The COVID-19 pandemic has profoundly impacted healthcare systems worldwide, and the management of dysphagia in nursing homes is no exception. A recent study titled "Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences" provides valuable insights and strategies that can be implemented to improve outcomes for nursing home residents. This blog will highlight key takeaways from the study and suggest ways practitioners can apply these findings to enhance their practice.
Two-Tier Protection System
One of the primary strategies employed was a two-tier protection system, where residents were categorized based on their contact and hospitalization histories. The study found that:
- Residents with recent hospitalizations or COVID-19 diagnoses were classified as "at-risk."
- Standard residents were those without recent hospitalizations or COVID-19 diagnoses.
This categorization allowed for tailored dysphagia management and appropriate use of personal protective equipment (PPE) for each group. Practitioners should consider adopting a similar system to mitigate infection risks while ensuring effective care.
Referral and Prioritization
During the pandemic, the study emphasized the importance of prioritizing referrals for dysphagia assessments and management. Key measures included:
- Urgent referrals were prioritized for both standard and at-risk residents.
- Non-urgent referrals for at-risk residents were deferred until they were reclassified as standard after a 14-day quarantine.
Implementing a structured referral and prioritization system can help clinicians manage their caseloads more effectively and ensure timely care for those in need.
Adaptation of Clinical Swallow Evaluation (CSE)
The study highlighted the need to adapt the CSE to reduce the risk of COVID-19 transmission. Recommended adaptations included:
- Emphasizing assessments of cognition and dentition, which do not require close proximity.
- Avoiding aerosol-generating procedures such as volitional coughing and certain swallowing maneuvers.
These adaptations can help clinicians maintain safety while still providing essential dysphagia assessments.
Personal Protective Equipment (PPE)
The study underscored the importance of proper PPE usage. Recommendations included:
- Face masks and gloves as minimal PPE for standard residents.
- Face shields and personal gowns in addition to face masks and gloves for at-risk residents.
Proper training in infection control and PPE usage is crucial for all healthcare workers to minimize the risk of cross-infection.
Use of Telepractice
Telepractice emerged as a viable option for dysphagia management, particularly for residents who could not be assessed in person. Key points included:
- Telepractice can be effective with the assistance of trained personnel at the remote site.
- Real-time videoconferencing can facilitate interaction between clinicians and patients.
While telepractice may not be feasible for all residents, it remains a valuable tool for those who can benefit from it.
Conclusion
The COVID-19 pandemic has necessitated significant adaptations in the management of dysphagia in nursing homes. By implementing strategies such as a two-tier protection system, structured referral and prioritization, adapted CSEs, proper PPE usage, and telepractice, clinicians can continue to provide essential care while minimizing infection risks. For a comprehensive understanding of these strategies, practitioners are encouraged to read the original research paper: Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences.
