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[Dysphagia] Autonomy & Orders
I work in a small acute care hospital with no rehab unit, just acute care. My answers are below--hope it helps......
-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com]On
Behalf Of Emily Wells
Sent: Wednesday, November 29, 2006 2:05 PM
To: dysphagia at b9.com
Subject: [Dysphagia] Autonomy & Orders
I know there has been discussion in the past regarding orders, but I am curious about the protocols, expectations, cultures within different hospitals. I'm trying to collect some data to present, with hopes of allowing patients to receive more timely services (vs awaiting every single specific order from a physician). I work in a hospital at which individual orders must be obtained for EVERYTHING (if we are consulted for "aphasia", we must obtain a separate order for swallowing if we notice, by chance, dysphagia while doing our assessment) - this standard per the rehab manager. FYI: in this same hospital, registered dietitians and nurses do have the privilege to write orders. SLPs cannot, due to our immediate management stating that this is a "slippery slope." I won't take out my personal frustration on this forum, but would appreciate data.
In your hospitals, what are the processes for obtaining orders for:
1. MBS/FEES: We don't do FEES. MBS needs an MD order separate from any other swallow eval order.
2. Diet initiation or NPO: MD order technically required. Nurses initiate the changes immediately following my eval when I give them my recommendaitons even if MD order is still pending
3. Diet upgrade/downgrade: either nursing judgement (downgrade) or need an MD order; SLP recommendations just become the MD order but nursing gets the order from the doctor
4. Passy-Muir evaluation, or placement: MD order needed to place PMV, but SLP determines frequency of use, etc. Depending on MD I can start with PMV prior to getting actual order based on my judgement
5. Speech/Language/Cog eval (if initial MD order is for swallow eval, or vice versa: SLP is an independent practitioner. Once we are on the case we can do anything in our scope of practice clinicially. Xtras like MBS or PMV need separate orders.
*****All of the above is null and void for the MD's that have given me the okay to just write my own orders for their patients. With those I just proceed as I wish and keep the MDs well- informed.
Thanks!
Emily
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