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Speech & Language Therapy (Dysphagia Only)

Please note: All fields are mandatory and must be completed.
To ensure a resident will be seen, an online referral form should be received 24 hours before the SLT visit is due.

I have completed the Referrals Flowchart* and the result indicates this referral is appropriate *

Consult the Referral Dysphagia Advice Leaflet ** 

To download/print a copy of this form, please click here.

Note: To ensure a resident will be seen, an online referral form should be received 24 hours before the SLT visit is due. I have completed the Referrals Flowchart* and the result indicates this referral is appropriate *



    Consent

    Is the person taking any medication that is affecting their swallow?

    Or causing the following

    Drowsiness

    Dry Mouth

    Has the resident had any chest infections?

    Antibiotics?

    Details:

    Please Select

    This is not an emergency service. Nurses have a duty to try and address swallowing difficulties whilst awaiting specialist assessment.

    Consult the Referrer Dysphagia Advice Leaflet**

    Does the resident have mental capacity, i.e. can understand, weigh up and communicate (verbally or non-verbally) the risks of not following recommendations?

    NB All health professionals are qualified/have a duty to assess capacity, it is not a specialist SLT skill

    • If the resident has capacity, it is their right to decline the recommendations. Document your capacity assessment and the resident’s decision clearly in the resident’s notes. There is no need to refer.
    • If the resident does not have capacity then the nursing home needs to make/facilitate a ‘best interest’ decision (involve the GP if necessary). Document this clearly in the resident’s notes. There is no need to refer.

    A speech and language therapist should only be involved if the patient has a complex communication difficulty and specialist communication assessment is required to determine capacity.

    Note: if you don't receive a confirmation email please contact your Nualtra account manager

    Referring nurse must sign referral with his/her name- any referrals signed as ‘CNM Nurse on duty’/‘Staff Nurse on Duty’ or left blank will not be accepted