and to restore, if possible, normal eating skills. Facilities must ensure that the resident environment remains as free of accident hazards as is possible. Facilities must ensure that residents receive adequate supervision and assistive devices to prevent accidents Dental services. Facilities must assist residents in obtaining routine and 24-hour emergency dental care Pharmacy services. The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist. Copyright 2000 by Bonnie Walker & Associates. Reprinted with permission from the copyright owner.