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In this article, Yvonne Fallon, Clinical Risk Advisor, and Dr Natasha Coen, Senior Clinical Risk Manager, present the risk factors associated with choking on food and provide advice for safe practice.*

Choking can result in serious or fatal outcomes and the risk of its occurrence can be reduced through careful risk assessment and management.

Those identified as being at higher risk of choking include those with neurological conditions such as stroke and motor neuron disease, people with dysphagia (difficulty with swallowing) or oeshophageal pathology, people with mental health difficulties, those with intellectual disabilities and older people.

Incidents related to choking, reported on the National Incident Management System (NIMS), include incidents where the diet was of unsuitable consistency, where bones were present in food (particularly fish or chicken), where the dietary plan was not followed, where “nil by mouth” instructions were not followed, or where high risk of choking was not recognised.

Risk Considerations

A number of risk factors have been identified which may contribute to choking incidents, such as:

  • Incorrect diet consistencies or food not prepared to correct level in line with the International Dysphagia Diet Standardisation Initiative (IDDSI)
  • Food that may contain bones
  • Lack of awareness or communication by health and social care professionals of dietary requirements, including during transfer of care between different settings
  • Lack of assistance and supervision at mealtimes where required
  • Dysphagia or impaired chewing
  • Maladaptive mealtime behaviours such as increased rate of eating or eating food in inappropriate amounts/size
  • Pica (eating non-food items)
  • Poorly fitting dentures and reduced oral care
  • Side effects of polypharmacy or certain psychotropic medications
  • Reduced level of consciousness

How to minimise the risk of choking in the health and social care setting

  • Provide people with different levels of dysphagia, as described in the IDDSI, with food, meals and fluids that are appropriate to their needs
  • Ensure all staff working with service users with dysphagia are trained in the IDDSI
  • Make appropriate referrals to a speech and language therapist for assessment and management
  • Seek dietetic input advice on adequacy of nutrition where modified consistency diets are recommended
  • Clearly communicate dietary care plans to all members of the multi-disciplinary team, including catering personnel
  • Use dietary status signage (where appropriate), in line with the IDDSI, to aid communication
  • Ensure family members and carers are aware of any modified diet and restrictions to dietary intake
  • Ensure appropriate supervision is in place for those identified as having a higher risk of choking when eating or drinking
  • Modify the mealtime environment so that service users have sufficient time at mealtimes and reduce distractions
  • Ensure appropriate positioning of service users at meal times
  • Address any higher-risk eating behaviours such as impulsivity
  • Optimise oral health care and ensure correct fit of dentures
  • Ensure all staff members have regular training in performing abdominal thrusts (Heimlich manoeuvre) and basic life support on people of all ages

*This advice was prepared in consultation with the Health Service Executive (HSE), Irish Association of Speech & Language Therapists (IASLT), and Irish Nutrition and Dietetic Institute (INDI).

References available upon request.

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