Preamble
BigDog Support Services Pty Ltd (BigDog) ensures that each client requiring severe dysphagia management receives appropriate support that is relevant and proportionate to their individual needs and preferences.
BigDog considers it imperative to involve our clients in all aspects of their service delivery and the direction of their services to their ability. The dignity of risk is an essential part of this choice and control.
Details
A swallowing difficulty (dysphagia) is any problem with sucking, swallowing, drinking, chewing, eating, controlling saliva, taking medication, or protecting the lungs from food and drink ‘going the wrong way’. It can be a problem with keeping the lips closed so that food, liquid, or saliva doesn’t dribble out. Sometimes, the first sign of a swallowing problem is coughing, gagging, or choking when eating and drinking.
Swallowing problems can mean food, drinks or saliva get into the lungs and this can cause lung infections (pneumonia). Reflux is a problem where the valves in the oesophagus cause the contents of the stomach (like food, drink or stomach acid) to come back up, sometimes reaching as far up as the throat and mouth. A swallowing problem can occur at any stage in life. Babies born prematurely, those with heart defects or damage to the brain (e.g. cerebral palsy) often have swallowing problems. Children with abnormalities in the structures of the head, neck and face such as cleft lip or palate may also have difficulty feeding.
Causes
Adults may also develop swallowing problems as a result of damage to the brain or structures of the head and neck. Almost half of everyone who has had a stroke will have a swallowing problem. People who have had a head injury, those with Parkinson’s disease, motor neuron disease, dementia, cancer of the head and neck may also have swallowing problems. The impact of swallowing problems may be short or long term and can have a big impact on a person’s life. Eating and drinking is an important part of everyday life. Not only do people need to eat and drink to live but eating and drinking should be an enjoyable pastime and many social activities happen around eating and drinking.
Swallowing problems can result in life threatening medical problems such as pneumonia, choking, poor nutrition and dehydration, if not managed properly. In babies and children, poor nutrition may impact on growth and brain development. Eating and drinking can be uncomfortable, stressful, and frustrating for a person with swallowing problems. They can’t have some types of food and drink and symptoms of swallowing problems can make eating and drinking in front of friends and family difficult and embarrassing. These problems can lead to anxiety, depression, and social isolation.
Types of Dysphagia
There are 2 main types of dysphagia, based on the location of the swallowing problem:
1. Oropharyngeal Dysphagia – This issue begins with chewing the food or appropriately moving it to the throat from the mouth.
2. Oesophageal Dysphagia – The food enters the airway rather than passing into the stomach; the person may or may not feel the sensation of food getting stuck after it passes the pharynx or back of the throat.
Identification
BigDog will identify each client requiring severe dysphagia management utilising the Client Profile Kit.
Assessment
With their consent, a client’s individual severe dysphagia management needs are assessed by appropriately qualified health practitioners, including by practitioners conducting regular and timely reviews if needs change or difficulty is observed.
Plan Development
Each client is involved in the assessment and development of the plan for their high intensity daily personal activity and management. With their consent, their individual severe dysphagia management needs are assessed by appropriately qualified health practitioners, including by practitioners conducting regular and timely reviews if needs change or difficulty is observed
The plan identifies how risks, incidents and emergencies will be managed, including required actions and escalation to ensure client wellbeing.
Policies and Procedures
Appropriate policies and procedures are in place in relation to the support provided to each client requiring severe dysphagia management, including training plans for workers supporting them
The requirements of this role will be clearly documented in a care management plan that has been developed and is overseen by an external health practitioner. Both the training plan and the management support plan will include the identification of risks including actions and escalations.
Support Worker Training
BigDog will ensure that each worker responsible for providing severe dysphagia management to client has received training, relating specifically to each client’s needs, managing any severe dysphagia related incident and the high intensity support skills descriptor for severe dysphagia management, delivered by an appropriately qualified health practitioner with expertise in severe dysphagia management.
In the NGO Training course staff learn why mealtime management is important for clients who experience difficulty swallowing. They will learn about the NDIS Mealtime Management Practice Standard and Quality Indicators. The course will give a sound understanding of
how this practice standard impacts the role and responsibilities as a worker providing mealtime support. They will also learn how a mealtime management plan is developed and how to implement a client’s mealtime management plan to support safe and enjoyable mealtimes.
After this course workers will be able to:
1. Understand mealtime management
2. Understand the NDIS Practice Standard for Mealtime Management
3. Identify Dysphagia and associated risks.
4. Provide mealtime support to clients.
5. Proactively manage risks and mealtime difficulties.
Course duration: 52 minutes
Any other client specific training will be delivered by an appropriately qualified RTO.
Procedure
Mealtime management plans and diets must be reviewed regularly as part of support planning processes, and with the health care professional as they recommend. Food preferences and mealtime support requirements will be documented in the client’s information form, support plan and mealtime management plan.
