Improving Patient Identification Skills in Long Term Care

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• Improving Patient Identification Skills in Long
  Term Care
• Linda Barboa, PhD., CCC, SLP
• Missouri State University
• Springfield, Missouri

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Speech Therapy Skilled Interventions

• Diet texture analysis
• Trial feedings
• Dysphagia Management
• Pre-feeding skills
• Oral/pharyngeal strengthening
• Oral/pharyngeal desensitization
• Thermal stimulation
• Oral/pharyngeal stimulation
• Motor speech training
• Dysarthria-Breathing coordination/ strength/ type
• Dysarthria-Pitch variation
• Prosody
• Thought organization

• Apraxia-Sounds/syllable/word/phrase imitation
• Apraxia-Automatic speech
• Oral/pharyngeal coordination training
• Oral sensitivity training
• Auditory comprehension activities

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Speech Therapy Skilled Interventions (contd)

• Pragmatics
• Dysarthria Oral motor strengthening
• Dysarthria Pacing
• Dysarthria Contrastive stress
• Dysarthria Oral pressure exercises
• Dysarthria Oral motor coordination
• Dysarthria vocal intensity variation
• Dysarthria Deep breathing
• Apraxia Contrastive stress drills
• Apraxia Phrase/ sentence completion
• Apraxia Placement/manner of production
  education
• Apraxia Sound sequencing
• Compensatory strategy education

• Aphasia management
• Dysphasia management
• Reading comprehension activities
• Evaluation of Speech
• Evaluation of Swallow
• Memory Techniques
• Task Segmentation
• Task sequencing
• Orientation to people, place, time
• Safety Judgment
• Home Safety management
• Home Education Program
• Agraphia Management
• Fluency
• Tongue Thrust
• Language Development

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Speech Therapy Skilled Interventions (cont)

• Cognitive/ Linguistic management
• Equipment adaptation
• Dementia Management
• Auditory Memory
• Auditory Training
• Auditory Perception
• Auditory Discrimination
• Auditory Memory
• Personal Decision Making
• Aphonia
• Dysphonia
• Vocal Resonance
• Vocal Abuse
• Verbal expression activities
• Verbal reasoning

• Laryngectomy management
• Tracheotomy management
• Augmentative Communication
• Aural Rehab
• Oral Hygiene Management
• Self Medication Management
• Positioning for feeding/ breathing
• Elimination of oral reflexes
• Trans. tube to oral feeding
• Telling Time
• Numerical Concepts
• Money Management
• Telephone skills
• Following directions

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Screening Rationale

• Improves patient function and outcomes.
• Enhances SLP partnership with facility.
• Increases SLP satisfaction through a varied
  caseload.

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Screening Responsibility

• The Speech-Language Pathologist will
• Screen routinely and timely.
• Develop communication with facility personnel to
  identify patients at risk.
• Educate facility staff to the role and benefit of
  Speech-Language and Swallowing services.

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The Speech-Language Pathologist will screen

• New admissions
• Readmissions
• Quarterly with care plans
• Change of status assessments
• Facility Referrals
• Incident reports
• Quality Indicator Report
• All patients recently admitted from the hospital
  who do not come with therapy orders.

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Screening Steps

• First, Scan the medical chart.
• Second, briefly interview and observe the
  resident.
• Third, ask the facility staff or the residents
  family if there have been any changes noticed in
  residents abilities.

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Scanning the Medical Chart

• Admission or face sheet
• Physicians notes or history and physical
• Acute rehabilitation progress notes
• Nursing assessment
• Physician order sheet (therapy orders might
  already be included)
• Patient care plan
• Discharge plan

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Medical Chart Reviewfor Indication of
Speech-Language/ Swallow Evaluation

• Prior level of function
• Hospitalization
• Past medical history
• Previous rehabilitation services (this does not
  rule out additional therapy!)
• Current status
• Potential to improve function or quality of life.

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What to look for when you screen

• Improvements, or Declines.
• Improvements-the patient might be able to
  tolerate more therapy, for a longer period of
  time, and achieve a higher level of function.
• Declines- rehabilitation could get the patient
  back to the prior level of function, and prevent
  further declines.

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Signals of Change

• Common changes in function which signal the need
  for an SLP evaluation are
• Weight loss, diet change or swallow problems
• Change in cognitive status
• Change in social interaction
• Change in speech or comprehension
• Change in hearing
• Pressure ulcers combined with weight loss or
  dietary issues.

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Screening Tips

• Stop the screening and request an evaluation if
• There is any indication that a problem exists.
• If the screening is taking too long to complete
  due to the residents special needs.
• If you feel the need to try some hands on
  assessment.
• If you feel that you could make suggestions to
  improve this patients quality of life as related
  to your discipline.
• If the screening is becoming too comprehensive.

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The Most Successful Screening Program

• .
• SLP advocates for optimal functioning of the
  resident.
• SLP screens to identify the changing needs of the
  residents.
• SLP ensures compliance with state and federal
  guidelines.

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Available Tools for Identifying Patient Needs

• Nursing Notes
• Doctors orders
• Physicians progress notes
• RAP
• Medication treatment sheets
• Resident Care Plans

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• Skin Integrity Lists
• Weight Loss Lists
• Fall Lists
• Dietary Notes
• Interviews with staff/ family/ doc.
• Incident reports

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Why Improve Your Patient Identification Skills?

• 1. Every SLP in Long Term Care is clearly
  responsible for high quality services to our
  patients and to our customers.
• 2. It is the job you were hired to do.

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Analysis of Referral Patterns

• New Admit screenings
• Care Plan screenings
• Incidents
• Nursing referral
• Family referral
• Patient self referral
• Social services
• Dietary
• Activities
• Other therapists
• Doctors
• Others (specify)

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Inservices

• Educate facility staff WHAT we do
• Educate facility staff about WHO to refer to SLP

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Consider all essential SLP programs in your SNF

• Rehab Dining
• Skin Integrity
• Dementia

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Caseload Mix Opportunities

• Look at your caseload patterns from the ICD 9
  code analysis. Consider all of the ICD9 Codes in
  your discipline.

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Your Professional Development

• List what you have done in the past month to
  increase your expertise so that you can better
  serve your patients
• Professional Books read
• Professional Articles read
• Topics researched on Internet

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