[Dysphagia] Dysphagia screening in the ER

[RN2D at hscmail.mcc.virginia.edu (Neubert, Rebecca R *HS)]

Hello,

The way we are handling the dysphagia screening is that the physicians
have a screen built in to their ordering pathway that asks them if the
patient has facial droop, dysarthria, decreased level of consciousness,
drooling, weak cough or voice, etc. If so, they are kept NPO until we
see them. If not the physician has them drink water and eat a cracker.
The critical issue with this screen (in terms of the JCAHO stroke rules)
is that the physician MUST document that either they cleared the patient
for p.o., or that they have ordered the SLP eval to do so. If they don't
document that they screened the patient (meaning they stopped and made a
judgment as to whether or not an evaluation was indicated) and they go
ahead and order a diet, that is where the JCAHO standard is not being
met. As you can imagine, it's a challenge getting them to document,
particularly when a patient comes in presenting with only L lower
extremity weakness or something like that. But that's the important
step. Our stroke docs have a H&P template and it has a section on there
where they select either "cleared by MD", "cleared by SLP" or "swallow
eval pending-NPO."  That has worked well (and it made the JCAHO reviewer
happy).

Rebecca

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of tiafamily@comcast.net
Sent: Saturday, May 21, 2005 8:01 PM
To: dysphagia@b9.com
Subject: [Dysphagia] Dysphagia screening in the ER

Does anyone work at a hospital facility that requires dysphagia
screening in the ER for CVA patients? If so, how have you logistically
managed this requirement?
Susan
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