Speech and Language Therapy Dysphagia Referral Form

 
Speech and Language Therapy Dysphagia Referral Form

WE ARE UNABLE TO ACCEPT INCOMPLETE FORMS (boxes with * are mandatory)

Note: To ensure a resident will be seen, an online referral form should be received 24 hours before the SLT visit is due.

Consent

Relevant Medical History

Relevant Medication

Or causing the following:

Chest Infections

Current diet and fluids consistency

Communication

Clinical indicators that specialist swallowing assessment is required

For residents declining swallowing recommendations

NB All health professionals are qualified/have a duty to assess capacity, it is not a specialist SLT skill

• If the resident has capacity, it is their right to decline the recommendations. Document your capacity assessment and the resident’s decision clearly in the resident’s notes. There is no need to refer.
• If the resident does not have capacity then the nursing home needs to make/facilitate a ‘best interest’ decision (involve the GP if necessary). Document this clearly in the resident’s notes. There is no need to refer.
A speech and language therapist should only be involved if the patient has a complex communication difficulty and specialist communication assessment is required to determine capacity.

Referrals Flowchart*
Included in the Referrals Procedure Pack. This tool helps referrers decide if a referral to Speech and Language Therapy is appropriate. Appropriate referrals enables us to provide a better, faster service.

Referrer Dysphagia Advice Leaflet**
Included in the Referrals Procedure Pack. This tool provides the referrer with advice and strategies to try with the resident whilst awaiting specialist assessment.

Sending