Even after Mr. Polombski’s choking was identified by staff, there was a significant delay in the process of attempting to clear his airway. In fact, evidence at the trial suggested that the facility waiting approximately 12 minutes from the time the choking was identified until they contacted paramedics. The delay in obtaining care to clear the airway was alleged to have exacerbated the situation.
Choking is a disturbingly common type of injury that threatens the safety of nursing home patients– particularly those who have sustained a stroke or other neurological injury. In order to minimize a patient’s risk of choking, facilities frequently utilize the skills of a speech therapist to conduct a swallowing test to determine what type of dietary modifications need to be made to the patient’s food: served cut up, ground, chopped, pureed, or in another manner which meets the patients physical abilities.
In patients with extensive swallowing difficulties, restrictions may me implemented on the type of food or drink that the patient can have. In extreme circumstances, a doctor may categorize the patient as “NPO”. NPO stands for Nothing Per Orem which means nothing by mouth. Doctors use this on orders when they do not want the patient to take in any type of food or liquid by mouth.
Once the dietary restrictions have been put into place, it is up to nursing home staff to carefully implement the orders and keep the dietary orders in place until they receive alternative orders from the patients physicians.
However, even in circumstances where patients have dietary restrictions in place, it is important for staff to monitor all patients during meal times to help patients safely enjoy their food. At all times, staff should always incorporated basic choking precautions:
- Encourage patients to sit upright
- Always keep a beverage within reach
- Don’t rush patients while they eat
- Warn patients about food that may have bones or skin that may not be apparent
- Train staff on how to dislodge food / Heimlich maneuver
Related:
Dysphagia In Nursing Home Patients May Contribute To Medical Complications Such As: Choking, Pneumonia Or Death
Swallowing Therapy of Neurologic Patients- Correlation of Outcome with Pretreatment Variables and Therapeutic Methods (pdf) Dysphagia 10:1-5(1995)
Jury awards $2.35 million for death caused by choking on meatball in Warren nursing home Daily Tribune