Management of patients who have “Eating and Drinking with Acknowledged Risk” decision made during hospital stay - QI

Introduction:

Eating and Drinking with Acknowledged Risks is an individualised clinical decision balancing risks (may refer to aspiration, malnutrition, dehydration and choking) and benefits (quality of life, pleasure of eating). It may be applied in patients who have irreversible swallowing difficulty, with swallow reflex present where alternative means of providing nutrition are not appropriate.

Method:

Previous work completed in 2023 looked at cohort of patients where “Eating and Drinking with acknowledged risk” decision was made on Ageing and Complex Medicine ward over 12month period (n=22). Adaptations to process were made following on from this in addition to education sessions and data re-gathered in 2025 from Speech and Language referral orders to evaluate current issues with management (n=27) from across the hospital.

Results:

Overall little improvement was observed in patients who lacked capacity with only 11.5% of the cohort having all four critical points addressed in a Best Interest Meeting discussion in 2025 and variable compliance across four core outcomes 2023 vs 2025 (risks 55% vs 69%, irreversibility 32% vs 58%, not suitable for NG/PEG 64% vs 61% and best option for quality of life 86% vs 65%). Same rate of 22% readmissions was observed across both cohorts despite advanced care planning completion improvement from 22% in 2023 to 50% in 2025.

Conclusions:

We have observed little improvement in the two cohorts analysed. A system change which encapsulates important considerations for EDAR discussions will be built on our clinical informatics system to address this.