CQC publishes choking incident guidance

The CQC has published new guidance on caring for people at risk of choking. The guidance is published online as part of a series reflecting learning from safety incidents.

The guidance states that, in 2017, the CQC prosecuted a care home provider for failing to manage risks to people’s safely. One of those risks involved a choking incident.

In this incident, the CQC states, the provider failed to:

• make sure that staff understood how to safely support a 77-year-old man to eat and drink – this was because they did not pass on advice from his speech and language therapist (SALT)
• maintain accurate care records.

The incident report reveals that the man had seen a SALT therapist for a swallowing assessment in March 2015. The resultant recommendation was for normal fluids and a pre-mashed diet. The SALT also recommended that he should be positioned upright and have his head supported to eat and drink.

Despite these recommendations, inspectors found that the provider did not review the man’s diet and did not update the man’s care records until six weeks after the assessment. Even then the provider did not include information about how care staff should support the man.

In June 2015, the man choked on thick porridge while he was receiving his breakfast in bed. Inspectors who assessed the provider’s care records found that staff were unclear about the consistency of the food and drink they should have been giving to the man and how they should be supporting him to eat and drink safely.

The provider admitted in court failing to provide safe care and treatment and was fined £82,429.

The CQC guidance points out that choking can result in serious or fatal injuries and is avoidable in cases where there is a known risk. If a service user with swallowing difficulties, such as dysphagia, is at risk of choking then the provider should have detailed plans in place for the affected person. These plans will usually be based on advice from a healthcare specialist, such as a speech and language therapist, and include guidance for care staff on how to prepare the person’s food and drink.

The incident report refers providers to detailed dysphagia management information from Public Health England on the GOV.UK website at https://bit.ly/2Py0IX2.

The CQC itself also publishes updated guidance on dysphagia and the use of thickening powders in food and drink on its website at https://bit.ly/2PxaQiE.

The CQC guidance is written to reflect new international standardised descriptors developed as part of the International Dysphagia Diet Standardisation Initiative. These new descriptors, which refer to texture-modified foods and thickened liquids for people with dysphagia, were introduced in April 2018 and have been adopted by the British Dietetic Association and the Royal College of Speech and Language Therapists. They replace previous descriptors. The CQC states that providers should put these changes in place safely to protect people from choking risks.