Over this past semester, I have seen many cerebrovascular accident patients. It is heart wrenching to see how both patient and family are impacted by this event; especially because of its unpredictable nature. A common link between all of them is a loss of one or more functions. Dysphagia is a dangerous result, and occurs in almost 65% of stroke patients. A main complication is aspiration of food or fluids, which in turn can cause acute airway obstruction, pneumonia, and impaired lung function.
There is a diagnostic test that helps decrease risk of complications related to dysphagia, resulting in an increase in quality of life. This test is referred to as a 'FEES': Fiberoptic Endoscopic Evaluation of Swallow. I have had the pleasure of not only watching this test be performed, but also assisting. It is interesting to see all of the components of this evaluation because swallowing is a function that is not appreciated enough.
The procedure/evaluation is usually ordered by a physician. This can be related to diagnosis or physical manifestations. An initial assessment is done and then the procedure starts. The patient bravely allows a tiny camera (Fiberoptic Endoscope) to enter through one nostril. As they swallow, the endoscope is positioned in the oropharynx. Then, different consistencies of food containing green dye are ingested. Ingestion provides information pertaining to how food is handled. They can view if there is residue present or if aspiration occurs. Once complete, a diet specific to capabilities is prescribed. This can range from regular to soft mechanical to pureed food with thickened liquids.
To provide quality results, there is an extensive process of documenting. There are three aspects to this documentation, which as a whole paint the entire picture. First, there is anatomic and physiologic assessment that provides a checklist of parameters to evaluate coordination, speed, and sensory testing. Second, there is a physical observation of swallowing. This is the 'interesting' part because you get to directly view the process of swallowing in an individual, in real time. The final aspect provides documentation of therapeutic strategies that were attempted as well as the success rate. A recommendation is provided upon these findings.
After implementing this new method of documentation and examination, total time and completeness were evaluated for each examiner. Each portion of the exam was timed as well as the total time for the whole evaluation; almost every portion of the time they looked at was significant with respect to the effectiveness of the examiners. The interpretation time was the only aspect not statistically significant, meaning that there was no difference observed between the examiners, meaning their knowledge and how they interpreted what they saw was the same. However, report completeness, documentation time, and the evaluation system were all significant! This means overall the entire system of documentation in this FEES testing really did reduce the time considerable and each report was finished to a higher level of completeness. Time was decreased by more than 35%, completeness increased from 39% to 70%, and while the interpretation time increased a little, it was not statistically significant. This essentially means that it could have been coincidence. While the study size could have been larger, and those specializing in swallowing disorder is limited, this study was still beneficial to see a higher documentation standard. When put into practice, is statistically significant in the patient care received by nurses and doctors.
Overall, there are many factors that contribute to the swallowing process I was unaware of. I am glad that this test is available and performed in a specific way to provide safety for patients.
After implementing this new method of documentation and examination, total time and completeness were evaluated for each examiner. Each portion of the exam was timed as well as the total time for the whole evaluation; almost every portion of the time they looked at was significant with respect to the effectiveness of the examiners. The interpretation time was the only aspect not statistically significant, meaning that there was no difference observed between the examiners, meaning their knowledge and how they interpreted what they saw was the same. However, report completeness, documentation time, and the evaluation system were all significant! This means overall the entire system of documentation in this FEES testing really did reduce the time considerable and each report was finished to a higher level of completeness. Time was decreased by more than 35%, completeness increased from 39% to 70%, and while the interpretation time increased a little, it was not statistically significant. This essentially means that it could have been coincidence. While the study size could have been larger, and those specializing in swallowing disorder is limited, this study was still beneficial to see a higher documentation standard. When put into practice, is statistically significant in the patient care received by nurses and doctors.
Overall, there are many factors that contribute to the swallowing process I was unaware of. I am glad that this test is available and performed in a specific way to provide safety for patients.
To view an in depth look at the documentation process and application of this test, visit:
