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Publication Type: Patient Safety Alert
Single or Multiple Incident: Multiple
Date: 1/26/2021 12:00:00 AM
Country: South Korea
This alert discusses the patient safety hazard of choking on food in patients at risk. Two fatal cases are described in patients with dysphagia and high risk of aspiration, respectively. Risk factors for choking, symptoms of dysphagia and symptoms of airway obstruction are identified in the alert. The alert provides recommendations for preventing airway obstruction by food describing preventative measures, response to emergency situations of airway obstruction and education and training for staff in medical institutions.

Additional Details

Device:
laryngoscope, tracheostomy tube, suction machine

Rules / Policies / Procedures
  1. Preventive measures against airway obstruction by foreign substances - Carefully observe the patient's intake, eating habits, coughing, and other meal problems during mealtime - Monitor the patient's meal time(eating speed) - Carefully monitor the food provided by carers - Provide supplementary food with different concentrations and texture in accordance with the patient's swallowing ability - Use prescribed viscosity enhancer to control viscosity of food (e.g. water at a viscosity of yogurt)
  2. Response to emergency situations caused by airway obstruction by foreign substances: When the patient is conscious - If can speak : Ask for help and encourage coughing (Recommended to tap on the back if can't cough effectively). - If can't speak : Ask for help and perform abdominal thrusts( Heimlich maneuver) until lose consciousness or foreign substances come out. - It is the most desirable to induce cough if can speak even a little bit, and need to press the chest not the upper abdomen for pregnant women or obese patients.
  3. Response to emergency situations caused by airway obstruction by foreign substances: When the patient is unconscious: - Perform CPR after asking for help. - Check the presence of foreign substances in the mouth before taking artificial respiration after chest pressure (remove them only if they are seen).
Training
  1. Education for medical staff and other workers in medical institutions: - Sharing (report) information among medical staff on prior identification and related information of the patients with symptoms of dysphagia (difficulty swallowing) and possibility of airway obstruction - Intervention methods for preventing airway obstruction (correct eating posture, food viscosity control, dietary assistance, sharing of food among patients and limiting external food) - Emergency response methods such as immediate recognition of patients with airway obstruction and proper actions to take - In case of tracheostomy tubes : Installation of suction machines in examination rooms, treatment rooms, and hospital rooms, and education on how to use the suction machines for the staff in charge

Airway obstruction (choking) by foreign substances(food)