[Dysphagia] Qualifications: Consider Dysphagia Teams

[mbuckie at dmc.org (Buckie,Marcia)]

I find that I work most closely with the dietician on the geriatric patients the most , where we are concerned about the efficiency of the swallow, and whether the patient will meet their nutritional needs by mouth, and discuss the pros and cons of textures, liberalizing diets to maximize intake.
 
To be honest, I have never been one to do an assessment alongside someone else..I am not sure that I see any more value in that talking then about it with the other person. I don't mean for that to sound snarky, I am open to hearing about why others find this valuable. Also, if you see them at different times of the day, then you can get more "snapshots" for the big picture. The major reason for not doing them together , though, is simply the logistics of lining up our schedules.
Also, our dieticians have cursory training in A&P of oral pharyngeal swallowing, and seem like they have so much on their plates as it is with diabetes education, cardiac, renal, tube feedings, ICUs, that our model seems to work for us and our patients.
 
Marcia

	-----Original Message----- 
	From: dysphagia-bounces@b9.com on behalf of Clarke-Goertz, Kim (PAPHR) 
	Sent: Thu 3/9/2006 3:03 PM 
	To: 'dysphagia@b9.com' 
	Cc: 
	Subject: [Dysphagia] Qualifications: Consider Dysphagia Teams
	
	

	
	I wholeheartedly agree. I have a similar relationship with my acute care
	dietician and it is wonderful.
	I just wish we had some trained OT's as well.  We end up with a lot of
	people coming 'through' our hospital (younger therapists) who have
	'interest' in the area of dysphagia, but no clinical experience or classes.
	I have an overwhelming caseload and thus not a lot of time to be mentoring
	folks who need 'basic training'.
	I hope education and clinical placements continue to be alive and well and
	OT programs, as I could really use one who had some training vs. ones who
	require it from me.
	
	And I appreciate Karen and Jeanne's contributions from an OT perspective.
	As much as I think our professions bring different things to the table in
	dysphagia care, it sounds as if the level of university preparedness is
	similar (unless you are not required to take basic sciences, which I find
	surprising that SLP or OT wouldn't be required to do so).
	
	I think this is a healthy discussion and aside from a few sniper shots at
	Irene, I think it has been valuable (judgement suspended in regard to
	Irene's battles, those she's perfectly capable of defending on her own).
	
	Thanks to all for contributing.
	I hope we all have the opportunity to work more in teams, I would guess
	inadequate staffing has much to do with the sparse opportunites.
	
	Kim
	
	-----Original Message-----
	From: Wilma Clancy [mailto:Wilma.Clancy@cdha.nshealth.ca]
	Sent: Wednesday, March 08, 2006 15:56
	To: dysphagia@b9.com; dysphagia-request@b9.com
	Subject: [Dysphagia] Qualifications: Consider Dysphagia Teams
	
	I find this discussion very interesting.  What is abundantly clear to me is
	that very few of you work in teams.  I don't mean teams that you only see on
	paper, but actual practitioners that do assessments and make decisions and
	make care plans cooperatively together.  I work in a Canadian tertiary acute
	care facility where the speech language pathologist and the dietitian work
	together--side by side.  Our training, skill sets and knowledge base are
	very complimentary and work together in the best interest of the patient.
	Where the SLP has a more vast knowledge regarding the neuro assessment, the
	dietitian has a better grasp on the medical condition of the patient.  We do
	both the clinical bedside assessments together and the modified barium
	swallow assessments together.  I'm sure many of you think this isn't
	cost-effective.  However, we find it very efficient, as we can "divide and
	conquer" the tasks at hand,  including:  charting, family education, staff
	education, diet orders, tube feed changes, posting feeding guidelines at
	bedside, etc.  The dietitian monitors medical, nutritional and hydration
	status carefully, while the SLP monitors neurological and respiratory change
	and together we alter the care plan and reassess dysphagia to provide
	patient-centred care.  We can't be expected to know it all and do it all,
	and it's very important to know where your expertise lies and to know what
	you don't know. We all try to keep up with the dysphagia literature, and
	even here find complimentary skills when looking at the literature and
	weighing the evidence.  Dysphagia teams work, and who better to be on them
	than the SLP and dietitian--especially in acute care. 
	
	Respectfully submitted,
	Wilma Clancy P.Dt.  Clinical Dietitian Stroke and Neurology
	
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