June 2009 Newsletter

Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
June 2009

Happy Father’s Day!
Do not forget to fly your American flag on the 4th in honor of our country, our troops and our freedom!

Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Monthly Motivator: Challenge
Never decide if the mountain is too high
until you have reached the top

Summer DiagnosTEX CEU Conference – ESTIM IN DFW!
Deciphering Dysphagia with E-Stim Neuromuscular Re-education of the Submandibular Muscles to Increase Laryngeal Elevation Using Class II NMES Device – Saturday July 18, 2009. Hosted by Rehab Pro and AMPCARE. 7.5 TSHA CEU’s Lewisville, Texas from 8:30am-5pm
Registration information included.

Got Ethics? – DiagnosTEX will host an ethics course at the end of August, in honor of the upcoming Labor Day!  Be looking for further details in July and August newsletters.

New DiagnosTEX SLP – We are excited to welcome Kelli Andrew M.S. CCC-SLP to the DiagnosTEX team. She is in the process of the “brutal”  DiagnosTEX 3-month training, so many of you will see her on the mobile clinic with us. She will be a wonderful addition to our staff and we look forward to her professional contribution to our company!

Dates to remember in June:
7th – Cancer Survivor’s Day www.cancer.org
9-15th – National Men’s Health Week www.menshealth.com
11th-18th – Nursing Assistants Day and Week www.cna-network.org
22nd-28th – Helen Keller Deaf-Blind Awareness Week www.helenkeller.org

Upcoming July holiday – DiagnosTEX will be closed Friday July 3rd in observance of Independence Day. Please keep this in mind when scheduling your MBSS.

MRSA Precautions –If your MBSS patient has MRSA of the sputum and has been on antibiotics for at least 2 weeks, please bring them out to the mobile clinic supplied with a gown and mask from your facility. We appreciate you having them properly prepared for their MBSS.
Top 10 medications prescribed in SNF
Most frequently prescribed medications in 2007 were: Laxix, Synthroid, Lisinopril, Zoloft, Aricept, Ativan, Seroquel, Coumadin, Remeron, Protonix. The most frequently occurring side effects of such medications are: muscle weakness, nausea, dizziness, diarrhea, drowsiness, stomach upset, tiredness, headache, sleeplessness, lightheadedness, and constipation. Side effects such as dizziness, weakness, drowsiness, tiredness, headache, sleeplessness, and lightheadedness could all trigger changes in cognitive status such as decreased attention and concentration or increased risk for disorientation. These side effects could also potentially impact endurance for SLP treatment sessions. Side effects such as nausea, diarrhea, stomach upset and constipation could all potentially increase the risk of weight loss and dehydration. Subsequently, there could be a negative impact on the patient’s ability to participate with dysphagia treatment. Successful intervention and optimal therapy outcomes can only be facilitated by our awareness and attention to potential medication side effects.
Reference: Rieinger, V., Glad, K., Aegies Therapies, 2007, The Top Ten Medication Prescribed in LTC Facilities – Revisited.

Dysphagia Tidbit – Case Studies in Dysphagia Malpractice Litigation
During dysphagia malpractice litigations, the accuracy of dysphagia screenings and dysphagia evaluations may be an issue. Attorneys will question accuracy, appropriateness and timeliness for a particular patent and their influence in the alleged negative dysphagia outcome. Attorneys usually provide a preliminary initial disclosure of the facts related to the case to a dysphagia expert witness. The clinical timeline begins with the first relevant medical notation of the dysphagia, or the disease/disorder associated with it, and ends with the final negative dysphagia outcome (often a death certificate, autopsy report, and/or cause of death statement from a medical pathologist). Of particular importance are medial pathologists who may confirm the presence of infiltrates in the patient’s lung(s) in the autopsy. (Tanner, 2006, pg. 16)
Case studies give an insight to what can go wrong in dysphagia management. Fear and anxiety should not be the driving force in the evaluation and/or treatment of dysphagia. However, if a diagnostic error is made and an SLP does not recommend an instrumental assessment when one is required, or an unnecessary delay in the assessment exists, the negative clinical outcomes can result in death, malpractice lawsuit, grief, and heartache. Primary dysphagia management issues include 1) professional proficiency in dysphagia management, 2) professional communication, 3) accuracy, appropriateness, and timeliness of assessment, 4) instrumental assessments, 5) diet/NPO status/tube feeding. (Tanner, 2009)
We have many facilities delay in scheduling an MBSS for a variety of reasons including but not limited to: time of day (a.m./p.m.), day of the week (i.e. NO FRIDAYS), family need to be present, etc. We have heard the “best of the best” here at DiagnosTEX in reasons why we can not do the studies… To name a few: 1) “It is not her day to have a chair.” 2) “I (the SLP) have to take my dog to the vet.” 3) “We are having a birthday party in rehab.” 4) “She is getting her hair done.” 5) “She only likes to get up between 2-3 p.m.” 6) “It can wait; she only coughs after the meal.”
None of these would stand up as a “necessary delay” in the instrumental evaluation. We understand many SLPs like to be present for the MBSS, but please consider the safety of the patient and the liability issue that could arise from a delay. Be looking for our August CEU course on ethics to hear more about ethics, malpractice, litigation and case studies.

Poem – I was very touched by a poem that was passed on to me and I have included it in this month’s newsletter. We love our patient’s and sometimes we need to reminded of WHO they are! Pass it on to those who need to see it!