What Does Aspiration Precautions Mean?
by Karen Sheffler, MS, CCC-SLP, BCS-S of SwallowStudy.com
Many hospitals, rehabilitation centers and nursing facilities use the term Aspiration Precautions. Doctors order Aspiration Precautions. Does it make the patient safer eating the ordered diet?
Research is inconclusive on what best practices for aspiration precautions should be. Studies frequently point to head-of-the-bed elevation above 30 or 45 degrees at all times. This can help prevent aspiration of refluxed food, liquid, or acid from the stomach. This does not prevent the danger of a tray being placed in front of a person with dysphagia (difficulty swallowing) who really needs one-on-one attention at the meal. This does not indicate that the person needs to sit fully upright for meals and medications. This does not remind staff to check for tray accuracy before feeding the patient. Therefore, Speech-Language Pathologists use best-practice based on expert clinical opinion to supplement the research. Remember, research is only one of the three prongs of evidence-based practice (read more).
Years ago, while preparing for our hospital’s Joint Commission review, we realized that we did not have an actual written policy of what aspiration precautions really meant. We worried that Joint Commission would ask us for our specific Aspiration Precautions Policy. We called other hospitals in the network and found they also did not have a written multidisciplinary policy. We created clinical guidelines and added staff training to the patient safety online module. We added decorative red mats to all dysphagia diet trays. We hung red swallow guides on the wall indicating the patient’s diet and safer swallowing strategies. The red tray mat and red swallow guide alerted staff that the patient needed extra attention with every meal. We then had numerous occasions where the kitchen host delivering the tray caught tray errors, as the tray did not match the red swallow guide sign created by the Speech-Language Pathologist.
You may find your facility in a similar situation with diet order errors and/or meal tray errors and no aspiration precautions policy to back you up.
Here is a policy that I wrote with the clinical guidelines attached. The guidelines are highly detailed and may need to be trimmed and tweaked to meet the needs of your facility.
Here is a generic multidisciplinary policy that refers to the guidelines.
Here is the meat of the policy in the clinical guidelines:
(Note: these guidelines include diet and liquid labels from the National Dysphagia Diet (NDD), as this was written in 2014. Please now see the International Dysphagia Diet Standardization Initiative’s framework at www.IDDSI.org.)
Here is an Aspiration Precautions Handout or Sign to alert your staff:
I hope these help you to boost your facility’s patient safety efforts. The key is a multidisciplinary effort. The team should create an aspiration precautions policy with detailed guidelines to meet the needs of the facility. The multidisciplinary team should sign off on the policy.
Thank you for reading, and I hope that others share ideas to continue to foster best-practice based on all the evidence.