Key points:
- Providers should be alert to choking risks within your service
- Providers should ensure 24/7 onsite first aid capabilities
- All staff should understand how to manage a choking event
- Clinical staff should be able to access and use suction devices to remove food and liquid from the mouth and throat if required
- Suction devices should be checked regularly to ensure they are functioning properly
- All staff should be aware that an advance care directive not to resuscitate does not mean first aid shouldn’t be performed when needed e.g. during a choking episode.
The Commission is advising you as a residential aged care provider to be alert to choking risks and to ensure 24/7 onsite first aid capabilities within your service.
This alert comes after a South Australian coroner made recommendations in a recent report about managing a choking incident in a residential aged care service.
You should ensure there is onsite first aid capability at your service and that all staff within your service know how to access this at any time.
Staff should be aware of the immediate measures required to manage a choking event, including how to call for assistance and commence first aid measures. Clinical staff should know how to access and use suction devices when required, and there should be processes in place to ensure suction devices are functioning properly at all times.
You should ensure your staff are aware that an advance care directive not to resuscitate does not mean first aid shouldn’t be performed when required e.g. in the event of airway blockage or in the event of injury with bleeding.
In relation to choking, your staff need to be made aware of the following:
- choking can occur at any time, including in people with no known swallowing issues
- there’s a higher risk of choking in people who have various types of dysphagia or swallowing dysfunction
- a speech pathologist can help assess swallowing risk and advise on strategies to minimise this risk, including feeding, timing and posture strategies and texture modification of foods
- any discussions between a resident, speech pathologist and staff member about swallowing issues needs to be consumer-focused, individualised and well documented
- risks can change over time and records of decisions and preferences must be kept up to date
- residents can decide to what extent they take the advice and accept known risks, which may include aspiration or choking events. Discussions around risk should include consideration of the degree of risk; nutrition risks; quality of life and food enjoyment; discomfort; potential distress experienced by those who witness a negative outcome of the risk; and any other issues relevant to the individual.
A choking event should be managed as an incident. This includes:
- open disclosure
- investigating and understanding the contributing factors in the individual and their eating/feeding and care
- assessing the staff response to the incident
- planning to make any identified required changes
- ensuring sustained implementation of changes
- having a speech pathologist assess or reassess the resident and discuss the person’s updated food risks preferences and decisions
- staff debriefing and support.
You can find accredited first aid courses at various locations including through St John Ambulance Australia, the Royal Life Saving Society - Australia and the Australian Red Cross.
Please print and display this St John first aid fact sheet at your service.
Please share this alert with relevant management and staff within your service.
Dr Melanie Wroth MB BS, FRACP
Chief Clinical Advisor