RCSLT NQP Competencies

1. A. Communicates with people in a manner which is consistent with their level of

understanding, culture, background and preferred ways of communicating in order to
sustain positive relationships and enable constructive outcomes to be achieved.

Evidence:
-I am aware of the protocol of getting a translator, (informing the staff nurse) and that family
members should not be used if at all possible. (Example: I had a patient who required a
communication assessment but, in his current state of delirium, could only understand Urdu.
I attempted to organize a translator but I was informed that the staff nurse must do this, so I
contacted them. They told me that this wasn’t necessary because his family came in each
day so they could interpret for him. I informed them of the correct protocol.

-I am able to recognize if patients are hard of hearing and will adjust my communication as
appropriate (Example: During a communication assessment I was unsure if a pt had
receptive language difficulties or was simply hard of hearing. To make sure, I switched my
mode of communication to written and she was able to understand.

-Writing the ‘what is dysphagia’ and ‘feeding advice’ leaflets gave me practice in explaining
these things in lamen terms, with feedback from other staff. This is important because
understanding the language means better results for patients.

Action plan: Attempt novel ways of achieving results which might not be able to be achieved
in the normal way. For example if a patient with dementia is unable to understand the
instructions in an oromotor ax, ask them to smile, or model the desired movement.

b. Facilitates access to speech and language therapy services by all members of the
community through the use of interpreters, translation, culturally appropriate materials etc.

Evidence:
-See above re translator.

C. Keeps accurate and contemporaneous records.

Evidence:
-I am aware of the department protocol around writing notes as quickly as possible (always
within 24 hours) after seeing the patient. I am aware that the safest approach is to complete
the notes for a given patient before moving onto the next, and that this allows it to be
freshest in the mind; this will allow the notes to be as accurate as possible. I am also aware
that every discussion with any family member or healthcare professional around a patient
must be clearly documented in detail.
(example: Recently on F12, having handed over to the nurse looking after the patient I had
just seen and the patient that I was about to see, the nurse informed me that the patient I
was about to see was due to be seen by physio soon. Knowing this, I adapted my usual
approach of fully documenting on EPR before seeing the next patient, and wrote down an
impression briefly before seeing the next patient. This allowed best use of time and also
allowed more patients to be seen).
 -Reports from my supervisors that notes are clear, detailed and appropriate.

2. A. Identifies development needs and engages in continuous self- directed learning to

promote professional development and quality of practice.
Evidence: Discussions with supervisors re strengths, weaknesses and action plans.
-Being the ‘flow-testing champion’ allowed me to understand the importance of good
relations and good communication between healthcare professionals. Here, I would test the
consistency of different supplements to ensure that patients on a modified diet were given
the appropriate ones. This is important because many of those on a modified diet are also
under dietetics and requiring supplements. It is therefore important that these supplements
adhere to SALT guidelines.

-My weekly reading afternoon has allowed me to learn new information about complex
patients so that, once I begin to see these patients, this can be integrated into my practice. It
has also allowed me to consolidate my knowledge around less complex conditions.

-Discussions with supervisors around disease-specific dysphagia, cranial nerves, swallowing

therapy and its uses.

-Examples: Knowing the function of each cranial nerve has allowed me to detect problems in
the oromotor phase which may be relevant for swallowing problems, and thereafter
integrate these into my impression of the patient and their swallowing.
-Learning about disease-specific dysphagia has allowed me to hypothesize the aetiology for
certain presentations (such as reduced laryngeal sensation and therefore silent aspiration
being related to COPD, due to increased coughing) which has helped me to manage the
patient appropriately.

B. Is involved in training other professionals, raising awareness of communication problems.

-Examples: Thickener training at OPAL and Macclesfield, flow testing information sheet, re
communication: Communication bedhead sheets, informing ward staff of an individuals level
of understanding
-Evidence: Discussions with supervisors re what can be communicated to ward staff to
ensure individual can communicate most effectively.

3.
A. Provides safe care within the scope of practice, adhering to health and safety
procedures and clinical guidance.
Evidence: Describing PPE donning/doffing and protocol for infection prevention,
discussion around safe practice with dysphagia patients, attendance at induction and
manual handling, incident reporting system
Examples: Filing incident report for patient on d+w who was at high risk of aspiration,
and had being handed over the wrong recs when moving ward. Wiping down equipment
after seeing patients, wiping down work surfaces, being able to identify clinical signs of
aspiration from medical notes, reports from nursing staff, history from patient and their
families, and observations during dysphagia assessments.

