Enhancing Care for Dysphagia: Establishing EDS Competencies for Improved Quality of Life

Dysphagia, or difficulty swallowing, is a condition that can significantly impact the quality of life for many individuals, particularly residents in health and social care facilities. Addressing the needs of those with, or at risk of developing, dysphagia is crucial for enhancing their daily experiences and ensuring high standards of care, to ultimately improve their quality of life.

To achieve this, it’s essential to establish Eating, Drinking, and Swallowing (EDS) competencies across whole care teams, to fully equip the multidisciplinary team (MDT) with the expertise needed to provide comprehensive support.

Embedding Eating, Drinking and Swallowing Competencies – a quick digest.
Establishing EDS competencies involves identifying the specific knowledge and skill sets required for each role within the care and catering teams, as outlined in the Eating, Drinking and Swallowing Competency Framework (EDSCF). This approach ensures that every team member, from carers and nurses to caterers and managers, possesses the necessary competencies to support residents effectively. Fundamental to this is adherence to the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework, which details the exact methods for preparing high quality, nutritious meals and drinks that are tailored to residents’ specific swallowing needs.

Supporting a sustainable implementation of EDS competencies involves addressing staff turnover, accommodating new staff members, managing role changes and providing ongoing training. Clear objectives and straightforward management protocols are essential for maintaining these standards over time.

Additionally, regular feedback mechanisms should be established to continually assess and improve the care provided, ensuring that residents receive the best possible support to enhance their quality of life and reduce the risks associated with dysphagia.

Implementing EDS at scale: Is it achievable?
Implementing EDS competencies at scale has been successfully demonstrated in various regions and care settings across the UK, with adoption globally too. Examples of this include East Sussex NHS Healthcare Trust, South Tyneside NHS Trust, the States of Guernsey, Ayrshire and Arran NHS Trust, along with private settings, Norse Care & Catering and Belong Villages. Between 2,000 and 6,000 staff from each organisation, across a wide spectrum of care, catering and management roles, enrolled and completed EDS and IDDSI specific training schemes. In all settings, integration of EDS training and systems has significantly benefitted the care facilities and their residents.

Tangible results demonstrate efficacy among MDTs.
Following an EDS training pilot with South Tyneside NHS community settings, 74% of participants reported they would change the way they would work as a result of completing the programme, with 34% stating they were more confident in knowing how to refer residents for assessments.

In East Sussex NHS Healthcare Trust, 86% of staff stated the catering for dysphagia diets course helped them in the way they work due to improved knowledge, which positively impacts quality of life, food safety and the choice that can be offered to patients in these settings.

Similarly, the States of Guernsey implementation report, showed that both the kitchen services and an acute stroke ward demonstrated an improvement in the production of foods for the IDDSI Framework, and the understanding and confidence in all staff to support patients with dysphagia.

Norse Care & Catering and Belong Villages have also seen improvements following engagement with a IDDSI and EDS-specific training programmes. Norse noted that 84% of attendees to the onboarding sessions felt they left with a good or strong understanding of supporting people with eating, drinking and swallowing difficulties. Belong also attested to training’s efficacy in improving confidence in compliance and quality practices.

The potential of sustainable integrated EDS training is huge.
The outcomes of implementing sustainable, integrated EDS training and systems are substantial. The pilot with East Sussex NHS Healthcare Trust led to reductions in incidents, increased confidence among staff, higher quality referrals as well as improved food quality. Specifically, an initial drop in incidents of 85%, with a year-on-year reduction of 33% in incidents on the unit until end of 2022. Since the introduction of this training, there has been just one incident in 2023 and no ‘never’ events or near misses. A value that cannot be underestimated.

Staff now also have a deeper understanding of the challenges faced by patients with dysphagia, enabling more compassionate and effective support to patients, resulting in meaningful impact on their lives.

Systematic catering systems provide numerous additional benefits.
The States of Guernsey audit report highlights improvements in staff efficiencies, consistency in service delivery, effective and speedy problem solving and enhanced due diligence processes. For example, all chefs undertaking IDDSI level specific food training responded ‘very confident’ or ‘extremely confident’ for all IDDSI food production levels.

Fiona Gardiner, Specialist Speech & Language Therapist, commented following the pilot; “Guernsey has embedded training throughout levels 1 and 2 of the EDSCF. The dysphagia modules support all levels of staff to meet their competency on the framework, and this training has meant that risks for people with dysphagia have significantly been reduced. In addition, we have used IDDSI catering training throughout the hospital catering departments, which has inspired the chefs.”

Improving quality of care for the long term.
These systematic approaches improve the immediate care environment and, through robust data capture highlighting better outcomes, can help provide confidence to organisations aiming to invest in a strong dysphagia management strategy. Establishing and maintaining EDS and IDDSI competencies across care teams is what’s needed to enhance the quality of life for residents with dysphagia and ensure long term sustainability and resilience in care standards.