If people have swallowing difficulties, do you have guidance and care plans on how to administer oral medicines safely and effectively, for example crushing a tablet?

The MHRA has asked manufacturers of UK macrogol (PEG) laxative products add information about this potential interaction to the Summary of Product Characteristics and the Patient Information Leaflet. Royal College of Speech and Language Therapists (RCSLT) (2014) Dysphagia resource manual for commissioning and planning services for SCLN. Available at: http://www.rcslt.org/speech_and_language_therapy/commissioning/dysphagia_manual_072014. Date accessed: May 2015.Most people need to drink 6-8 glasses or mugs of fluid (around 2 litres) every day to keep well hydrated. You may need more on a hot day. Emma Derbyshire. The Essential Guide to Hydration. Available from: http://www.naturalhydrationcouncil.org.uk/wp-content/uploads/2012/11/NHC-Essential-Guide-Hydration-FINAL.pdf Date accessed: July 2019 Dysphagia can occur at any age, from premature babies, through to the elderly and those at the end of life. Problems may arise as a result of: Has a medicines review been carried out to make sure that medicines are necessary and can be taken safely? The patient will need to drink 200ml to receive the full dose. This is unlikely to be acceptable, particularly if they take multiple medicines. Directions

Martino R et al. (2005) Dysphagia After Stroke Incidence, Diagnosis, and Pulmonary Complications. Stroke; 36(12):2756-2763. It is not possible to properly assess the consistency achieved, making this option unsuitable other than as a last resort. As you get older, the swallowing muscles in the mouth and throat often become weaker, slower or less efficient. This can be made worse when you’re ill. Certain medical conditions can also affect your swallowing. These changes might make swallowing drinks more difficult so that there is a risk the drink could go down the wrong way. If it gets into the windpipe and even the lungs it can cause you to cough or choke when drinking. This is called aspiration. Sometimes a person might not cough or choke when they have aspirated. This is called ‘silent aspiration’. Aspiration can cause serious chest infections, or even pneumonia. The Francis Report highlighted the importance of giving people food and fluid in a form they can safely consume. It forms part of NICE Guideline NG128. Considerations for providers Guan XL etal. (2015) Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci ; doi. 10.1007/s10072-015-2067–7

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Matching the national descriptors**, improved mixing quality ensures the right consistency is achieved every time. Dissolve the tablet or sachet first in a small amount of water and then whisk the liquid medication into the drink. Individuals may have difficulties with a range of actions required for eating and drinking safely and efficiently. Such as:Do staff know how to spot warning signs such as difficulties and discomfort at meal or drinks time, dehydration, weight loss, and chest infections? O’Loughlin G and Shanley C. Swallowing problems in the nursing home: A novel training response. Dysphagia 1998; 13:172–183. National Institute for Health and Care Excellence (NICE), Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition: NICE Guideline [CG32]. 2017. Available from: https://www.nice.org.uk/guidance/cg32 [Accessed 1st December 2017]