B. Maintains all aspects of patient/client confidentiality

 Evidence: Discussion with supervisor re correct protocol for ensuring confidentiality.
Examples: Closing/locking computers on ward when not in use, correct encrypting of
emails according to which email type and to whom I am sending it, using only initials on
bedhead sheets if it is on the door to a bay, when speaking to family members on the
phone always making sure I am speaking to the correct person before giving
information, never giving full name or NHS number in voicemails.

4. A. Is aware of current clinical audit findings and incorporates these into practice
(e.g. evidence of adherence to service guidelines; understanding of departmental policies,
procedures and guidelines through practice; participation in case note audit; attendance at
clinical audit forums)

Action plan: Further investigation into audits

5. B. Understands and follows the clinical administration processes.

Evidence: paperwork completed and filed, discussion demonstrating understanding of
departmental processes.
Examples:
-Risk feeding protocol: Once the individual is deemed to be unsafe on all consistencies or
certain consistencies (with the individual wanting to continue with these consistencies), a
discussion with the individual must take place. If there is concern around capacity and they
are found not to have capacity for this decision, a best interest discussion should take place
between professionals and the family of the individual. There are two separate forms
depending on whether or not the individual has capacity; if they do, the individual completes
the form. For the form which is not completed by the individual, the medic must complete
sections relating to future treatment of chest infections/capacity. This form is then
photocopied and placed in SALT notes and medical notes, RF stickers with the appropriate
consistencies are placed in SALT notes and med notes, a special RF bedhead sheet is placed
above the patient’s bed. At this point, a decision must be made about whether improvement
in swallow is likely; if so, the individual will be reviewed. On discharge, a GP letter should be
sent with a copied version of the paperwork. Recommendations must be given to the
appropriate family members or nursing staff (if NH) on discharge.
-Discussion around EPR protocol

C. Accesses support from mentors/specialists for complex cases.

Evidence: Questions asked during dysphagia training or clinical supervision, protected
learning time, evidence of an appropriate number of requests for second opinions with
wider management decisions when doing LCs
Examples:
-After calling a patient who had been intubated multiple times and noticing voice
changes, I asked him about whether this bothered him, which it did. I consulted a
specialist SLT about appropriate management of dysphonia secondary to intubation
trauma, who suggested joint ENT and SALT clinic, to which I referred the patient.
-I had a liason contact with ward staff about a patient who was managing fine at bedside
on thin+regular, no concerns from NS. However, upon noticing R sided chest symptoms
and raised inflammatory markers in the medical notes, I consulted with a band 7 about
the possibility of instrumental ax; this was agreed and carried out.
 D. Manages and prioritises demands involved in meeting the needs of the caseload.
Evidence: Correct use of the D1, D2 and D3 prioritization system, discussion delineating
this system, discussion around ward efficiency, being efficient on the wards, seeing all
allocated patients during most sessions balancing clinical/admin time

Example:
-Knowing that a patient who is NBM/showing signs of aspiration or have been
repredicted previously are prioritized.
- Recently on F12, having handed over to the nurse looking after the patient I had just seen
and the patient that I was about to see, the nurse informed me that the patient I was about
to see was due to be seen by physio soon. Knowing this, I adapted my usual approach of
fully documenting on EPR before seeing the next patient, and wrote down an impression
briefly before seeing the next patient. This allowed best use of time and also allowed more
patients to be seen).

Action plan: Review the prioritazation system so that you can explain it correctly

E. Manages time effectively to balance clinical and nonclinical responsibilities.

Evidence:
Demonstrating the ability to: plan (prior to sessions(, be flexible (see above example)
and good critical thinking and self-awareness in supervision sessions; manager/
peer/client report).

Action plan: Become more assertive during patient sessions to ensure time is managed
correctly.

F. Is aware of and adheres to current legislation, incorporating this into practice.

Evidence: (e.g. discussions around appropriate protocol for consent, care pathways,
support agencies)
Examples:

Action plan: review MFT dysphagia document to feed back on, discussions around what
counts as consent, best interest meetings etc.

6. A. Acts in ways that acknowledges people’s rights to make their own decisions and
recognises their responsibilities.

Evidence: Case discussion

Examples: Knowledge of RF protocol and rationale for this, and role in informing
individuals about risks and benefits relevant to them.

