December 2014 Newsletter
Merry Christmas from DiagnosTEX!
Welcome to the Clinical Caffé DiagnosTEX Newsletter
Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
By: Ronda Polansky, M.S. CCC-SLP
December 2014
During this season, our thoughts turn gratefully to those who have made our success here in D/FW possible. In this spirit we say simply but sincerely, may the gift of peace the surpasses all understanding, as well as indescribable joy and happiness be yours at Christmas and throughout the New Year of 2015!
Everyone at DiagnosTEX wishes all of you a very Merry Christmas!
It’s a Giving time of year! It is better to give than to receive and we enjoy giving back to you for your trust in us!
Its back! The 2015 DiagnosTEX Dysphagia Calendar will be ready this month!J
Educational handout for treating SLPs– Dysphagia Diets for the Holiday Season for Family Education
A DiagnosTEX Documentation CONTEST! Are your ready for the challenge??? If you fill out the DiagnosTEX History/Consult form in its entirety with NO blanksandprovide us with an H & P, you will get a sweet treat the day we do your study AND your name will be placed in a drawing. At the end of each month whoever’s name is drawn will win a PRIZE which will be delivered to you the next time we visit your facility! It’s something that should be done for Medicare documentation anyway so let’s see who takes the extra time and LET the documentation challenge begin! J
Scheduled ETA’s – Please be aware that when we call to schedule a time with you we can only guarantee it as an Estimated Time of Arrival. Being mobile subjects us to many delays: traffic, road construction, maintenance issues, weather, cancellations, add-ons, difficult to complex patient MBSS, patients not up and ready for us when we arrive, family members and additional education required, behavior/agitation, nausea and vomiting (at times on the van) etc. Please know our techs will always call before we leave the facility before you and then again when we are 5 minutes away. The mobile unit is an option for an MBSS for the convenience of us coming to you so no one has to be transported out to the hospital, yet mobile does require some flexibility on everyone involved. Thank you for your understanding of this unique diagnostic setting.
DiagnosTEX December Holiday Schedule – DiagnosTEX will operate Monday (12/22), Tuesday (12/23) and Wednesday (12/24) the week of Christmas. DiagnosTEX will not run vans Thursday (12/25) or Friday (12/26). We will also run Monday (12/29), Tuesday (12/30), Wednesday (12/31) the following week of New Years. We will not run vans Thursday (1/1) and Friday (1/2). We want to meet all of your MBSS needs; we know PO feeding becomes very important on several levels to many patients and their families around the holidays. The days prior to the holidays are long for us as we work very hard to get everyone’s requests completed. We must also be considerate to all of our DiagnosTEX employees and their families. Please keep these holiday schedules in mind when scheduling your MBSS in December!
******Please take note and keep in mind during this busy time of year******
ASAP requests often cannot be accommodated to the satisfaction of those requesting it.
Specific requests for specific times and/or days become exponentially difficult to accommodate and therefore, we may be unable to quickly schedule your patient with any specific time and day requests.
Please notify your staff, patients, and families as such.
Being mobile allows the convenience of the service coming to you – not for the customized flexibility of schedules and times. We are a venue option for an MBSS and we must schedule our mobile clinics for efficiency and cost effectiveness.
If you or the patient and family require a specific time and/or day,
please consider a free-standing outpatient facility (e.g., a hospital).
Christmas Ideas for your favorite CFY or SLP evaluating and treating dysphagia!
ABOVE and BEYOND
Patient, Caregiver, and Healthcare Professional Educational Reference Sheets and Handouts for Effective Dysphagia Rehabilitation.
By: Ronda Polansky M.S. CCC-SLP
Over 30 handouts on specific disorders in dysphagia in ONE location to use in your practice, plus a resource section for SLP’s on cranial nerve testing, pharyngeal exercises, and treatment techniques. A must have booklet in your therapy bag!! Cost: $40.00. Holiday Discount $30.00 (+S&H). Call us and we will get one out to you! Thank you to all who have ordered already and have also referred others SLP’s to it.
What You Can’t See at Bedside Educational DVD – $60.00, Holiday Price $40.00 (+S &H)
DVD includes 12 MBSS showing aspiration, Zenker’s Diverticulum, Parkinson’s disease, Pharyngeal obstruction etc.
