The link above (to the e-referral form) is only to be used by nursing and care homes whose residents are registered to these GP surgeries
Click on the image on the left to download the Referral Flow Chart
What swallowing difficulties should I refer to SLT?
There are many issues relating to your residents on intake that you can manage without a specialist SLT assessment. The swallow resource pack is designed to give you as much information as possible to support you with your decision making.
When should I refer to SLT?
- Difficulty with fluids that suggests there is an aspiration risk. Refer to Managing Fluids fact sheet if they have been started on thickened fluids by another health professional and/or trials of naturally thickened fluids have been started and they are presenting with reduced adverse clinical signs.
- You have followed the guidance in the Swallow Resource Pack and taken steps to manage any risks and your resident continues to present with swallowing difficulties not related to challenging behaviours, positioning issues or purely medication.
- Complex Neurological condition e.g. Huntington's Disease, MND.
- New dysphagia and presenting with multiple dysphagia warning signs e.g. chest infections, wet voice.
What would give me no reason to refer?
- Diet texture change – to make it easier to swallow. Trial a lower Level IDDSI diet, one step-change at a time e.g. Level 7 Normal Diet to Level 6 Soft Bite Sized to Level 5 Minced Moist. No more than 2 dietary Levels. Refer to Frequently Asked Questions in Swallow Resource Pack
- Diet texture change – increase texture due to improvement. No previous concerns of choking risk. Trial higher level IDDSI diet one step-change at a time
- Best interest – SLT recommendations are in place with a known risk of aspiration or choking but patient and/or family requesting upgrade in diet and/or fluids. The home will need to arrange an MDT meeting with GP and NOK to agree a care plan ensuring that a balance is maintained between independence, safety, nutritional requirements, and quality of life.
- Issues with dentition impacting chewing, with the absence of other swallowing difficulties
- Issues with swallowing medication, with the absence of other swallowing difficulties
- Issues with challenging eating and drinking behaviours and no clinical signs of dysphagia
- Already has a SLT care plan in place and this is not being followed
- Agreed Eating and Drinking with Acknowledged Risk in place
- Weight loss in the absence of swallowing problems
- Vomiting or gastro-oesophageal problems in the absence of other swallowing difficulties
- Resident wants to eat a softer diet
- Too drowsy to eat and drink
- One off choking incident Refer to Swallow Resource Pack
- Poor positioning, refer to OT or PT for support
- Referral for completion and endorsement of Nursing/Care Home documentation. Specialist SLT assessment is not required
- A resident deemed to have Mental Capacity for choices around eating and drinking, who chooses to make what may be deemed as unwise choices around what they eat or drink and/or against SLT recommendations
- End of Life – if your resident is considered palliative, medication has been stopped and/or they are declining or too drowsy to eat and drink, consider if SLT input will be of benefit to the individual. Declining oral intake is a natural part of the dying process.
Please ensure you complete the Managing Dysphagia Checklist before referring.
If you need to get in touch with one of our team please use this form: Contact Us. Please give us as much detail as possible, and remember this is not an e-referral form.
