Enhancing dysphagia management: Facilitated e-learning works and offers value for money.

Introduction: Dysphagia is a common, potentially life-threatening problem that compromises quality of life. A collaborative project was set up between the CLAHRC for South Yorkshire and the Stroke Service at Sheffield Teaching Hospitals to tackle identified inconsistencies in the management of dysphagia. The aim was to enhance staff knowledge and skills by piloting an innovative approach to workplace-based e-learning. Each session comprised a needs analysis, e-learning programmes, practical skills about modifying fluids, and action planning to transfer learning into practice. Method: Twelve-month’s (March 2010-February 2011) action research on a stroke rehabilitation ward, evaluating the training effect and resource use cost of the facilitated e-learning. The methods were a scoping review, baseline and follow-up observations of dysphagia management (16 and 18 hours respectively), four bespoke questionnaires with attitude (Colodny 2001) and knowledge scales; and the cost per working hour for the stroke service. Results: Only five of 32 participants (22 registered nurses, 10 health care assistants) reported attending any previous dysphagia training. The training effect was evident in statistically significant differences in attitudes and knowledge held by the same people, at two time points, using the Wilcoxon signed rank test. The most common changes in practice related to medicines management, thickening fluids and oral hygiene. The resource use cost was estimated at £2,688 for 108 hours training. Conclusion: All participants achieved Assistant Dysphagia Practitioner competence level. Key success factors were designating dysphagia as mandatory, job specific training and combining expert facilitation with relevant e-learning programmes. These factors are easily replicable.