Care plans, recording and escalation

Clear, accessible plans reduce guesswork. CQC guidance on choking requires care records to state how food and drink must be prepared, and incident reviews show harm can occur when SALT advice is not communicated, records are inaccurate or discharge information is not shared. Swallowing care plans should be easy to find, simple enough for agency or night staff to follow, and updated whenever instructions change.

Recording should note what was offered, how the resident managed it, any coughing or distress, whether the exact texture and positioning were followed, what support was provided, and who was informed. Escalate when plans are unclear, when symptoms worsen, when the resident eats or drinks less, when chest infections recur, or when the current plan no longer appears to keep the resident safe.

What a useful swallowing plan should cover

• Current texture and fluid instructions: clear terms, not vague labels.
• Support method: position, pace, prompts, supervision level and any equipment.
• Medicines guidance: what has been approved and what has not.
• Warning signs and escalation: what should trigger same-shift review or urgent help.
• Communication: how changes are handed over to the next shift, the kitchen and outside teams.

Manager focus: kitchen, agency and transfer safety

A swallowing plan only protects people if every shift can find it, understand it and follow it exactly.