[Dysphagia] Dysphagia - texture recommendations

[kcaranci at lakeridgehealth.on.ca (Caranci, Karen M )]

Hi,
The S-LPs at our facility have recently been questioned about the risk
(to the hospital) in providing a patient a diet texture not compliant
with recommendations from the S-LP swallowing assessment.  It is not
uncommon for a patient or substitute decision maker to choose /refuse
diet texture recommendations made by the S-LP.  It has been our practice
to clearly document the discussion regarding assessment results and
recommendations, as well as risks involved in not following
recommendations, but understand (and support !) that ultimately it is
the patient's right to choose.  This issue raised is that is
documentation enough.  Some staff feel that if a patient understands and
is willing to accept the risk of alternate texture, then this should be
permitted only with foods brought in from home.  Staff feel that the
hospital should provide the texture recommended by the S-LP and that we
are putting the facility at risk if we don't.  They argue, for example,
that although patients have the right to refuse medication, they do not
have the right to decide what type of medication they receive.

We used to have patients/families/substitute decision makers sign a
release of responsibility form if they chose to remain on a texture not
recommended, but this was discontinued several years ago, after much
discussion, because it was felt that the proper documentation was
enough.  I was just wondering what other facilities were doing to
support the patient's right to choose.

Karen Caranci M.Sc., S-LP(C)
Inpatient Rehabilitation Unit & Profession Leader,
Speech-Language Pathology
Lakeridge Health Corporation