In the event that the medical team initiate this process prior to SLT assessment, they are able to access the protocol and print out the documentation. This prevents delay in appropriate management. A SLT assessment should always inform the eating and drinking with acknowledged risk decision so that risk reducing consistencies and strategies can be established, where possible.

If there is no concern over capacity, the SLT should clearly document this in their notes using the eating and drinking with acknowledged risk capacity sticker (paper notes) or eating and drinking with acknowledged risk capacity standard statement (electronic notes).

If there are concerns raised regarding an individual’s capacity, the medical team member is responsible for conducting a capacity assessment which explores whether the individual has capacity regarding nutrition planning and the risks involved in continued eating and drinking.

Where a patient has a communication difficulty, SLT can assist in gathering information to inform the capacity assessment and support the individual to make their needs known using a total communication approach.
5.5 Whilst conducting a swallow assessment the SLT will establish the individual’s baseline communication and whether they have a consistent, reliable means of communication.

The risks of continued oral intake will be fully explained to the individual and where required supportive communication boards/pictures, Talking Mats or easy read information resources may be used to optimise the individual’s understanding of the information discussed. The alternative supports listed are not an exhaustive list and a person centred, total communication approach should be employed at all times.

The medical team member or SLT will then return at a later point to confirm retention of the information explained. In the community this may be a follow phone call or visit on another day. The SLT can use the Capacity Gathering Information Tool to assist in collating this information.

The SLT will discuss the capacity gathering information and swallow assessment findings with a member of the medical team before an eating and drinking with acknowledged risk decision is documented. Where the individual is deemed to have capacity to make this decision, professional colleagues should discuss with the individual their wishes around sharing the outcomes and management plan with their family/next of kin. Those present during the discussion might include the medical team, SLT and Dietitian.

Where the individual lacks capacity, a best interest multidisciplinary decision can be taken, and this may include a best interest meeting with the family/next of kin. This should be clearly documented in the patient medical records. The guideline must be signed by a consultant or GP as they will ultimately make the best interest decision on eating and drinking with acknowledged risk.

Information about eating and drinking with acknowledged risk should be presented in an accessible way and individuals and relatives should be given a copy of the information leaflet so that they have further opportunity to reflect on and process this information.

The eating and drinking with acknowledged risk decision must be documented clearly in the following places:

• Medical, Nursing and SLT notes (using eating and drinking with acknowledged risk recommendations sticker).
• EMIS/ Carepartner (using eating and drinking with acknowledged risk recommendations standard statement).

A copy of the eating and drinking with acknowledged risk summary document and the capacity gathering information tool (if used) must be:

• Filed at the front of the medical notes.
• A copy sent to health scanning for upload to the clinical portal.
• A copy emailed to GP practice.
• Uploaded to EMIS or Carepartner.
• The original retained in SLT paper notes (if using).

An Eating and drinking with acknowledged risk Care Plan (Appendix 3) should be completed and/or filed somewhere accessible.

Depending on the management plan, the SLT should complete either the eating and drinking with acknowledged risk standard letter or the eating and drinking with acknowledged risk discharge report. This should be disseminated to all relevant parties. This may include, but is not limited to;

• GP
• Consultant
• District Nurse
• CNS
• Nursing Home Manager
• Care at Home Manager
• Social Worker
• Next of Kin
• Dietetics

Appropriate nursing handover should take place to ensure that risk is acknowledged and minimised this may include; scrupulous oral care, optimum seating position and where required assistance with eating and drinking.

The medical team should ensure that an escalation plan is in place (which has been agreed with the person and/or their family/care team) in the event the individual becomes unwell as a result of eating and drinking with acknowledged risk.

It is important that clear communication around eating and drinking with acknowledged risk recommendations takes place between the community and acute interface. This allows cohesive care to support the individual who is eating and drinking with acknowledged risk to be managed at home, taking account of their individual treatment escalation plan.

All discharge documentations should be emailed to health records to ensure it is uploaded onto the clinical portal and the individual, their family and care team (e.g. GP, care home staff, district nurses, home care etc.) should also have a copy.