Care Home Charter for Swallowing and Medicines

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Link: http://www.carehomecharter.org/

The Patients Association UK have developed a charter for use within care homes.

Two versions of the charter exist, one for carers and one for residents and their families.

The Patients Association did some research with care homes and found that many residents were struggling to swallow their medicines. This meant they weren’t always getting the tablets they needed, so a group of healthcare experts developed a Swallowing and Medicines Charter. There are two versions of the Charter one for residents and their families and the other for carers.

Free online course

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Dysphagia: Swallowing Difficulties and Medicines

Link: https://www.futurelearn.com/courses/dysphagia

This course will enhance the knowledge of any person involved in the administration of medicines to patients with dysphagia.

The course offers an opportunity to network with other learners and with the creators of the course through discussions, graphs and social networking features and to share knowledge with other learners and professionals.

The course covers:

  • Definition and causes of dysphagia
  • How to improve medicines administration for patients with dysphagia
  • Supporting patients with dysphagia to take their medicines
  • Different medicine formulations and the important considerations for patients with dysphagia
  • Legal and ethical considerations when administering medicines to patients with dysphagia
  • Standardising the approach to reviewing medicines in patients with dysphagia

The current course opened for registration on the 28th of January 2019 and will be open until the 25th of February 2019.

Future courses will open for registration on:

28th May 2019

12th August 2019

21st October 2019

Swallowing problems and stroke – watch the video

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New video ‘Swallowing problems and stroke’

Over a million people in the UK are living with the aftermath of having a stroke. The numbers are increasing all the time, and every five minutes another person has one1.

One consequence of having a stroke is difficulty in swallowing, which may affect up to 78% of people2.

A new video ‘Swallowing problems and stroke’ can be viewed on YouTube at: https://www.youtube.com/watch?v=HEmgFVSlV0Q

Hala Jawad, a Practice Pharmacist presents the video, which features Dharinee Hansjee, an expert in stroke and swallowing problems and Janice Clark, a carer who has first hand experience of caring for relatives with swallowing difficulties. The video gives an insight into some of the issues surrounding swallowing problems and stroke, as well as offering practical advice.

The production of this video was supported by Rosemont Pharmaceuticals.

References

1. Stroke Association, State of the Nation Stroke Statistics, 2016

2. RCSLT RESOURCE MANUAL FOR COMMISSIONING AND PLANNING SERVICES FOR SLCN Dysphagia, 2009, updated 2014

Residents in care homes with dysphagia found to be almost twice as likely to experience medication administration errors as those without

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A small-scale observational study in six care homes with 166 residents in Northern England identified from observing 738 individual medication administrations, an error rate of 57.3% in those with dysphagia compared to 30.8% in those without.(1) The main differences in the reasons for errors seen in the residents with dysphagia were drug omission, incorrect performance in drug administration and inappropriate prescribing.  Signs of aspiration were witnessed in 20% of residents with dysphagia during drug administration suggesting that the formulation may not have been optimised.

The authors suggest that the omission errors may have resulted from the observation by a pharmacist and nurses choosing not to administer a medicine to a resident with dysphagia rather than administer it incorrectly. It could be seen however that administrations to residents with dysphagia were frequently incorrect and this was believed to the additional complexity which dysphagia adds to the administration process.  Inappropriate prescribing was determined largely because residents had swallowing problems, which had probably not been communicated to the prescriber, and therefore the formulation selection was unlikely to be ideal.

The authors suggest that nurses and carers should be observed regularly when administering medicines to enable solutions to improving medicines administration performance to be identified and implemented.

  1. Serrano Santos JM, Poland F, Wright D, Longmore T. Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice. International journal of pharmaceutics. 2016;512(2):416-21.

New products launched.

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Glenmark Pharma have two new branded generic soluble products.  Glensoludex is a soluble dexamethasone tablet, available in strengths of 2mg, 4mg and 8mg.  Glensoludex is indicated for use in certain endocrine and non-endocrine disorders, in certain cases of cerebral oedema and for diagnostic testing of adrenocortical hyperfunction.

Alzhok is a soluble memantine tablet, available in strengths of 5mg, 10mg, 15mg, 20mg.  Alzhok is indicated for the treatment of adult patients with moderate to severe Alzheimer’s disease.

Patient’s association launches care home charter for swallowing and medicines

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In Jan 2017 the UK Patient’s Association launched a charter to improve the care of residents in care homes who have swallowing difficulties. In response to a survey results which identified sub-optimal practices with respect to covert administration and medicines administration for care home residents with dysphagia, the Patient’s Association convened an advisory group to address the problem.  Consisting of representatives from care homes, primary care organisations, the nursing, medical and pharmacy professions and leading academics in the field, nine point charters for both patients and healthcare professionals were developed.  With recommendations that medicines and formulation choice be regularly reviewed, that residents are placed at the centre of any decision making and assessment for dysphagia is regularly undertaken it is hoped that residents in care homes will receive better quality care.  Detailed guidance on the charter and how to implement it into care homes is due in August.

Mixing medicines with thickeners can significantly reduce their effectiveness

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Recent research published in the international journal Dysphagia has shown that if Mitiglinide tablets, a treatment for type 2 diabetes are mixed with a thickener before being administered to healthy volunteers, Mitinglinide’s ability to reduce blood sugar levels was seriously affected.  In practice this would mean that if the drug was routinely administered with a thickening agent then the patient’s diabetes control would be poor.  The trial was in five patients who received the tablets on their own and then in a thickening agent and therefore acting as their own controls.  The results showed that the thickener not only delayed absorption of the drug but also resulted in reduced effectiveness. 30 minutes after ingestion the blood glucose level in patients when they had used the thickener was 160mg/dl on average compared to 110mg/dl when it was not used and this difference was shown to be statistically significant.  The authors recommend that if medicines are to be mixed with thickeners then it would be wise to carefully assess and monitor the patient.  The paper’s full title: Tomita T, Goto H, Sumiya K, Yoshida T, Tanaka K,, Kudo K, Kohda Y.Effect of Food Thickener on the Inhibitory Effect of Mitiglinide Tablets on Post-prandial Elevation of Blood Glucose Levels. Dysphagia. 2017 Jun; 32(3): 449-503. doi: 10.1007/s00455-017-9787-1.

Acupuncture Restores Swallowing After Brain Injury

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A recent study has demonstrated that acupuncture combined with neuromuscular electrical stimulation and rehabilitation exercises is an effective treatment for restoration of the swallowing function when dysphagia (defined as a disorder involving difficulty or discomfort when swallowing) has occurred following craniocerebral injuries; injuries involving both the brain and the cranium. The acupuncture practice is based on traditional Chinese medicine.

Article available at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1709-acupuncture-restores-swallowing-after-brain-injury

This shows a similar outcome to a study in 2010 where neuromuscular electrical stimulation was found to help stroke victims swallow. This second news article states that 75% of stroke sufferers are left drooling or choking on foods and drinks because they have lost their swallowing function. It is well known that improving the swallowing function in stroke patients can significantly improve their quality of life. This same improvement will apply to the aforementioned craniocerebral injury patients.

Article available at: http://www.foxnews.com/story/2010/02/25/electric-stimulation-may-help-stroke-victims-swallow.html

Both acupuncture and neuromuscular electrical stimulation are thought to be easy and quick to deliver to patients, and they also require very little patient adherence. This suggests that they may be used concomitantly in the future to help patients with swallowing difficulties.