When you are faced with new information about evidence-based practice in dysphagia, all of the following are true, except:

What benchmarks on the change journey may provide the strongest impetus to persist with efforts to make change?

True or False: The term “PO trials” is just a semantics issue, and all that is needed is to alter documentation to updated terminology, such as oral trials, bolus trials, or IDDSI level administered.

All of the following statements are true, except:

Water can be used in a clinical swallow evaluation in a variety of ways – as a screen for aspiration, a test of swallowing capacity, swallowing volume, swallowing speed, and swallow duration. Select the test which was designed to assess swallowing capacity, with a simple cut point of 10mL/sec or more to indicate normal swallow speed.

Which of these swallow evaluation protocols uses 100g thin liquids, 100g honey thick liquids (IDDSI level 3), and solid cream cracker to assess safe swallowing capacity?

Some basic elements of the evidence-based CSE for most patients would likely include:

You have SLP orders to evaluate a patient in the ICU for dysphagia who is s/p acute respiratory failure and was intubated 4 days, extubated 4 hours ago, stable on 2L nasal cannula without any source of oral or enteral nutrition. The patient is awake and alert, and asking for food. Nursing needs to give oral medication so the order is marked “stat.”  Respiratory rate is 18, the patient is recovering from sepsis, and has been talking to his family via FaceTime.  He received early mobility in the ICU, can stand at edge of bed, can take 3-5 steps to bedside commode or chair with walker and gait belt with contact guard assist.  He completed oral care 1 hour ago using the suction toothbrush since he can’t stand long enough at the sink yet. What option is the best evidence for a swallow protocol for this population?

The speech therapy team is currently using the Northwestern Dysphagia Patient Check Sheet (NDPCS) in the electronic chart to complete the clinical swallow evaluation in your facility. The typical practice is to complete an oral mechanism exam, then give the patient ice, sips of water, teaspoon sips of nectar and honey thick liquids (IDDSI level 2 and 3), 3 bites of applesauce, and a graham cracker.  If a patient demonstrates signs of aspiration, patients usually get nectar thick liquids or honey thick liquids for 3 to 4 days to see if they will recover from their acute dysphagia before imaging is recommended.  After reviewing the NDPCS in the course, you’ve discovered that some changes are necessary.  Identify the main problem in this situation.

Using the situation from the last question, what might be the next steps on the change journey to align with evidence-based practice?