Week 1 Readings Flashcards
why is disphagia a malpractice ligation?
Can cause aspiration pneumonia and lead to serious medical complications
Dysphagia ligations and expert witnesses
Who? professor or speech & hearing scientist
What? give opinions about commissions and omissions (failure to do something) by other slps, healthcare providers and other healthcare professionals
Defining dysphagia legally
15 million have swallowing disorder
Definition: “Impairment of the emotional, cognitive, sensory and motor acts involved with transferring a substance from the mouth to stomach, resulting in failure to maintain hydration and nutrition and posing a risk of choking and aspiration
assessing responsibility fro negative dysphagia management outcomes
team approach includes: primary care physician, registered nurse, nurse assistant, dietician/nutritionist, radiologist, OT, respiratory therapist, gastroenterologist, neurologist, social worker, SLP
Primary care: ultimately responsible for medical management of dysphagia BUT other can be sued
- attorneys research for proffesionals responsibilities of where it went wrong
Places where happens: nursing homes, hospital emergency wards, private physicians, medical and nursing consultants and home health agencies
Dysphagia Clinical Timeline
GOAL: determine who did what and when the probable clinical outcomes
attoruney, legal team must agree on timeline
the possible probable continuum: Dysphagia
Possible: suggest that a clinicians action possibly resulted in a clinical outcome is non-descriptive and essentially a useless expert opinion because virtually anything is possible
Probable: indicates that the expert believes the action likely caused the clinical effect
Clinical proficiency in the management of dysphagia
Witnesses deicide if lcinitian shows competency in:
- identify individual w/ dysphagia
- performed oral pharyngeal and respiratory examinations
- review medical history
- performed competent instrumental/structural physiologic examinations with feeedback from others
- appropiate patient/client management decisions with: oral intake, risk precausions, candidacy and treatment strategies
- appropiate treatment procedures
ASLO if goals objectives and procedures were logical
Videofluorographic swallow study
central to many medical malpractices
- provides the most objective info about the patients swallowing function
- usually provided too late (bc they usually stay with the bedside swallowing evaluation)
- should be routinely conducted
-
misleading 4 independent stages
oral preparation, transporation, pharyngeal, and laryngeal esophageal
BC of chewing and swallowing
dividing them is analogous to viewing running as many movements
Bedside: only determine possible strutural, neurological or muscular deficiencies that interfere with bolus or liquid movement
adequacy of professional communication
Formal communication: medical chart, consultation copies
Informal verbal communication: staff meetings, telephone conversations and personal contacts.
Lawyers usually look at recommendations made about:
nothing by mouth (NPO)
videofluorographic swallow studies
dietary recommendations
clinical documentation
inadequate clinical documentation: handwritting is illegible, diagnosis reports and notes are too brief and vague
Bedside: Answer within functional limits (WFL) within normal limits (WNL) not adequately assessed (NAA) *WNL but actually mean incompletely asses, patient was unresponsive and only partially assessed
diagnostic and treatment practices relative to current professional standars
Main question: parties involved fell below current accepted and general standards of professional conduct in their management of the patient
usually asked “if a clinician practicing within professional stands have made the same conclusion this clinician made?
dysphagia
a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.
consequences of dysphagia
malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death.
disinterest, reduced enjoyment, embarrassment, and/or isolation related to eating or drinking.
Dysphagia intervention may concentrate on
swallowing exercises, compensatory swallowing strategies (including posture considerations), bolus consistency modification, and caregiver/patient education.
Incidence
refers to the number of new cases of dysphagia identified in a specified time period.