[Dysphagia] Re: [asha-div13] medication assessment

[Marie.Isbell at state.tn.us (Marie Isbell)]

DMRS for the State of TN adopted guidelines for diet texture based on
the size of the piece (pureed, ground, diced, regular cup-up, regular
whole).  Medications are then altered, whenever possible/appropriate, to
go along with the person's diet texture.  Pills/tabs/caps are offered
one at a time in some kind of medium, usually applesauce or pudding. 
The person offering the meds must follow the person's Mealtime
Instructions that provide specific techniques that must be followed for
the person to be safe.  We have had very few problems since this policy
was adopted statewide.  I don't know if there was specific research that
was done other than the State adopting policies offered by consultants
from other states who had adopted similar strategies to prevent or
resolve law suits related to unsafe conditions for adults with
developmental disabilities.  Marie
 
Marie M. Isbell, MA, CCC-SLP
West TN Regional PNM Team
West TN Regional Office
8383 Wolf Lake Drive
Bartlett, TN 38133
(901) 213-1847
Fax: (901) 372-3460
Marie.Isbell@state.tn.us
 
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>>> Sally Simpson <Sally.Simpson@ncmail.net> 8/30/2005 11:43:55 AM >>>

I asked this question a few months ago related to research in the area
of medication administration, etc.  Now , I really need some help.  I
am
the swallowing coordinator at a residential facility for people with
developmental disabilities.  I have been advocating, along with the OT
in my assigned homes that we really look at individuals on reduced
diet
textures and how they receive their medications.  We did observations
and they revealed that individuals were receiving up to 14 pills in
one
spoonful with pudding (most observations noted 7-8 at a time) with
people on pureed diet textures.  We individually assessed everyone in
this home and came up with recommendations.  If the medication did not
come in a liquid form or the individual did worse with liquids, then
we
recommended the following for most of them: 1. always give meds in an
upright position (some were given while lying flat), 2. no more than 2
small pills in a spoonful (we named the pills that could be given
together), 3. one large pill at a time and if it could be scored, then
do it, 4. after meds, give some fluid.  I forget that we recommended
if
the med could be crushed, then crush it if Pharmacy says ok.  Also
asked
that individuals remain upright for at least 15 minutes after
administration but pushed for 30 minutes.  Since then, all of this has
been stopped by the medical services administrator.  Oh, a nurse told
me
she never realized that someone on a reduced diet texture meant they
had
reduced oral-motor/swallowing skills.  Yes, this was a RN and a nurse
supervisor.  We have been told they don't have time to do it this way
and will address individuals as they have problems.  This is a home of
20 profoundly retarded and multi-handicapped individuals with very
involved health.  Thus one individual now gets her 4 meds crushed due
to
a choking episode.  Since there is no specific research per se on why
these type of folks should be given medications differently, then why
do
it.  Also, they said that now "an article" said no meds should be
crushed.  Please help me if you can.  Can anyone provide articles,
specific tools/assessment tools for medication administration they may
use.  Using my bedside screening tool/assessment does not appear to
meet
their needs as they want to see if someone has the following oral
motor
skills then they should receive -------------------.  You would think
common sense would play in at some time.  I am sorry to ramble but
this
issue I am afraid might be the one that really gets me going
somewhere.
Thanks,
Sally

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