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[Dysphagia] Extubation policy
Actually lately I've been really irritated to receive orders on pts who are
STILL intubated, often with both ETT and OGT! Sometimes they came with a
comment of "after extubation" I came to realize the docs were putting in the
orders right away (per a nurse) "so the order would already be there." How
frustrating that the docs could not count on themselves to remember to order
it after the pt was successfully extubated or trached. They expected us to
follow their intubated pt & go ahead with eval when the pt was ready. Of
course sometimes they never become ready. I have tried to explain that these
types of orders are often part of the reason it takes us so long to get to
their pts. We waste so much time on these types of things. And in a big
hospital it takes time to walk across to the other wing only to discover the
pt can't participate or benefit, write a note, talk to the nurse, etc.
Obviously I'm "signing off" with the request to be reconsulted when pt is
appropriate...
>From: "Alicia Multari" <MULTARIA at nychhc.org>
>To: <tweetsalong at aol.com>, "Bill Connors" <bill at aphasiatoolbox.com>,
><bsonies at comcast.net>, <paula.garbin at gmail.com>, "Sheri L Edgar"
><SLEdgar at LancasterGeneral.org>
>CC: eripley at yahoo.com, dysphagia at b9.com
>Subject: [Dysphagia] Extubation policy
>Date: Wed, 16 May 2007 10:42:35 -0400
>
>I believe this topic has come up before but I need to address it
>again..What is your policy/protocol for evaluating patients s/p extubation?
>For example (to make it a bit more concrete)-
>
>Does the SLP get an automatic referral for ALL patients s/p extubation?
>OR are there other criteria that would warrant a referral (duration of
>intubation, comorbidities, etc)?
>
>Do you wait 24 hours? 48 hours? longer? s/p extubation to evaluate
>swallowing taking into account laryngeal edema, secretions, mental status,
>duration of intubation etc?
>
>Are you referred patients who were intubated for only a few days (less than
>a week)?
>
>And if you have a specific protocol how did you let the MDs know?
>inservice? ??
>
>Thanks in advance
>
>
>
>
>Alicia Multari, M.S., CCC-SLP
>Speech Language Pathologist
>Elmhurst Hospital Center
>79-01 Broadway
>Elmhurst, NY 11373
>
>718 334-3398 (office)
>718 334-3909 (fax)
>
> >>> "Edgar, Sheri L" <SLEdgar at LancasterGeneral.org> 05/16/07 8:42 AM >>>
>Allie,
>
>I feel your frustration in terms of people reactions on this listserve,
>it can get brutal at times. Chalk it up at passionate professionals
>just wanting to pass along their knowledge. (I am not saying it always
>comes across the way we wish it would) but
>hang in there you will develop a tough skin as well as how to phrase
>your question(s) so you do not get misinterpreted.
>
>And yes we ALL have been there, some of us just forget from time to
>time.
>
>Take care,
>Sheri Edgar
>
>-----Original Message-----
>From: dysphagia-bounces at dysphagia.com
>[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Bill Connors
>Sent: Wednesday, May 16, 2007 7:50 AM
>To: tweetsalong at aol.com; paula.garbin at gmail.com; bsonies at comcast.net
>Cc: eripley at yahoo.com; dysphagia at b9.com
>Subject: Re: [Dysphagia] (no subject)
>
>
>Hang in there Allie and keep learning. Experiences like this even
>though
>they may be a bit rough on the ego can be educational. Whatever you do,
>keep asking questions; never stop asking questions. We all have lots to
>learn.
>
>Bill Connors
>The Aphasia Center of Innovative Treatment
>bill at aphasiatoolbox.com
>
>
>-----Original Message-----
>From: dysphagia-bounces at dysphagia.com
>[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of
>tweetsalong at aol.com
>Sent: Tuesday, May 15, 2007 7:30 PM
>To: paula.garbin at gmail.com; bsonies at comcast.net
>Cc: eripley at yahoo.com; dysphagia at b9.com
>Subject: Re: [Dysphagia] (no subject)
>
>Hello everyone!
