Journal of Community Nursing - page 86

86 JCN
2013,Vol 27, No 4
When a medicine is recommended
for administration outside of licence, it
is important that this recommendation
comes from a reliable source and
that it is recorded. This demonstrates
that the patient has been treated and
considered fairly.
In their follow-up to
Death by
, Mencap (2012) concluded
that many clinicians still fail to
provide adequate treatment to
patients with learning disabilities.
The guidelines highlight the
clinician’s duty to the patient, the
need to demonstrate equality in
their subsequent actions and the
need to be aware of the regulator’s
perspective (Wright et al, 2012).
A duty of care arises when a health
or social care professional undertakes
the management of a person with a
learning disability — the clinician is
legally obliged to provide evidence-
based care and treatment tailored to
the individual.
This duty continues until treatment
is no longer clinically required, the
service user refuses further treatment
or care is transferred. Deciding to
discontinue the medication of a person
with a learning disability because of
their inability to swallow would be an
example of a breach of this duty of care.
The law clearly states that any health or
social care professional who fails in this
duty is accountable, and has to answer
for that failure.
Discriminating against a person
with a learning disability because of
that disability is unlawful and is an
offence under the Equality Act, 2010.
Where an inability to swallow is a
feature of a person’s learning disability,
the proper assessment, identification
and management of that person’s
swallowing difficulty should be
carried out. Consequently, a minimum
requirement from the point of view of
the community nurse is that anyone
with a learning disability suspected of
dysphagia should be referred to a GP.
The Health and Social Care Act 2008
created the Care Quality Commission
(CQC), which has imposed essential
standards for quality, safety, and
management of medicines as
summarised below:
Medicines prescribed or
administered must be appropriate
and person-centred
A person’s disabilities must be
considered when prescribing and
administering medicines
Prescriptions must be up to date,
regularly reviewed and changed
following the individual’s needs
If a person develops swallowing
difficulties, the route of drug
administration should be reviewed
Risks should be managed through
effective medicines handling,
including correctly dispensing,
preparing, administering,
monitoring and disposing
of medicines
Procedures should be in place
for providing medicines covertly
in accordance with the Mental
Capacity Act, 2005.
Unsurprisingly, failure to comply
with these guidelines can result in
a clinician receiving a warning or a
fine, and may also lead to closure of
a service. Additionally, following a
2010 amendment to the 2008 Health
patient and carers and by observing
the administration of food, liquids
and medicines.
Any patient with dysphagia should
be referred to their GP to enable them
to decide the most appropriate actions
and the recent guidelines provide
detailed and considered guidance in
this respect (Wright et al, 2012).
Simple interventions to improve
food and liquid consistency
and review medicines and their
formulation can reduce the risk
of choking and aspiration. The
community nurse is ideally located
to monitor adherence to swallowing
care plans and to instigate medication
reviews. Where medicines are being
tampered with before swallowing, this
practice should be carefully considered
for appropriateness, safety and legality.
Medicines are central to the decision-
making process and are focussed upon
by external regulators.
Patients with learning disabilities
should be treated in the same way as
patients without learning disabilities
and all actions and decisions should
be accurately documented to
demonstrate this.
‘A duty of care arises when
a health or social care
professional undertakes the
management of a person with
learning disabilities.’
and Social Care Act, the CQC will
also pass on evidence of poor practice
to a professional’s regulator, which
could lead to the investigation of an
individual’s fitness to practice.
Community nurses frequently
provide care for patients with learning
disabilities. Dysphagia is found in
more than one-third of these patients
and in addition to affecting quality of
life, it increases the risk of choking and
aspiration. Appropriate management
can improve patient care and
minimise NHS costs.
It is, therefore, important that
dysphagia is identified and any risk of
choking and aspiration assessed. This
can be undertaken by speaking to the
Over one-third of patients with
learning disabilities will have
some form of dysphagia.
Dysphagia increases the risk
of choking and aspiration
Discussion with carers and
observation of feeding may be
required to identify the possibility
of dysphagia.
Where dysphagia is suspected
then referral to the patient’s GP
is necessary.
Medication review is essential
to ensure that the patient only
receives medicines that
are necessary.
Medication formulation requires
careful consideration to ease
administration and patient
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