HealthLink BC File #110a, May 2010
Preventing Choking in Residents in Residential Care Facilities
A Focus on Staff
- On admission to a residential care facility
- During care
- What can I do to help prevent choking during snacks and mealtimes?
- What special training should workers have?
Some adults and youth who live in residential care facilities may have chewing difficulties, swallowing problems or dementia and can be at high-risk for choking. Residents who have had a stroke or head injury, or those with conditions such as Multiple Sclerosis (MS), Parkinson's Disease, Cerebral Palsy or Amyotrophic Lateral Sclerosis (ALS), are also often at higher risk for choking. It is important that staff is aware of ways that they can help prevent choking.
On admission to a residential care facility
When a new resident comes to live at a residential care facility, a Nutrition Care Plan must be completed as part of the professional clinical assessment and care plan. The Nutrition Care Plan includes information about what type of diet the resident needs, and any specific mealtime changes or help that is needed to prevent choking. If the resident arrives with a special diet or meal plan, it is to be followed until they are assessed by a qualified health care provider.
The Nutrition Care Plan must be developed with the assistance of a Registered Dietitian in facilities with 25 or more persons in care. If the facility has fewer than 25 persons in care, the Nutrition Care Plan may be completed by another staff member. A Registered Dietitian will be consulted if staff decides that the resident needs further assessment. A nutrition screening form is used to decide when to refer to a Registered Dietitian. See the "For more information" section.
If the resident is admitted with "dysphagia" (or swallowing difficulty) a Registered Dietitian or dysphagia team member should assess the resident as soon as possible. Changes in the texture of foods may be needed. Some residents may also have trouble swallowing thin fluids such as water or milk and may need thickened fluids.
A resident's health condition can change over time. If you notice that a resident is having any of the following difficulties during or after eating and drinking, they may need to be assessed by a Registered Dietitian and/or dysphagia team member:
- Coughing, choking or excessive drooling,
- Pocketing food (holding food in the cheek area, under the tongue, or on the roof of mouth),
- Making "gurgling" sounds,
- Having slurred speech,
- Complaining that food "gets stuck" or "goes down the wrong way",
- Clearing the throat regularly,
- Refusing or avoiding certain food(s),
- Lung congestion or chronic respiratory infection,
- Sleepiness, tiredness or slumping over during meals,
- Eating very slowly (longer than 30 minutes to eat a meal) or leaving meals uneaten,
- Forced chewing or swallowing,
- Taking many swallows with one bite,
- Eye tearing after swallowing,
- Food or liquid comes out of the nose at meal or snack time or with attempts to swallow.
Some residents may not show any signs of choking or coughing even when food or drink "goes down the wrong way" or enters the airway. This is called "silent aspiration". In some cases the resident may not be aware that this is happening or may not be able to tell you what they are feeling. If you are in doubt, refer the resident to a Registered Dietitian and/or dysphagia team member.
Residents with swallowing difficulties may have trouble eating enough food and drinking enough fluids to stay healthy. Weight loss and signs of dehydration are other signs to watch for, although swallowing difficulties are not always the cause of weight loss or dehydration.
What can I do to help prevent choking during snacks and mealtimes?
- If you help prepare foods in a facility, get training in how to prepare modified texture foods (such as pureed, minced or chopped foods). You also need to be familiar with the different consistencies of thickened fluids.
- Be familiar with the facility's Choking Response Protocol, and follow this during meals and activities involving food. If you are supervising volunteers, be sure that they are also aware of what to do if choking occurs.
- The food that is served to each resident should be the same as what is written in the Nutrition Care Plan. Check that texture changes in foods and the consistency of fluids are correct. Refer to the resident's Care Plan or a list of current diet plans if you are not sure.
- Check that the correct meal is served to the correct resident.
- If needed, make sure that feeding aids (such as special cups, plates or cutlery) are at the table for each meal or snack. Check that dentures are in and fixed in place before the meal starts.
- Mealtimes should be supervised, especially for those who are ill or at risk for choking. Watch for signs of swallowing difficulty or choking risk. Refer to a Registered Dietitian and/or dysphagia team member for further assessment as needed.
- Provide help during meals to those who need it. This may include:
- helping residents to sit upright when eating, drinking or swallowing medication;
- cutting up food;
- helping residents get food or fluid from the plate or cup to their mouth; and
- reminding or prompting the resident to swallow, slow down or to continue eating or drinking.
- Limit distractions during mealtimes (such as loud talking or television sounds).
What special training should workers have?
It is a regulation that residents in licensed BC residential care facilities must have immediate access to at least one employee who:
- has a valid first aid and CPR certificate;
- is knowledgeable about their medical conditions, including their risk of choking; and
- is able to communicate with emergency workers.
For more information
Meals and More Manual: A Foods and Nutrition Manual for Homes of Adults and Children with 24 Persons or Fewer in Care. www.health.gov.bc.ca/library/publications/year/2008/Meals_and_More_Manual.pdf
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