2.  Nutritional assessment  Meal observation

3.  Drooling  Coughing  Gagging  Pocketing of foods  Wet sounding voice  Prolonged eating time unrelated to inability to feed self

4.  RD should not change diet orders related to dysphagia- SLP scope of practice  Only SLP or MD can order a diet upgrade  RD can change diet related to patient or family preference

5.  RD  SLP  Nursing  MD

6.  Coordinate accuracy of patient’s diet and liquids  Follow up patient tolerance/acceptance  RD adjusts preferences to increase acceptance  Both may be involved with staff education regarding thickened liquids

7.  Tube feeding or TPN must meet patient’s nutritional needs; RD assesses this.  Weaning from nutritional support to oral diet, needs a team approach.  RD must make sure needs are met and weight status is carefully documented.

8.  Protocols vary by facility  Do not assume that kitchen staff is well trained!  Bedside fluids very important as these patients are at higher risk of dehydration

9.  Regular  Mechanical Soft  Mechanical soft with gravy  Mechanical soft, ground meats  Puree  Slurries