Speech and Language Therapy

The following describes the skills required for a novice speech and language therapists to be able to work competently and confidently in critical care. Workforce planning should ensure that the below are included in the training and development of staff to ensure we have the necessary skills and knowledge amongst speech and language therapists to provide safe and high-quality patient care.
Attainment of the Shared AHP Competencies, Speech and Language Therapy Core Competencies and EPA sign off will ensure the clinical caseload is managed by a sufficiently skilled therapist who can work independently.  

It is recommended that critical care speech and language therapists (especially those working in isolation) consider membership to intensive care societies such as the RCSLT critical care specialist group.

The competency domain headings are shared with those of the Intensive Care Society Speech and Language Pillar, indicative of the mapping and alignment of the C3Framework to the Intensive Care Society pillar. Completion of EPAs 3 and 4 is underpinned by the RCSLT Tracheostomy Competencies.

Some of the domains within this document can be better understood by engaging with those outside your profession (eg asking a bedside nurse to explain the lines and wires, learning from the medical team regarding shift handovers, discussing with the nurse in charge which MDT meetings are most relevant for your role and contribution). See Appendix 2 for suggested MDT shadowing experiences which will aid the completion of both shared and speech and language therapy domains of the C3Framework.

EPA quick access

Speech and Language Therapy Entrustable Professional Activities (EPAs)

Speech and Language Therapy EPA 1 : Assesses and manages communication disorders in critical care
Description

This EPA includes:

  • Determines patient’s suitability for communication assessment considering clinical presentation, personal factors and wider treatment plan.
  • Uses appropriate communication assessment tools.
  • Diagnoses communication deficits and disorders and develops an appropriate management plan.

Context:

  • Adult patients in the critical care setting.

Limitations:

  • Patients may have a tracheostomy but this EPA does not address manipulation of the tracheostomy to facilitate communication.
  • Refer to Speech and Language Therapy EPAs 3 and 4 for tracheostomy specific skills.
  • Specialist assessment with high-tech AAC devices is not covered in this EPA.
Required knowledge and skills
  1. C3Framework Shared AHP Competencies
  2. C3Framework Speech and Language Therapy Domains:
    • Critical Illness Equipment and Pathophysiology: Communication
    • Intubation
    • Medications
    • Delirium
    • Post Intensive Care Syndrome
    • Tools for Assessment: Communication
    • Communication
    • Critical Thinking and Clinical Reasoning
    • Working With Others: Communication
    • Evidence Based Practice
Assessment to measure progress
  • Review of anonymised patient records of complex patients and reflection pertaining to the Speech and Language Therapy management of the patient
  • Supervision documentation
  • Reflective reports
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care SLT after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Speech and Language Therapy EPA 2 : Assesses and manages swallowing disorders in critical care
Description

This EPA includes:

  • Determines suitability for swallowing assessment, considering clinical presentation, personal factors and wider treatment plan.
  • Uses appropriate swallow assessment tools.
  • Diagnoses dysphagia and develops an appropriate management plan.

Context:

  • Adult patients in critical care cleared for oral intake by the critical care and/or surgical team.

Limitations:

  • This EPA does not include patients with a tracheostomy, refer to Speech and Language Therapy EPA 3 and 4 for tracheostomy specific skills.
  • This EPA does not address FEES (endoscopy) and videofluoroscopy skills and competencies.
Required knowledge and skills
  1. C3Framework Shared AHP Competencies
  2. Speech and Language Therapy EPA 1: Assesses and manages communication disorders in critical care
  3. C3Framework Speech and Language Therapy Domains:
    • Critical Illness Equipment and Pathophysiology
    • Tools for Assessment: Swallowing
    • Critical Thinking and Clinical Reasoning: Swallowing
    • Working With Others: Swallowing
Assessment to measure progress
  • Review of anonymised patient records of complex patients and reflection pertaining to the Speech and Language Therapy management of the patient
  • Supervision documentation
  • Reflective reports
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care SLT after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Speech and Language Therapy EPA 3 : Assesses and manages the non-ventilated tracheostomised patient
Description

This EPA includes:

  • Determines suitability for Speech and Language Therapy input for tracheostomy weaning.
  • Integrates tracheostomy presentation with wider clinical presentation to develop a tracheostomy weaning plan in collaboration with MDT colleagues.
  • Uses knowledge of dysphagia and communication assessment and intervention and applies this to patients with a tracheostomy to make safe and appropriate recommendations.

Context:

  • Adult patients in the critical care setting with a tracheostomy on room air or supplementary oxygen only.

Limitations:

  • This EPA does not apply to patients on ventilator support at the time of Speech & Language Therapy intervention.
  • Speech and Language Therapy EPA 1 and 2 must be completed prior to undertaking EPA 3.
Required knowledge and skills
  1. C3Framework Shared AHP Competencies
  2. Speech and Language Therapy EPA 1: Assesses and manages communication disorders in critical care
  3. Speech and Language Therapy EPA 2: Assesses and manages swallowing disorders in critical care
  4. Clinicians must be either fully competent or undertaking competencies with supervision as per local trust policy and either:
    • The Royal College of Speech and Language Therapists Tracheostomy Competency Framework
    • Local Speech and Language Therapy tracheostomy competency documents
  5. Additional C3Framework Speech and Language Therapy Domains:
    • Critical Illness Equipment and pathophysiology: Tracheostomy
    • Tracheostomy
    • Working with Others: Tracheostomy
    • Evidence Based Practice: Tracheostomy
Assessment to measure progress
  • Review of anonymised patient records of complex patients and reflection pertaining to the Speech and Language Therapy management of the patient
  • Supervision documentation
  • Reflective reports
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care SLT after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Speech and Language Therapy EPA 4 : Assesses and manages the ventilator-dependent tracheostomised patient
Description

This EPA includes:

  1. Determines suitability for Speech and Language Therapy input for ventilator-dependent tracheostomy weaning.
  2. Integrates tracheostomy presentation with wider clinical presentation and treatment plan to develop a ventilator-dependent tracheostomy weaning plan in collaboration with MDT colleagues.
  3. Uses knowledge of dysphagia and communication assessment and intervention and applies this to patients with a ventilator-dependent tracheostomy to make safe and appropriate recommendations.

Context:

  • Adult patients in critical care with a tracheostomy who are ventilator dependent at the time of Speech & Language Therapy intervention.

Limitations:

  • This EPA does not apply to patients on room air or supplemental oxygen only the time the intervention (see EPA 3).
  • Speech and Language Therapy EPA 1, EPA 2 and EPA 3 should be completed prior to undertaking EPA 4.
Required knowledge and skills
  1. C3Framework Shared AHP Competencies
  2. Speech and Language Therapy EPA 1: Assesses and manages communication disorders in critical care
  3. Speech and Language Therapy EPA 2: Assesses and manages swallowing disorders in critical care
  4. Speech and Language Therapy EPA 3: Assesses and manages the non-ventilated tracheostomised patient
  5. Additional C3Framework Speech and Language Therapy Domains:
    • Ventilation
Assessment to measure progress
  • Review of anonymised patient records of complex patients and reflection pertaining to the Speech and Language Therapy management of the patient
  • Supervision documentation
  • Reflective reports
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care SLT after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.