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.