Background: In response to adverse choking events resulting in serious harm and death, Safer Care Victoria (SCV) developed their best practice guidelines for 'Communicating Safe Eating and Drinking' in 2020. The Monash Health speech pathology department conducted a gap analysis comparing these best practice recommendations to current organisational standards. In order to overcome identified gaps in best practice and mirror SCV recommendations, a working party was established to develop and implement departmental dysphagia clinical guidelines and minimum documentation standards .

Aims:
- Understand current practice of speech pathologists in dysphagia assessment, management and documentation;
- Improve patient safety outcomes relevant to dysphagia assessment, management and documentation; and
- Influence lasting behaviour change to standardise dysphagia management clinical documentation.

Method: Following development of the clinical guidelines and minimum documentation standards, a retrospective audit of current dysphagia assessment and documentation standards was completed. Education of minimum standards and expectations of documentation were communicated to all speech pathologists utilising the best practice guidance inspired by SCV. Speech pathologists provided feedback on the barriers and enablers to meeting the required standards. Behaviour change strategies were employed in order to influence lasting improvements in dysphagia assessment, management and documentation.

Results: An initial post-implementation audit revealed areas of strength: 98% of initial dysphagia assessments commented on communication functioning; and 90% completed an oromotor exam. However, areas for improvement were also identified: consistently adding the dysphagia ‘problem’ and risk of aspiration ‘alert’ in the EMR and clear documentation of supervision requirements. Speech pathologists engaged well in behaviour change strategies, such as participating in regular documentation reviews as learning opportunities. Results from a follow-up audit are pending.

Conclusion: Communication of clinical risk in dysphagia management remains critical to mitigate adverse events. The implementation of best practice dysphagia assessment and documentation guidelines can improve patient safety outcomes.

1. Safer Care Victoria released their best practice guidance for 'Communicating Safe Eating and Drinking' in 2020 in response to harm and death caused by choking deaths in hospitals;
2. Monash Health developed and implemented dyphagia guidelines and minimum documentation standards based upon SCV guidance;
3. An audit and feedback approach was adopted in order to influence departmental behaviour change, resulting in improved assessment and documentation standards and mitigating clinical risk.