Safer mealtimes, positioning and supervision

CQC guidance on dysphagia includes practical details such as posture and positioning, pace of presentation, time allowed between bites and swallows, the dining environment, and how staff should assist during meals and drinks. Good support requires more than the correct texture: the resident must be alert, upright, calm and supervised as set out in their swallowing plan.

CQC's learning from choking incidents shows the harm that can follow when positioning advice is ignored. In one case, a resident whose SALT plan specified an upright position with head support choked while eating breakfast in bed after care records were not updated correctly. The practical lesson is clear: mealtime instructions in the swallowing plan must be followed.

What safer mealtime support often includes

• Position: help the resident into the posture specified in the plan.
• Pace: allow adequate time between bites and swallows.
• Attention: reduce rushing and unnecessary distractions where the plan requires focused eating.
• Supervision: provide the level of observation and assistance the resident has been assessed to need.
• Alertness: escalate if the resident is too drowsy, distressed or breathless to eat safely.

The right texture can still be unsafe if the person is in the wrong position or the support is too rushed.