>
>Thank you to Paula and Lucy for responding without passing judgment. I
>guess maybe some of you misunderstood (or maybe I stated it wrong) what
>I
>was saying...
>
>I understand how to treat a pt who has dysphagia. I understand that you
>are
>supposed to treat the actual problem (reduce tongue base ret, reduced
>larngeal elevation)! I would never tell or document that a patient has
>failed an MBS. I was using that terminology to present my case to the
>listserv. I just found out the results today (he will continue to be
>NPO)
>via a message left on my voicemail from his wife. I am still waiting
>for
>the actual results of the study.
>
>On his previous MBS he had (off the top of my head) a 6 sec. delay,
>reduced
>tongue base retraction, reducecd laryngeal elevation, and aspirated
>every
>consistency attempted. I have been doing thermal stim, OME's, using
>lemon
>glycerin swabs,etc. This pt. has a hx of oral cancer and has a fistula
>the
>size of a golf ball in the roof of his mouth and wears a prosthesis for
>this. When the pts cancer was treated, the salivary glands in his mouth
>were burned...SO...the pt has decreased saliva and is unable to produce
>a
>timely dry swallow (time ranges from 5-9sec).
>
>I guess I had a miunderstanding about what the point of this listserv
>is...I
>thought we could rely on our fellow colleagues to help us out when
>needed.
>I will admit that I am a fairly new SLP...haven't you all been in my
>shoes??
>
>Allie
>-----Original Message-----
>From: paula.garbin at gmail.com
>To: bsonies at comcast.net
>Cc: tweetsalong at aol.com; eripley at yahoo.com; dysphagia at b9.com
>Sent: Tue, 15 May 2007 2:38 PM
>Subject: Re: [Dysphagia] (no subject)
>
>
>Hi Allie,
>
>I can understand what the other ladies were stating. There has to be
>something more specific that you need to focus on with this man's
>treatment.
>What are the main areas of difficulty? And yes is he aspirating
>everything?
>I can understand the use of the word FAIL, but it does need to be
>qualified.
>What did this man "fail" to do during this MBS. And I think you should
>continue to treat him with another MBS at the end. If no progress has
>been
>made by that time then I would call it. At that point something is
>working
>against you.
>
>We are here to help other people and answer questions; not to make other
>people feel incompetent due to misuse of terminology. Wording and
>presentation is everything.
>
>Please let me know what the outcome ends up being.
>
>~Paula
>
>
>On 5/15/07, Barbara Sonies <bsonies at comcast.net> wrote:
>No one FAILS an MBS- this is an incorrect interpretation of the
>test-what do
>you possibly mean by fails??!!! Did he aspirate on all textures, did he
>have
>
>pooling for some, did he fail to produce any swallow, was there reduced
>hyoid elevation or epiglottal lowering, did he penetrate into the
>vestibule,
>did he attempt to clear the pharynx, did some bolus enter the
>esophagus???
>These are among the observations one makes to analyze a swallow or set
>of
>swallows--he can not FAIL.
>Dr Barbara Sonies, BRS-S
>
>
>On 5/15/07 4:44 PM, "tweetsalong at aol.com " <tweetsalong at aol.com> wrote:
>
> > Hello everyone-
> >
> > I am looking for a little advice regarding one of my homecare
>patients.
>This
> > gentleman came to me as NPO back in the beginning of March. I have
>been
> > seeing him since then and have recertified him for services. Today he
>went
> > for a repeat MBS and failed once again. I know that he has made some
> > progress. He is very motivated and practices his exercises 3 times a
>day.
>I
> > will continue to see him for the remainder of the certification period
>which
> > ends at the beginning of July. Should I recommend another MBS at that
>time or
> > do I discharge him and encourage him to continue to pactice? When do
>you
>draw
> > the line as to how long you should continue services (especially if no
> > progress has been made)? I am waiting for the updated MBS to be faxed
>to
>me
> > to see if anything at all has changed...
> >
> > Any thoughts would be greatly appreciated...
> >
> > Allie
> >
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