RN BEDSIDE SWALLOW SCREEN

3 OUNCE WATER TEST Evidence Based Research – 1992’ 98% effective for identification of aspiration (Suiter...) Despite Failure of 3 ounce H2O test- Research shows that referral to SLP w/ Ax resulted in 70.6% of individuals went on to take some level of PO. (modified liquid & food consistencies, & postural)

Why Water….? Use of water versus, juice or other.. Less harmful to lungs if aspirated when compared to juice or liquids w/ increased sugar.. (Orange Juice) **Check for oral hygiene

Step 1- Begin Assessment: Prior to Water Trials Lethargic Weak Cough Unable to manage secretions Unable to control head position Facial Weakness Slurred Speech History of Dysphagia

If patient does not pass Step 1 TIME… Something more to do… Time Saver…. If patient does not pass Step 1 NPO & SLP order Call us - X6172 Patient Saver & save time later…..

History of Dysphagia Do not rely on H&P SLP – Increase reporting about previous patients- Patient Profile Reported Problems Oropharyngeal Dysphagia or Aspiration Risk Reported Procedures Modified Barium Swallow Study

Dysphagia History for Patients that have no previous admission to SCHS Do simply rely on patient’s self report. Ask family/friends about eating habits or specific s/s’s Ask patient about s/s’s & specifics about eating habits

What to ask…. Do you ever feel like food or liquid goes down the wrong way? How often? Are there any foods that feel get stuck on the way down? If so… can you show me where? Are there any foods that you find difficult to chew?

Continued…. Which ones? How do you take your medications at home? (w/ water…? How many at a time?) Any coughing or throat clearing during meal time? Esophageal / Reflux related questions…

Esophageal / Reflux Questions Heartburn / Indigestion? Regurgitation Do you feel food or liquid are slow getting to your stomach? If Yes, why? SLP scope of practice is expanding & moving into education & training more so in this area – 5+ years

If No to Step 1: Begin Water Trials Overview Check for clean oral cavity Assess for xerostomia- (dry mouth) PO trial given to patient w/ xerostomia may give you a false positive.

Signs & Symptoms Prepare the Patient Do not give them instruction Achieve a dry vocal baseline if wetness perceived For example, if voice is wet from congestion, CHF or wheezing at baseline…. ** Have Patient clear throat or cough & swallow.

Dry Vocal baseline Listen to patient’s voice (talk or say /ah/ Then begin water trials Wet/Gurgly Voice or Wheeze **True differential assessment achieved when following the above.

Why is this important? You may perceive a slight increase in vocal wetness but no cough or throat clear This may be s/s’s of “silent aspiration” ***When in doubt … Order SLP

All Patients… Not just for CVA diagnosis Know if you are even thinking about it… Order SLP ------ 911 ***CALL US ANYTIME- X6172

Aspiration PNA Statistics CVA: 29/60 Suffer from Aspiration PNA in year (Johnson et al.. 93’) CVA: Prevalence of dysphagia 13% Other Diagnoses Respiratory Failure w/ trach: 85% (Tolep, 96’) Spinal Cord Injury: 74% ACDF:45-60% Other Diagnoses: Referral Parkinson’s, other neurdegenerative… Now exacerbated.. Other: UTI, Sepsis, delerium

Thick liquid treatment Questions?? THANK YOU! From… Our patients & Family…. For decreased LOS & For the wonderful ... Thick liquid treatment