2.1 Development of South Yorkshire Dysphagia Toolkit

The history and development of South Yorkshire Dysphagia Toolkit are summarised in this section.  The Toolkit was created as part of the CLAHRC SY Translating Knowledge into Action Theme studies, conducted in collaboration with Sheffield Teaching Hospitals NHS Foundation Trust, between 2010 and 2013. 

 

What is the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for South Yorkshire?

It was a five year (2008-2013) programme of work to translate healthcare research into healthcare practice, particularly in relation to people with long-term conditions.  The programme was funded by the National Institute for Health Research (NIHR).  The partners were the health communities in Barnsley, Doncaster, Rotherham and Sheffield, and the two Universities in Sheffield.   For further information, see link

 

What is Translating Knowledge into Action (TK2A)?

This was one of the 11 work streams within CLAHRC SY.  A key aim of TK2A was to develop a step change in the way research findings were implemented in practice by trialling and evaluating innovative implementation strategies to facilitate evidence-based care.  This was to enhance service quality and contribute towards improved patient outcomes and/or increase patient safety. For more information see link

 

Dysphagia: a patient safety issue

Promoting dysphagia as a patient safety issue was a key recommendation arising from a collaborative project between the TK2A Theme and the Stroke Service at Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) in 2010-2011.  A pilot study, evaluating workplace based, blended e-learning as a knowledge translation strategy, was conducted on a stroke rehabilitation ward.  Dysphagia was identified as everyone’s business because of the impact on core aspects of care, particularly nutrition, hydration, medicines management and oral hygiene.  For information about all the recommendations see link.    


Workplace based blended e-learning

In the pilot study we evaluated workplace based, blended e-learning about dysphagia on a stroke rehabilitation ward (Ilott et al 2013).  Understanding dysphagia management, at the level of Assistant Dysphagia Practitioner competence was designated as job specific training for patient safety.  This meant that all the Registered Nurses and Clinical Support Workers were rostered to attend a training session during a shift.   Each session was facilitated by Dr Bev Bennett, an experienced nurse lecturer and blended different approaches to teaching and learning. These included a needs analysis to identify what people knew and wanted to know; e-learning programmes, practical skills about modifying fluids, and action planning to transfer learning into practice.  Most sessions were held in an Open Learning Centre, a room with computers with internet access, on the hospital site.  The ward manager co-signed the attendance certificate confirming the expectation that the learning would be put into practice. 

We chose to use three existing e-learning programmes about dysphagia which had been developed by national organisations in Scotland and England. These were Swallowing (Stroke Core Competencies No.13) and Feeding, Hydration and Nutrition Following Stroke (Advancing Module No. 3). The third programme was a NHS Skills for Health Core Learning Unit which is only available to National Health Service (NHS) employees.  These programmes contain the essential knowledge about swallowing and how to help someone to eat and drink safely.   All three were positively evaluated, by both trainers and trainees: they were easy to use, short (taking about 10-20 minutes) and relevant.   This is why we recommend these e-learning programmes as part of this Toolkit.   See Tips for Trainers for more details about each e-learning programme.

Spreading and sustaining the dysphagia recommendations 

Follow-up research tracking if, and how, the dysphagia recommendations were spread and sustained across a large, acute hospital and along the care pathways for stroke and fractured neck of femur, was carried out in 2012-2013.     The research proposal is available in the journal Implementation Science.

One recommendation was to use the Inter-Professional Dysphagia Competency Framework (Boaden et al 2006) for workforce development by embedding dysphagia training in local induction programmes, preceptorship for newly qualified nurses and as job specific training for relevant members of the multi-professional team.  A Training Needs Analysis identified gaps at Awareness and Assistant Dysphagia Practitioner level.  Awareness is aimed at staff who provide transient care.  Assistant Dysphagia Practitioner competence is intended for all staff who help patients eat and drink.   

A train-the-trainer intervention was evaluated as a way of spreading the dysphagia recommendations on two care pathways: stroke and fractured neck of femur.    Local trainers were trained to cascade Awareness and Assistant Dysphagia Practitioner competence training amongst their colleagues on the ward.   They were expected to apply, and share their new knowledge and skills when working with patients.   The Toolkit was developed as a training resource for the local trainers, and as an information resource for all staff.  


Testing the Dysphagia Toolkit

A printed version of the Toolkit was tested by experts and local trainers in South Yorkshire in 2013.  The Toolkit was used to support the training of 31 local trainers between January and November 2013.    The ward based trainers included Registered Nurses, Clinical Support Workers and Housekeepers.   In addition, feedback was sought from dysphagia experts working in a university hospital, a district general hospital and in community services in South Yorkshire.   These included Speech and Language Therapists and Dysphagia Trained Professionals in Sheffield Teaching Hospitals NHS Foundation Trust and Rotherham NHS Foundation Trust.

Written and verbal feedback about the utility of the Toolkit was given by eight people, including Registered Nurses, a Speech and Language Therapist, a Catering Manager  and an Occupational Therapist.  The most helpful sections were the session plan and the handouts for the practical sessions.  They suggested including a PowerPoint presentation to help trainers recap the key messages from the e-learning and a training equipment box.   These have been incorporated into this electronic version of the Toolkit.   


References

Ilott I, Bennett B, Gerrish K, Pownall S, Jones A, Garth A (2013) Evaluating a novel approach to enhancing dysphagia management: workplace based, blended e-learning.  Journal of Clinical Nursing. First published online: 16 DEC 2013 | DOI: 10.1111/jocn.12409

 

Ilott I, Gerrish  K, Pownall  S, Eltringham  S, Booth  A (2013) Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia careImplementation Science, 8:128.  DOI:10.1186/1748-5908-8-128.