Mealtime and menu planning is to be conducted in the context of a person’s health needs, culture, religion and personal preferences, and includes family and other people important to the person.
Staff are to encourage clients to engage in good nutritional practices through participation in social and physical activities that promote good eating and a healthy lifestyle and include regular exercise.
Working with a client meal plan includes:
How to understand and implement each client’s plan
Preparing and providing safe meals with clients that would reasonably be expected to be enjoyable and proactively managing emerging and chronic health risks related to mealtime difficulties, including how to seek help to manage such risks.
Procedures for the client, including how to prepare the correct texture and consistency of food and fluids required in their diet.
Foods that the client is not to consume (as they may cause harm to the person)
Ensuring the client is supported to eat in the correct posture or seating arrangement.
Summary
Any client who requires a special diet must have it prescribed by a qualified health professional. Copies of menu or diet plans are to be placed in client files.
Any high intensity daily personal activity and management forms part of the formal training program and must be signed off by a Registered Training Organisation (RTO).
Supporting Documents
Forms
Client Profile Kit
NGO Course Report
NGO User Report Training Attendance Sheet
Information Sheets
Dysphagia Practice Alert (PA04)
NGO Training
Dysphagia (PA04)
Mealtime and Dysphagia Management
Legislation
Disability Discrimination Act 1992 (Cwth)
Disability Services and Inclusion Act 2023 (Cwth)
Disability Services Act 2006 (QLD)
Health Act 1937 (QLD)
Health Regulation Act 1996 (QLD)
National Disability Insurance Scheme Act 2013
NDIS (Provider Registration and Practice Standards) Amendment Rules 2021
Queensland Guardianship and Administration Act 2000 (QLD)
Queensland Human Rights Act 2019 (QLD)
Queensland Mental Health Act 2016 (QLD)
NDIS Practice Standards and Quality Indicators
BigDog Support Services Pty Ltd (BigDog) is a registered NDIS provider and is required to apply the scheme’s practice standard and quality indicators.
The standards have been developed to create an important benchmark to assess provider performance and ensure that high quality and safe supports and services are provided to NDIS participants.
The four core modules are:
1.0 Rights and Responsibilities;
2.0 Governance and Operational Management;
3.0 The Provision of Supports; and
4.0 The Support Provision Environment.
The supplementary modules cover:
5.0 Specialist Support
5.1 High intensity daily personal activities
5.2 Implementing behaviour support plans.
5.1 High Intensity Daily Personal Activities
These NDIS Practice Standards set out the responsibilities of BigDog when providing supports and services to clients that require the following.
5.1.1 Complex Bowel Care
5.1.2 PEG Feeding and Management
5.1.3 Severe Dysphagia Management
5.1.4 Tracheostomy Management
5.1.5 Urinary Catheter Management
5.1.6 Ventilator Management
5.1.7 Subcutaneous Injections
5.1.8 Complex Wound Management
5.1.3 Severe Dysphagia Management
Each participant requiring severe dysphagia management receives appropriate support that is relevant and proportionate to their individual needs and preferences.
Human Services Quality Standards
The Standards set a benchmark for the quality of service provision. Each Standard is supported by a set of performance indicators which outline what BigDog is required to demonstrate to meet that standard.
3 Responding to Individual Need
The assessed needs of the individual are being appropriately addressed and responded to within resource capacity.
3.3 BigDog ensures that services to the individual/s are delivered, monitored, reviewed and reassessed in a timely manner.
6 Human Resources
Effective human resource management systems, including recruitment, induction and supervisory processes, result in quality service provision.
6.3 BigDog provides people working in BigDog with induction, training and development opportunities relevant to their roles.
Delegation of Authority
Name Position Details
Steven Paull Director
Courtney Carroll Director
David Burrett Operations Manager
Monique Paull HR Manager Lawyer
Authorise review and implementation
Authorise review and implementation
Ensure information dissemination
Ensure compliance by employees
Version Details
This policy will be reviewed every twelve (12) months unless circumstances deem it necessary to review earlier. The review process will involve an analysis of the usefulness of the policy and to note any changes which are required to improve the policy. If minor changes are made in wording or to clarify the intent, the version number will indicate this by adding a ‘point’ i.e. Version 1.0 indicates the original version and 1.1 with the first round of minor changes made. A significant change or intent of the policy will be indicated by a whole new number i.e. Version 2.0. The following rules also apply in interpreting this policy:
• Headings are for convenience only and do not affect interpretation.
• A singular word includes the plural and vice versa.
• A word that suggests one gender includes the other genders.
January 2023 6 0 Included Human Services Quality Framework (HSQF) and Child Protection Act and the term “Participant” is returned to “Client” to allow for policies to cover NDIS and HSQF.
March 2024 6.1 Disability Services Act 1986 replaced with Disability Services and Inclusion Act 2023 and policy review process included.