Physicians Order The physicians order for the MBSS needs to be signed by the physician or at least by an RN who received a verbal or telephone order before we can schedule the MBSS, it can not be signed by the Speech Pathologist only. Also if the SLP writes the order please word it as the following “Dysphagia Consult including Modified Barium Swallow Study”. If you can provide us with their copy of the Medicare and/or Medicaid Card, that would be more than helpful to us! Thank you!

MRSA Information for DiagnosTEX mobile MBSS – MRSA (Methicillin Resistant Staphylococcus Aures) of the sputum.

The health care standard locally for MRSA is 3 negatives lab results to remove a patient out of isolation or contact isolation for current positive cultures. Exceptions can be made if the patients MRSA is colonized, being treated currently with antibiotic longer than 24 hours, tolerate masking, and can be scheduled as the last study for the day on the mobile clinic.

Please realize to schedule a patient at the end of the day may require special scheduling and may require several days to make this accommodation work.

Thank you Rehab Pro Thank you Rehab Prop for asking me to present “Dysphagia Program Development and Management” last month. I enjoyed it and enjoyed the time with your staff!

Next DiagnosTEX CEU Conference This is still in the works……………………..

I did 2 articles with Russ Campbell and Rick McAdoo on E-Stim in 1997 and 1998. This upcoming conference will discuss these articles/my research, review swallowing A& P, discuss current trends, protocols, and controversies, get some PT perspective on NMES as well as some SLP’s currently using various E-Stim protocols on adults and infants. No date or time has been set at this time. I will keep you informed. Plan on bringing your PT co-worker as they will be able to get credits as well.

This conference will not promote any E-stim/NMES device. This is an educational conference, your right to academic freedom. We all have an “ethical responsibility not only to learn from but also to contribute to the total store of scientific knowledge when possible, etc.” (E 9.095 – AMA Policy).

Often asked Question to ASHA: My facility wants to reduce costs and thinks that reducing dysphagia services will save money. What data is there to show that dysphagia services are cost-effective? The Agency for Health Care Policy and Research (AHCPR) developed a report about dysphagia in 1999. They found that bedside exams can detect aspiration risk with an 80% accuracy rate. Using this figure, and the fact that approximately 75% of all stroke patients exhibit some form of dysphagia, it was concluded that 150 of every 1000 stroke patients who aspirate would be missed. The AHCPR report noted that 37% of patients with aspiration develop aspiration pneumonia. Therefore, approximately 56 of the 150 patients missed would develop pneumonia at a cost of $11, 000 – $15, 000 per hospital course of treatment for pneumonia (total cost = $616,000 – $840,000).A typical instrumental assessment to identify aspiration risk costs $250. If all patients identified at bedside as dysphagic were followed up with an instrumental assessment, the cost would be $200,000 (800 patients x $250/exam). As you can see, this figure is well below the cost of treating pneumonia. Proper dysphagia treatment can save a facility thousands of dollars per patient, which makes it very cost effective.

Dysphagia Tidbit The FDA recently published an advisory on “Reports of Blue Discoloration and Death in Patients Receiving Enteral Feedings Tinted with the Dye, FD&C Blue No. 1“. The purpose of this advisory was to alert practitioners about reported cases of patients experiencing blue discoloration of the skin or other organs, as well as more serious complications, after receiving blue-tinted tube feedings. In 2000 a letter to the editor in the New England Journal of Medicine reported 2 deaths due to blue-dye absorption in patients with sepsis, which increased gut permeability and allowed the

blue –dye to enter the bloodstream. Although a definitive link between the blue dye and these complications has not been established, many facilities have reduced or even banned the use of blue dye. ASHA does not endorse any procedure or therapeutic technique and therefore does not have a position about the use of blue dye for swallowing assessments. Certainly, SLPs who use blue dye need to be aware of this FDA advisory and consider the use of blue dye in patients who may be at risk for complications. In a 2003 ASHA Leader article, Nancy Swigert summarized the issues surrounding the use of blue dye in swallowing assessments. It should be noted that there no longer appear to be any distributors selling single-use vials of sterile blue dye. You can find her article at www.asha.org/about/publications/leader-online/archives/2003/q1/030318a.htm.