Need DECEMBER CEU’S!!!! AMPCARE is in California and Dallas
December 2-3 – ASHA CEU course in Burbank, CA
December 13 – ASHA CEU course in Dallas, TX
Check out the website at www.ampcarellc.com for more information and to register
DIAGNOSTEX POLICIES AND PROCEDURES ON MRSA, VRE, C – DIFF – We have had several instances recently where the SLP or health care staff completing the consult/hx forms, have not put any information on the infectious disease the patient may have. We are surprised by these diagnosis when we see the chart and come in to get the patient and find them in isolation. Our mobile clinic is subject to 10+ individuals a day with already compromised immune systems, unlike a patient’s isolated room, and we MUST be notified of these infectious disease BEFORE we schedule and bring the patient out to the mobile clinic. Please provide us with this VERY important health care and medical history information on any infection that can be spread through the air or bodily fluids. The DiagnosTEX policy for MRSA, VRE, and C-Diff, is that a patient must be on antibiotics for 2 weeks prior to scheduling an MBSS on our mobile clinic. If there are multiple patients to be seen at that facility, the infected individual should be the last person seen. If they have not had at least 2 negative cultures, the facility should provide the protective equipment for the patient (gowns and masks). As you know, in an MBSS on the mobile clinic we are up close and personal with episodes of coughing, sneezing, vomiting, leaking tubes, and wandering unclean hands. If you have any questions, feel free to call us at any time.
Is the patient appropriate for an MBSS right now? We have had several instances lately where we have had inappropriate patients on the mobile clinic for an MBSS. In fact, some of the first words of the treating SLP upon entrance to the van have been that “this patient isn’t really appropriate.” We have been subject to being hit, kicked, bitten (with lasting effects), spit on, vomited on, and/or patients requiring immediate suctioning due to vomiting or inability to manipulate the bolus orally. Positioning is also an area that is necessary to evaluated for an MBSS. If the patient is unable to be positioned appropriately for the MBSS and we are unable to see the entire airway and VC, this pt is inappropriate for an MBSS. If they cannot hold an upright position for an adequate and complete evaluation, they are also inappropriate for an MBSS. The bedside swallow evaluation is completed to determine appropriateness for further instrumental assessment. Although we do many, many MBSSs and are extremely well-versed on a large variety of patients, diagnoses, and behaviors, it does not make the situation any more appropriate if the patient is inappropriate.
Not only is it unethical to order an MBSS on an inappropriate patient, but Medicare sees it as fraudulent because there is lack of medical necessity. You can also refer to the ASHA website and the Dysphagia Instrumental Assessment.
Attempting MBSS on these types of patients can create a liability issue for us as the company providing the service on a high-risk patient or a patient that is not appropriate. If “family isrequesting a study” for a patient that does not meet the necessary requirements for an MBSS as medically necessary, then Medicare will likely deny coverage and they may have to pay “out of pocket.” I would recommend you not put this in your documentation for medical necessity or reason for study.
Patient safety always comes first!! No matter how much the MD, nursing, DOR, or the administrator, etc. wants a study completed, the risk of frank aspiration on a medically unstable patient is inappropriate. Note the following as a list of indicators that may signify your pt is inappropriate for a MBSS:
- Medically unstable
- Agitated or physically aggressive with possibility of harming themselves in a small contained environment or harming the therapist
- Refusing PO intake (if they won’t take pudding inside the facility, they will not take pudding with barium for us)
- Unable to manage their own secretions and saliva (If they cannot do this, they will be unable to manage a bolus adequately or its oropharyngeal residues.)
- Unable to trigger a swallow reflex on command or reflexively. (You do not need an MBSS to diagnose this)
- Not alert, lethargic (This is key to a functional swallowing assessment and safe PO feeding, you would not feed them a meal this way, we do not need to do an MBSS this way)
- Poor sitting position for study and for feeding (If we cannot see the VC or posterior wall of vestibule, we will not complete the study, because it will not be complete, accurate, and/or efficient.)
- Nausea and vomiting within the last 24 hours, with or without fever. (Please be considerate of the patient , when you are nauseated, the last thing you would want to eat or drink is barium, applesauce, and pudding)
The DiagnosTEX team (MD and SLP) have the right, as the consulting providers, to determine whether they feel the patient is appropriate and they will decide whether to continue with the MBSS or not. If the patient is not appropriate and we are unable to get the study completed there will be cancellation fee to the facility for our travel there and time spent at the facility.
Food Allergies – The DiagnosTEX hx/consult form, has a blank for this information. It is certainly information we like to have, to avoid giving any food a patient may be allergic to, but DiagnosTEX will not be providing any specialized food for the exam. Therefore, if there are limitations such as gluten free, nondairy, fruit allergies etc., please provide any specialty food items in testable consistencies (i,e, crackers) otherwise the study may be limited to the barium liquid and paste. It is also important to realize that barium liquidand powder has strawberry and lemon flavoring (natural and artificial) so please be aware of this and let us know if there are such allergies to this fruit, as this might affect the ability to complete the study at all.
Dysphagia Tidbit – What does a Head Turn do?
- Turning to weaker (damaged) side eliminates the damaged side from the bolus path,
allows the bolus to pass through the intact side. (This can reduce unilateral pyriform retention) - Pulls cricoid cartilage away from posterior pharyngeal wall, reducing resting pressure in UES
- Increases vocal fold closure by applying extrinsic pressure, narrows laryngeal entrance
- Used if there is unilateral pharyngeal paresis; cricopharyngeal dysfunction; unilateral laryngeal dysfunction
- Can possibly bypass an asymmetrical anatomical structure (i.e. osteophyte)