An interesting article about dysphagia screening and assessment, and the various professions roles in this process:

Hospitals that are credentialed as stroke centers must have a screening tool for dysphagia in place, according to the American Heart Association. Furthermore, the Joint Commission states that a screen for dysphagia should be administered to patients with stroke before they are given “food, fluids and medications by mouth.”1

In compliance with these requirements, some hospitals are introducing a swallow screening procedure designed specifically for nurses. The purpose of the procedure is to enable them to screen newly admitted patients who may be at risk for aspiration and quickly determine if they are safe for oral intake.

And:

It’s important to note that the nurses who perform the screening are not performing swallow evaluations, nor are they replacing speech-language pathologists.

“My job is to perform a comprehensive evaluation on every patient. This [procedure] allows nurses to more accurately determine who needs a full evaluation and who can start their oral intake. An evaluation is far greater than that,” said Audrey Cohen, MS, CCC-SLP, of the Department of Speech, Language and Swallowing at Massachusetts General Hospital (MGH)in Boston.

Training the nurses:

Staff can access a Web-based training module via CD or the hospital Intranet. The module includes background information on the nature of dysphagia, aspiration and oral hygiene. It also differentiates between a swallow screen and a comprehensive evaluation and explains the role of the nurse in caring for patients with dysphagia.

The training module shows a demonstration of how to perform the screening appropriately, with video clips of patients exhibiting normal and abnormal responses. As part of their training, nurses must perform the screening at least five times under the supervision of a speech-language pathologist.

Where CNA’s come into this:

If a swallow evaluation is warranted by an RN, nurse practitioner or physician, the speech-language pathologist establishes the patient’s safest diet level and discusses safe swallowing techniques with nursing. All of the information is placed on a swallowing instruction sheet in a Communication Binder that the departments pass back and forth.

“We write down the patient’s diet level and any safe swallowing strategies that we feel need to be implemented with the patient during the meal,” said Repsher.

In each dining room a trained certified nursing assistant (CNA) is assigned to a supervision table and uses the information on the swallowing instruction sheet to ensure the patients eat safely. The CNA adds specific comments, such as if patients are having difficulty during the meal.

The facility offers dysphagia groups for patients. Speech-language pathologists instruct patients on compensatory strategies and safe swallowing techniques. They assess the safety of the patient’s swallow and increase the diet level as tolerated.

When appropriate, the nursing staff is given a demonstration on how to carry out these instructions.

“We show them what the patient needs to do,” said Repsher. “If the nursing assistant is in the dining room at the same time that we’re at the supervision table, we would instruct the nursing assistant on the strategies the patient needs to use.”

This information is then included in the Communication Binder.

CNA’s are on the forefront of dysphagia. We see it, hear it, watch it happen when we witness coughing, choking, strained swallowing, pocketing of food, slow or incomplete swallows. Our observations are critical to the entire process. It’s very important to share these observations with the nurses or SLP when they ask. Episodes of difficult swallowing or choking must be reported and potential illnesses watched for. The CNA is the vital link in this.

Nursing homes should have a similar plan in place for these issues. “Resident Oral Intake” Guidelines should be set up for each resident who eats.