A ‘Near Miss’ Choking Incident: SJOG’s response

We recently had a near-miss choking incident in one of SJOG’s services. Support colleagues acted immediately in-line with first aid training and best practice, and thankfully the person fully recovered.

This is a rare event for SJOG, however a ‘belts and braces’ approach was implemented to ensure we understood how this happened, and help us to improve the safe care and practice to people we support.

This overview is an example of an outstanding response to a serious incident.

We completed a fact-finding investigation as part of the learning from this event. Several colleagues were invited to discuss the events, which helped to establish a detailed understanding of the incident. Following completion of the fact-finding report, it was identified that colleagues required additional first aid training, to enable them to support people who are positioned in wheelchairs, who may be experiencing a choking incident.

The head of health and safety was instrumental in these discussions and worked closely with the people we support to reassure them and to consider the best training approach possible. Contact was made with an external training provider and the head of health & safety explained the incident and the training requirements, to ensure the training was bespoke and in-line with learning outcomes from the recent near miss incident.

The head of health and safety led and had full involvement in the fact finding and de-briefing of colleagues and people using the service. The first aid technique of using abdominal thrusts for a person positioned in a wheelchair was the focus area as emergency first aid training does not consider the risks this can cause. Discussions with the training provider were positive and bespoke training was provided to the entire team. People who use the service were invited to attend the training and offered their experiences. The learning from this training was embedded into people’s support and risk planning records.

The head of health and safety reviewed all choking incidents across the charity between 2020— 2023. This was useful information and allowed us to focus on the services that required closer attention. These statistics were also reinforced by national data and research. This information was shared with managers to illuminate the situation in SJOG. The first aid training was implemented in several of our services nationally where additional risk was identified.

Feedback from the people we support:

“I just want to thank SJOG very much for inviting me into this training as it has highlighted how staff will need to support me in an emergency situation”.

“I found the training really good. I realised how important it is for me to be careful whilst I am eating and to follow my SALT plan”.

“It has made me appreciate what my support staff will do for me”.

“I enjoyed attending the training, it took me back to when I was working. Please can I attend more training like this?”

Feedback from colleagues:

“Can we have more exercises like this? The team all commented it was one of the most impactful exercises they had done”.

The training has given me the competencies to support a person positioned in a wheelchair, in an emergency”.

“The training was excellent very informative.”

“We enjoyed the role play; this enabled us to try out the techniques, which gave me more confidence.”