B. Acts in ways that are nondiscriminatory and respectful of others’ beliefs and
perspectives.

Evidence: Case discussion, recognition of conditions/disabilities or potential obstacles to

good SLT care such as hearing loss or not speaking English, and finding ways around
these.
 Examples: see examples in entries above relating to communicating with such patients.

7. A. Identifies and collects relevant information through appropriate formal and informal
assessment, including discussion with the client/carer.
Evidence:
-Detailed case history taking including details about chest history, swallowing difficulties etc.
including investigation of more subtle problems which might not suggest a swallowing
problem to the patient, but might indicate one to a trained specialist.

-Forming an impression of the patient from the initial assessment, appropriately ringing care
homes/family members prior to assessments if this is implicated

Example: Gathering the information from the case history, oromotor and swallowing trials, I
was able to make an impression of a patient with silent aspiration. This patient was admitted
with heart issues and PMH included COPD and anxiety. This patient had reported repeated
chest infections, and had presented with poor tongue movement in the oromotor
assessment. From the swallowing trials, it was hypothesized that the individual had poor AP
tongue motion, potentially resulting in pharyngeal residue which was aspirated; no overt
signs of aspiration were noted at bedside.

B. Makes a clinical judgement/diagnosis in relation to the nature and extent of less complex
speech and language therapy difficulties.

Evidence:
-Accurate and clear writing of impressions
-See above
-Discussion around clinical judgement and diagnosis
-Being able to form an impression based on chest status, inflammatory markers, case
history, oromotor assessments and swallowing trials combined.
-priority assigned appropriately (see prioritization section)
-Evidence of referral to other agencies where appropriate
-Documented advice sort from medics about whether findings of chest x-rays might signal
aspiration, or whether bedside findings in swallowing assessments might indicate aspiration
(e.g. cervical auscultation)

Example:

-When initially assessing an elderly patient with no significant past medical history who was
admitted with a UTI, I was able to form an impression that, given no reported history from
the nursing home or family re swallowing difficulties or chest concerns, together with the
patient’s current state of delirium and ‘passive’ swallow presentation, that his swallowing
problem was influenced largely by his delirium (on top of presbyphagia). With temporary
NBM and subsequently a temporary modified diet, the pt recovered and his swallow went
back to baseline.

C. Interprets the assessment information and produces an appropriate evidence-based

therapy management plan, involving key people in the client’s environment.
Evidence:
-Discussion around accurate decisions re individual’s ability to cope with specific diet and
fluid textures in less complex dysphagic presentations; this leads to correct
recommendations for diet/fluid modifications as well as positioning requirements, pacing or
further instrumental assessment.
-Comm screens analysed and summarised
-Regarding communication, I am able to summarize the findings of communication screens
and informal chats with patients; this allows me to make appropriate recommendations for
ward staff/the patient to make communication easier for both the patient and staff.

Examples:
-Dysphagia: Patient admitted with new Parkinsonian symptoms, no current chest concerns,
able to conclude that oral phase difficulties were resulting in refusal to eat and this was
contributing to poor PO intake. Once easy to chew diet was implemented, PO intake
improved; chest remained clear throughout admission.
-Communication: A lady with a PMH of dementia who had suffered a ? new intracranial
event during admission was referred due to swallowing difficulties, but the SLT had noticed
poor comprehension and limited verbal output. I called the family to clarify communication
baseline, which was normal. From trials of communication boards and sections of the
communication screen, I was able to clarify that the lady could follow one stage commands,
and some two-stage commands. Naming was NAD, but she also suffered from hearing loss
pre-admission. I was able to provide the ward with strategies for communicating with this
lady, and had asked that her family bring her hearing aids in next time they visit.

D. Makes and justifies independent decisions on less complex patient/client care.

Evidence:
-Discussion of selected cases with manager
-Documentation of effective outcomes
-Ability to independently carry out less complex/lower priority diet and fluid upgrades

Examples:
This will be based on the action plan below

Become independent with carrying out less complex/lower priority assessments

E. Refers to other professionals in a timely and appropriate way.

Evidence:
-Appropriate suggestions for food charts/dietetics referral on EPR
-Appropriate referral to OT
(e.g. appropriate reports and referrals)

Examples: Referring Muhammad (F6) to OT after I was asked to do a comm screen, but upon
investigation discovered that it was more of a cognitive issue than a language deficit. Called
OT, included why I believed he was more cognitively than linguistically impaired, suggested
an interpreter and wrote on EPR.
 -Referring Simon (Jim quick) for a joint OT and SALT assessment when it became clear than
both cognition and pragmatic language were impaired.

