Objective: To evaluate dysphagia management in Parkinson’s patients according to National Confidential Enquiry into Patient Outcome and Death(NCEPOD)report 2021 recommendations.

Background: Dysphagia is inevitable in Parkinson’s and is a disease progression marker.Lack of dysphagia recognition and documentation puts patients at risk of malnutrition and pneumonia.The NCEPOD report made following recommendations for Parkinson’s patients admitted to acute hospital:
1-Refer patients who have swallowing difficulties( or communication problems)to speech and language therapy(SALT)
2-Notify specialist Parkinson’s service if there is indication(from notes or patient discussions)that there has been a deterioration/progression of clinical state
3-Provide written information at discharge on management of swallowing difficulties

Method: Parkinson’s patients admitted between June and September 2021 were identified and data on above-mentioned recommendations was collected though Electronic Patient Record.

Results: 30 patients(20 males)average age 82 years were reviewed.Presenting complaints were fall 37%(11/30),abdominal pain13%(4/30),pneumonia 7%(2/30) and dysphagia 3%(1/30).67%(20/30)were referred by emergency services and 4%by GP(General Practitioner).Swallowing status was not documented in any GP referral.Table 1 shows the initial assessments.
In the relevant cohort SALT referral was done for 44%(8/18)patients.Table 2 shows diet modification and feeding decisions.
RBH ‘Feeding for Comfort Form’for patients not appropriate for parenteral feeding was used for 2/12 high risk patients.10 patients required a Rotigotine patch,1needed orodispersible Parkinson’s medication.
6patients received written information about managing dysphagia on discharge.MDT involvement was relevant in 40%(12/30)cases.
Parkinson’s team reviewed 43%(13/22)patients.

Conclusion: 67% referrals were from emergency services and none of the GP referrals had swallowing status documented.Not all patients requiring SALT review were referred.Modified diet was recommended following SALT review and those with ongoing dysphagia received written information about management strategies on discharge.A working MDT group(doctors, nurses,SALT, physiotherapist, occupational, pharmacist and dietician)has been established to organise teaching for clinical staff about screening,assessment and management of dysphagia in Parkinson’s in line with the NCEPOD recommendations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dysphagia-management-in-parkinsons-patients-during-admission-to-royal-berkshire-hospitalrbhreadinguk/