77 Evaluating saliva management in Motor Neurone Disease within Yorkshire: a regional audit

Introduction Motor neurone disease (MND) is a neurodegenerative condition that affects the brain and spinal cord. Excessive drooling of saliva affects up to 50% of people with MND, in 42% of these individuals the symptom is poorly controlled. Patients may also experience issues with thick secretions. Methods An audit was developed reviewing current practices in assessment and management of salvia issues in patients with MND alongside NICE guidelines.¹ This was performed in 2 regions within Yorkshire, Scarborough and Mid Yorkshire, each covering a large geographical area. Results In total 86 patients were included, 27 from Scarborough and 59 from Mid Yorkshire, 39 patients (45%) were identified as having saliva issues. Saliva consistency was documented in 34 out of the 39 patients. Severity of the issue was discussed with all patients however there are no formal scales available to quantify this. 11 patients received non-pharmacological advice however it is likely that this is a higher and simply not captured in the documentation. In both regions patients received appropriate first line medication. In Mid Yorkshire, 5 out of the 59 patients required Botox, 3 of whom found it beneficial. Unfortunately, patients in the Scarborough region do not have access to Botox. Conclusion There is similar practice within the 2 regions and these are in line with NICE guidelines. A patient information leaflet explaining non-pharmacological methods for managing saliva issues has been introduced in Scarborough and a re-audit is planned now that it is in use. Another area for improvement is in measuring severity of the symptom which could also be useful to determine effectiveness of management strategies. NICE guidelines recommend using the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale when predicting prognosis. This contains a section on saliva severity which could be utilised and is being considered by both regions. Reference https://www.nice.org.uk/guidance/ng42/chapter/Recommendations#managing-symptoms