May 2019 Newsletter
MAY IS BETTER SPEECH AND HEARING MONTH
Happy Mother’s Day to all mothers! And Happy Memorial Day!
Remember our men and women (including moms) that have sacrificed ALL to fight and maintain our freedom!
Hug a Mom and a Veteran this month, whether it is yours or not!
MAY is Better Speech and Hearing Month –This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. ASHA has many resources to help you celebrate BHSM every day at www.asha.org. Some good educational material to share can also be found in the booklet ABOVE and BEYOND.
ABOVE and BEYOND By Ronda Polansky M.S. CCC-SLP - Patient, Caregiver, and Healthcare Professional Educational Reference Sheets and Handouts for Effective Dysphagia Rehabilitation. 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 need-to-have booklet in your therapy bag!! Cost: $40.00. (plus S&H). Discounted to $30.00 for MBSH Month. Call us, we will get one out to you!
DVD – What You Can Not See at Bedside- Copies of MBSS studies for the education of staff and families on various disorders and clear episodes of penetrations and aspirations. Cost - $40.00 (plus S & H). Discounted to $30.00 for MBSH Month. A great educational tool for anyone! This is the same videos we presented at TSHA.
An SLP Should NEVER Lose Their Voice - Advocate for Proper Dysphagia Evaluations - Material to assist in educating Physicians, Administrators, Nurses and other Medical Professionals on Dysphagia and MBSS
DiagnosTEX Holiday – Memorial Day - DiagnosTEX will not be operating vans on Monday, May 27th, but will run all vans Tuesday through Friday that week. Please keep this in mind when scheduling your MBSS around that time. We have veterans working for DiagnosTEX. We honor them, any others who have served, and those who are currently sacrificing for our freedom! We also remember those who paid the ultimate price for our country and our freedom today! Thank you from the bottom of our hearts to all the veterans who served and are serving our country for the freedom we cherish.
CEU Opportunities in Texas with Ampcare ESP - Go to www.ampcarellc.com to register or see more course schedules. DiagnosTEX customers get a discount on the CEU courses! Register at use the code “diagnostex”.
Next local course is May 13 at Texas Woman University in Dallas, Texas.
Just a shout out to Rehab Synergies to say THANK YOU for inviting us to speak at the monthly meeting Dysphagia and Dining last month!
PDPM Questions – We have received LOTS and LOTS of questions regarding the new upcoming changes with PDPM, the final update will not be until October, yet we are finding there are already MANY misconceptions being taught on this in the field. There is a new FB site called PDPM Resources for SLPs, join this group to get some of your questions answered!
DiagnosTEX QA results are in! GREAT STATS!! - Several attempts were made to follow up with the referring/treating therapists, patient, or family members but despite committed efforts, our follow-up calls were often not returned, or information on the patient was unobtainable due to the turnover of staff, patients relocating or patients expiring. Therefore, regarding this month of QA, we were unable to retrieve follow up information on 44 of the patients assessed. Final statistics regarding post- MBSS recommendations are based on the information we could compile from direct communication during our follow up. A GREAT BIG THANK YOU for those who called us back!!!
Resultant from 452 performed MBSS, Pureed diets were recommended for 77 of the cases, mechanical soft for 71 soft regular for 12 and a regular diet for 184. Liquid recommendations were as follows: thin liquid for 259 cases, nectar thick liquid for 53 cases, honey-thick liquids for 31 cases and 2 cases for pudding thick liquids. On 8 studies, we were unable to complete full assessment/protocol, therefore full recommendations of PO were not possible due to various interfering factors (patient refusal, limited participation, inability to complete the study, etc.). We think it is important to note that thin liquids (with and/or without strategies) were recommended more than all thickened liquid recommendations combined. Thin liquids were recommended for 58% of the studies completed. In comparison, nectar thick liquids were recommended for 12% of studies completed (honey for 7%, and pudding for less than 1%). This disputes the argument or concern that many patients receiving an MBSS are most often recommended thickened liquids as a conservative measure to reduce dysphagia.
PO to NPO - Fifty-three (53 = 12%) patients that were reported as receiving PO prior to assessment ultimately received a recommendation of NPO following the MBSS. Of those 53 patients, 45 (85%) were silent aspirators.
NPO to PO - Forty-one (41 = 9%) patients with previous NPO status received some degree of PO recommendation (including therapeutic trials or pleasure feedings) following instrumental evaluations by MBSS. Of those 41 patients, 10 (24%) were silent aspirators.
NPO to NPO - Forty-seven (47 = 11%) patients that were NPO prior to MBSS remained NPO. Thirty-four (34 = 72%) of those patients were silent aspirators. Of the 47 patients that remained NPO as a recommendation by the completion of MBSS, 15 (32%) were allowed some sort of therapeutic trials to initiate PO in a safe, controlled environment under the direct supervision of the SLP treating for dysphagia. 100 recommendations were made for NPO (i.e., nothing by mouth) and subsequently alternate means of feeding for the main source of nutrition and hydration.
Silent Aspiration - The total number of patients who aspirated during October, 2018 MBSS performed by DiagnosTEX was 203. Of the 203 patients who aspirated, 177 were silent aspirators. This statistic is extremely important, indicating that 87% of those who aspirate did so SILENTLY.
Reduction of Feeding Tube Use - Eighty-nine (89 = 20%) patients had a previous diet of NPO/PEG or NG (nothing by mouth/alternate means of nutrition/hydration). Of these 89, 41 cases of PO recommendations were followed through and alternate means of feeding was decreased and/or eliminated through means of upgrades to full diets or pleasure feedings. Two (2%) of the 89 were recommended to initiate PO trials through therapeutic feedings by the SLP treating for dysphagia.
Esophageal - During the month of October 2018, out of the 452 patients evaluated, there were 40 patients that could not be evaluated for esophageal scan, either a result of limitations of positioning (unable to be turned to evaluate the AP view, required for the esophageal scan), patient refusal, early termination of studies, etc. Four hundred twelve (412 = 91%) patients could participate in the esophageal scan. Of those 412, 211 (51%) patients were noted to demonstrate some level of esophageal dysfunction.
AMA - Seventy-nine (79 = 19%) cases reported that recommendations determined by the MBSS were not followed because the patient, the patient’s family and/or power of attorney (POA) chose for these patients to have desired consistencies against medical advice (AMA).
Quality assurance provides effective measurements to show the importance of an instrumental assessment (MBSS) in the evaluation and treatment of dysphagia. Following up on patients and tracking trends assists in appraising the overall cost-effectiveness this type of measurement provides to healthcare and rehabilitative treatment. This instrumental evaluation for dysphagia has shown that the completion of MBSS contributes to cuts in treatments of recurrent pneumonia, repeat hospitalizations, therapy rates (by increasing discharge rates), spending within areas of tube feeding, etc. The modified barium swallow study is the most documented instrumental evaluation in literature for identifying and recommending treatment for dysphagia in any/all phases of the swallow.