-Referral (along with Claire) to chest physio due to copious secretions which were limiting an
individuals appropriacy for oral intake.

F. Uses the Royal College of Speech and Language Therapists’ guidelines within practice.

Evidence:

Examples:

(e.g. knowledge of RCSLT’s Communicating Quality 3, clinical guidelines, and competencies project)

Action plan: Get a copy of guidelines

G. Is aware of current critically appraised research and is able to use it to inform practice.

Evidence:

-Involvement and presenting in journal club

-dysphagia training presentations

-Discussions around information gained through reading/protected learning time (e.g. discussion of
patients re disease-specific dysphagia, medications and dysphagia, respiratory, therapy etc)

Action plan: Journal club

8. A. Agrees with relevant others and implements an appropriate therapy management plan
based on functional outcomes and clearly defined goals, including an understanding and use
of preventative strategies.

Evidence: Plans written at the end of all EPR entries containing realistic aims (e.g. diet
upgrade, determine whether silent aspiration is present on VFS, be able to eat and drink
certain diet fluid textures e.g. puree/thin fluids following period of NBM/therapy), evidence
through discussion of agreement and/or cooperative planning with key others

Examples: See EPR entries

B. Prepares, evaluates and modifies aspects of the therapy management plan to be carried out by
key agent(s) of change considering their knowledge and abilities.

Evidence:

-communication strategies provided to care homes and ward staff

-Taking into account the knowledge of the professional reading notes on EPR.
-Assuming no prior specialist knowledge of family members when suggesting which strategies be
implemented.

Examples:

-adapting language, for example rather than suggesting they limit verbal instructions to ‘two stage
commands’, suggesting ‘only including two important pieces of information in a command’

- in the impression, not going into too much detail about the swallow itself, instead keeping it to
those parts relevant for the professional e.g. safety of swallow, risk of aspiration/choking, strategies
suggested, our ongoing plan and suggested referral to other professionals.

-When suggesting a specific diet texture (e.g. puree), explaining exactly what is meant by this and
providing information (often written) which details this, and explaining why it is necessary.

C. Continuously evaluates the efficacy of the therapy management plan, and modifies it as
appropriate.

Evidence:

-Liaison contacts which were thought to be likely diet/fluid upgrades, becoming need for re-reviews,
including some instances of observing overt signs of aspiration and placing nil by mouth.

-Feeding back to more experienced colleagues regarding changes in the presentation of

swallowing/voice following a block of intensive swallowing therapy.

Examples:

-Instance of tolerance check on F12 which was checking tolerance of ?new baseline with view to
discharge. Staff nurse was mildly concerned due to coughing on fluid intake in the morning, and
when I asked to see him have a drink, note ++wet sounding coughing and wet voice. Discussed with
patient and consultant (Dr. Ahearn) and agreed NBM awaiting SALT rv the next day.

-When seeing a patient named Thomas on F6 every day for swallowing therapy, feeding back to
more experienced and FEES-trained member of staff regarding improvement in voice and swallow;
this informed whether any changes may be necessary (e.g. phagenyx, repeat FEES sooner than
planned, alternative swallowing therapy)

D. Discharges client appropriately, agreeing a point of closure with the client/carer and informing
other professionals.

Evidence: Shows understanding of discharge criteria and protocol (for different client groups e.g. risk
feeding, new baseline, those with reversible illnesses, etc.) through discussion; discharge protocol
followed (e.g. handovers, referrals, instructions of when to re-refer for other professionals, transfers
out, letters written)

-Shows understanding of how ensure individual has good support in place for e+D prior to discharge.

Examples:

-Discharge criteria for those deemed to be unsafe on any oral intake: Ensure that no further review
is required, or if it is and the individual is no longer under the care of Wythenshawe SALT, to transfer
out appropriately. Risk feeding paperwork should be completed and sent to GP along with letter
explaining the individuals safety for oral intake, and recommendations should be handed over to
family members or, if at care home, nursing staff.

-For patients with new baselines, it can be useful to provide longer-term reviews, so might be useful
to keep patient on caseload for two or so weeks while an IP, or if they are being discharged,
recommend this as an OP to their local community team.

-When any patient is discharged, it is important to ensure that they are aware of any
recommendations (e.g. have they had thickener training? Are they able to remember this? Are they
aware of the risks of not following the recommendations?)

Safe feeding, dysphagia sheet, flow testing