Nursing doing bedside swallow studies...

[jlcole45]

At our hospital several select nurses have been asked to train to do bedside swallow studies. Is anyone

else doing this? In the past its always been done by speech therapy but I think in our case we don't have

enough speech therapists. If you are doing it how has it gone? Do the doctors believe the results?

[MAISY, RN-ER, BSN, RN]

Every nurse in my ED is expected to complete a swallow evaluation in the event of ANY patient presenting with a neuro complaint-from CVA to numbness in fingers. This was initiated to comply with stroke certification and can be initiated by any nurse in our facility if there is a change in mental status or probable neuro event.

It is very simple, clear throat, cough, speak clearly, tongue midline, sip water from spoon without difficulty and swallow, sip from straw and swallow without difficulty and no oral obstructions such as dentures. There are sub categories, but if the patient does not pass-NOTHING is given PO.

Speech therapists are few and far between these days in my hospital and will complete dysphagia studies, and evaluate failures of RN initiated evals.

M

[SummerGarden, BSN, MSN, RN]

one floor i used to work required all patients with a recent cva to receive a bedside swallow and stroke assessment by the nurses on the floor. all nurses were trained and certified to perform the assessment. if the patient failed the bedside swallow offered by the nurse, then the patient was automatically npo. doctors believed the result, however, the patient continued to be followed up by a speech therapist. if the patient failed the swallow study twice (once by the nurse then by the speech therapist) he/she continued to be npo and was followed up for further study before given a different diet suggested by the speech therapist and ordered by the physician.

[nicole109]

I came from a neuro floor, and there are 2 different schools of thought on this. One is that the RNs can be trained to do the swallow with a sip of water, a cracker and applesauce. If there is any coughing, then they are NPO until a formal swallow eval can be completed with speech. Because we were a stroke center we had a speech therapist at our disposal. She was there M-F and on call on the weekends. We, as nurses did not complete swallow evaluations under any circumstances though. MDs only completed them, and that was part of our stroke certification under JCAHO. The MD would do the swallow in the ED and determine them either pass or fail, if they passed, then they got to eat and take meds. Speech would still "stop by" at the earliest opportunity to see how they were doing. If they failed, then they were NPO until speech could complete a formal eval. I think the reason that only our MDs and SLP were doing the bedsides is because there is so much research out there supporting inappropriate evals and not catching silent aspirators. Our SLP had an amazing fluoro on a patient that had absolutely passed their bedside and when they went down for fluoro later, their bolus was going right into their lung, they had no gag whatsoever. Even the SLP had no idea they were aspirating at the bedside. Many of our patients were like that--and I don't want that on my license.

[jlcole45]

Thanks so far for all the comments. Obviously I had concerns otherwise I wouldn't have posted anything. I have taken care of silent aspirators and I think it happens a lot more then we know. I am hesitant to be the one giving the thumbs up on these folks without having

something like an XRay or fluro to back me up.

[NHSLP1]

What Maisy describes is a swallow screaning and not a bedside swallow study. SLP's have masters degrees in the area and have had comprehensive training. While screenings are a quick way to see if a patient may be at risk, they are not a substitute for either a bedside swallow evaluation nor instrumental swallow evaluation. I would be wary of a hospital asking nursing to perform a full bedside swallowing evaluation since it is the nurse who can get sued if something goes wrong.

[xoemmylouox, ASN, RN]

I know many places have the nurse do an initial screening, but a full on evaluation is typically done by the SLP. Hopefully the OP's employer simply means the nurse will do the simple screen and will receive a complete eval for a patient that fails the initial screening.