Presentation on theme: "(the medical term for difficulty swallowing)"— Presentation transcript:
1(the medical term for difficulty swallowing) Dysphagia(the medical term for difficulty swallowing)
2Refer to SLP When your patient is requiring cues to swallow. When food/liquid is falling out of patient’s mouthWhen food is stuck in their cheeksWhen patients are coughing or choking when eatingWhen their voice is wet/gurgly consistentlyWhen the patient reports “things are getting stuck”
3Obtaining a Referral 1. Consult with the SLP 2. Request swallow evaluation throughnursing or physician
4Cues for safe intake Swallowing strategies or “cues” may include: Small bites/single sipsChin tuckTongue or finger sweepAlternate liquids with solidsClear throat (if gurgly) and swallow againSwallow with effortDouble swallow
5RHFW Swallowing Protocol Have you ever wondered if your patient is on a special diet due to dysphagia ?If so, the following information will be very beneficial to you.
6How to check patient’s diet 1. Physician’s orders2. Nursing blue book3. Orange arm band on patient to havecurrent diet4. Rehab Dining Program book for specialdiets (located in top drawer in diningroom)
7How to check patient’s diet – cont’d. 4. Orange sheet placed above patient’sbed lists diet and strategies5. If still unsure, consult with SLP
8RHFW Diet Modifications Mechanical soft – No tossed salad, bread is being sent out instead of toast at breakfastMechanical soft with chopped meat – as listed above, except the meat is cut into small piecesMechanical soft with ground meat – as listed above, except the meat comes ground
9Diet Modifications Cont’d Mixed Mechanical Soft and Pureed dietThis is when 1 or 2 items are soft solidi.e. macaroni and cheese.*the rest of the patient’s foods are pureeconsistency, i.e. applesauce, mashedpotatoes
10RHFW Diet Modifications - cont’d. Pureed diet – all foods are pureedAppropriate snacks we offer are applesauce, yogurt, ice cream, pudding, baby food (available from kitchen)
11Liquid ModificationsNectar Thick Liquids – the consistency of syrup or fruit nectar.To thicken to nectar consistency, use a 120ml juice or ½ of a styrofoam cup of liquid, add 1 nectar thickener packet and stir 15 sec., let sit 3 minutes, assess consistency prior to giving to patient. Is it too thick or not thick enough? Do you know what to do if it doesn’t look right?
12Liquid Modifications – cont’d. Honey Thick Liquids – thicken to the consistency of honey.Thicken 120 ml juice or ½ of a small styrofoam cup of liquid by putting in 1 honey thickener packet, stir for 15 seconds and then sit for 3 minutes. Assess the consistency.
13Where to find thickener 1. With the condiments in the dining room2. Ring the bell and ask the dietary staff3. Nurses station, in the nourishment room.
14What kind of thickener do we use? RHFW currently uses Thick & EasyComes in individual packetsStarch based productWe also have pre-thickened apple and orange juice as well as thickened milk.
15Where would a patient buy thickener? Thickener can be purchased at places such as Wal-Mart or other pharmacies. Often you may have to ask at the counter for it.Thickeners can be purchased in packets, in canisters or in pre-thickened liquid form.
16Do we have any pre-thickened liquids? Yes, we have nectar and honey thickened boxes of milk, apple and orange juice. Ensure and V-8 are naturally nectar thick.Location: Cafeteria and in the nourishment room.
17Rehab Dining ProgramPurpose: To provide a comprehensive, multidisciplinary, organized system to identify, assess, treat and supervise/assist patients with swallowing and/or feeding difficulties.
18Dining Program Objectives To identify patient with need for assist/supervision at meal to increase independence and safety with eating/swallowing.These patients eat together at RESERVED tablesWritten recommendations for swallow precautions, self-feeding techniques and adaptive equipment for consistent follow through.Advance diet and reduce assist/supervision as appropriate to reflect progressEducate patient and caregiver regarding swallowing/feeding needs throughout their stay.
19Appropriate Dining Program Referrals Oral and pharyngeal dysphagiaVisual deficits including neglect and/or inattentionInadequate intake due to cognitive deficitsHemiparesis, quadriparesis
20Rehab Dining Procedure Patients will be identified as possible candidates during assessment and as they progress, i.e.: from NPO to PO statusSpeech and/or Occupational Therapy will assess and recommend dining program as appropriate. Nursing may refer for consideration also.Speech and/or OT will complete a Rehab Dining Precautions/Program Sheet (Orange). This will be placed above the patient’s bed and in binder. This binder is located in top drawer of cabinet in the dining room.
21Rehab Dining Procedure - cont’d. 4. Patients will sit at designated tables during mealtime. Visitors may sit close by as appropriate.5. Assigned therapy/nursing staff will supervise the patients given their individualized programs. Other staff will also assist with tray set-up.6. Status/progress will be documented in the therapy notes and nursing notes. Change in status should be communicated directly with the primary therapist for the responsible patient.7. A change in diet or strategies will be updated on the orange sheet in binder and above patient’s bed.
22Team Conference Form and Swallowing Goal: to be consistently completed by OT or SLP (when on the case).
24SLP’s are currently scoring the swallowing section using Max, Mod, Min etc. depending on the level of cuing.Also, list the diet (Min A mech. soft & grd meat)Use FIM scoring as follows
25FIM Scoring Independent (7) – Regular diet and thin liquids, no cues. Independent with strategies (6) with all consistencies.Supervision (5) = Pt. swallows more than 90% of the time without cues.
26FIM Scoring – Cont’d.Min A (4) = Pt. swallows % of the time without cues.Mod A (3) = Pt. swallows 50 – 74% of the time without cues.Max A (2) = Pt. swallows 25 – 49% of the time without cues.Dependent (1)– Pt. is NPO or swallows without cues less than 25% of the time.
27Contact Speech Therapy at Questions?Contact Speech Therapy atX 6135 or x 6136
28Print the test, complete, copy for your records and give the original to yourmanager.For Therapy Services, Evan should receivea copy in his box.Thank you!