Picture Of Dr DU Rand And Maddy Roberts

Addressing Aspiration Pneumonia in Care Homes

Tuesday, April 30, 2024

Respiratory Futures spoke to Dr Ingrid Du Rand (Respiratory Consultant) and Maddy Roberts (Speech & Language Therapist) at Wye Valley NHS Trust in Herefordshire. Here they share with us the background and outcomes of the Aspiration Pneumonia in Care Home project in their Trust.

What were the main drivers behind the development of the Aspiration Pneumonia in care homes project?

Aspiration pneumonia and admissions from care homes represents two thirds of admissions to care homes.  During often prolonged admissions with pneumonia, the frail elderly are susceptible to additional complications such as pressure sores, hospital-borne infections, loss of muscle mass, falls, distress, and delirium associated with a longer hospital stay.

The challenge was to lower the number of hospital admissions from care homes with a diagnosis of pneumonia.   Pneumonia accounted for 2,741 hospital admissions in Herefordshire over the past 3 years in the ‘Over 80s’ age patient group. 

Aspiration pneumonia was cited as the cause of death for 28 residents from care homes in Herefordshire in 2018.

What were the goals of the multiple phases of your study?

There were a few goals of this project.

  1. Raise awareness of Dysphagia and Aspiration Pneumonia in Care Homes through targeted teaching and support sessions.
  2. Reduce the incidence of Aspiration pneumonia in Care Homes and inpatients.
    This began with a project led by the Hospital Respiratory Team, who went out with information leaflet to care homes. The addition of input from Speech & Language Therapy (SLT) and Care Home Clinical Practitioner (CHCP) teams for the second phases has strengthened the project and impact on the outcome measures: to reduce incidence of aspiration pneumonia.
  3. Avoid Hospital Admissions/return admissions.
    The Hospital Respiratory Team recognises that those who have been diagnosed with aspiration pneumonia often ‘bounce back’ with additional chest infections shortly after returning to their care homes

How did you grow engagement of, and secure funding for, this project?

The Respiratory Consultant and Team engaged the help of a Speech & Language Therapist (S&LT) who wanted to advance Clinical Education Opportunities for Care Assistants. She encouraged application to West Midlands Academic Health Science Network to gain sufficient funding for resources. The S&LT approached the 20 largest care homes in Herefordshire to offer free training, resources and support.  Some declined this offer, but 9 of the largest care homes (over 40 beds / home) did choose to engage, as did 5 medium-sized homes (over 25 beds).

What are some of the outcomes that have resulted from your work?

The aim was to provide training, resources and follow up support to 10 of the larger care homes in Herefordshire within a 6 month period, with the aim of rolling out the provision to a further 5 care homes and countywide within the following 12 months.

We managed to achieve the following:

14 homes received the intervention within the initial 6 month period, involving 125 care staff.

A further 10 homes have received information and remaining resources: posters and leaflets.

Further Measurable Outcomes

  • Registers of staff attendance were kept within the 14 care homes, showing over 200 face-to-face interactions, representing a total of 125 different staff (attending 1 or more sessions); 20 seniors and managers attended the initial webinars.
  • 2 of each large poster (3 Ms, and 6-step check for mealtimes) was delivered to each home.
  • Each attendant received 1 of each different type of 3 leaflets, entitled “Mouthcare”, “Oral Care for healthcare staff” and “Aspiration Pneumonia and Dysphagia”.
  • 64 evaluation forms and ‘group’ evaluation sheets were studied for outcomes.

Some comments on ‘New Learning’ and ‘Useful Strategies’ discovered during the work included:

  • ‘Check for dysphagia before feeding new residents’
  • ‘At mealtimes the’ 6-step check’ poster will help to reduce aspiration.’
  • ‘Use different cups to help people with swallow difficulties’.
  • ‘Helping residents stand twice per day helps them retain lung capacity’.
  • ‘Deep breathing exercises expand the lungs’.

The Respiratory Team has subsequently used data from the project to produce a Quality Improvement Plan to introduce an electronic ‘aspiration pneumonia’ screen on elderly inpatient admission. This action then automatically triggers a referral to S&LT for a swallow assessment on admission.

This work also created follow up initiatives, for example targeted ‘Mouthcare Mobility and Mealtimes’ training sessions on the wards of the main county hospital, delivered by the Inpatient Adult SLT Team.

For people or organisations who are interested in developing or improving their prevention measures for aspiration pneumonia, what advice would you give?

  • Raise awareness around dysphagia and aspiration
  • Introduce screening: Introduce a screening form on admission to hospital for a) Dysphagia, b) Past incidence of Aspiration Pneumonia
  • Introduce protocols: Introduce protocols for resident/patient: Mouthcare e.g. pack with toothbrush and toothpaste for emergency admissions, staff having access to oral health risk assessment.