Genesis Research SummitJune 18, 2015

Darci Becker, PhD, CCC-SLP, BCS-SKatherine Locricchio, MS, CFY-SLPCarli Schieferdecker, MS, CCC-SLP

2003-2005 An Oral Water Protocol in Rehabilitation Patients With Dysphagia for Liquids” Genesis Medical Center (Becker, Tews & Lemke)◦ Randomized controlled trial investigating the risks and

benefits of a water protocol in patients with dysphagia for liquids (thin liquid aspirators)

2010-2011 Dissertation: Patient Awareness of Dysphagia (Becker)

◦ Awareness of one’s dysphagia diagnosis and compliance with swallowing recommendations two days after modified barium swallow study (MBSS)

Research

2014 Exploring Oral Care Practices in a Regional Hospital (Schieferdecker, Tapper & Becker)

Many healthcare professionals use foam swabs as a primary method of oral care for some patient groups (Turk et al, 2012; Binkley et al., 2004; Grap et al., 2003)

Several studies have shown foam swabs provide mucosal stimulation, but alone are inadequate in the removal of dental plaque (Grap, Munro, Ashtiani, & Bryant (2003)

Oral care, particularly in those with dysphagia, is crucial to reducing risk of aspiration pneumonia (Langmore et al.,, 1998)

Goal: gather information on typical oral care practices at Genesis Developed a survey for nurses and therapists on the Rehabilitation floor of Genesis

West Administered 71 surveys; received 55 Asked 29 questions regarding practices and attitudes surrounding oral care

One key finding: given a scenario with a patient who was NPO, had dysphagia and dependent for oral care… 70% selected foam swabs vs. 30% selected a toothbrush (manual, suction) as the method

they would be most likely to use This, and other findings, supported efforts to educate staff on the benefits of

toothbrushes, for this population, given evidence in the literature

First Collaboration: Genesis and St. Ambrose

2014 Are Patients With Silent Aspiration More Frequently Admitted/Readmitted With Pneumonia Than Those With Audible Signs of Aspiration, (Krull & Becker)◦Retrospective chart review of 50

Patients who had a MBSS at Genesis 20/50 patients (40%) aspirated

Of the 20 patients, 10/50 (50%) were readmitted to Genesis within a year Of those who were readmitted, 3/10 (30%) were

diagnosed with “aspiration pneumonia” All 3 (100 %) were originally “silent” aspirators

Two more collaborations…

Article in Dysphagia (2013), Bonilha et al. “Radiation Exposure Time during MBSS: Influence of Swallowing Impairment Severity, Medical Diagnosis, Clinician Experience, and Standardized Protocol Use”◦ Use radiation counter that appears on video image to

measure exposure time (so no additional equipment needed!)

Genesis Speech and Hearing: Store 5 years (roughly 1750 DVDs) worth of recorded swallowing studies

Push for standardization◦ We do not use a standardized MBSS protocol

Use anywhere from 0-3 solids ◦ My training= assessing ONE solid is adequate/preferred

2014 “The Effect of Assessing Multiple Solids On Radiation Exposure Time During a Videofluoroscopic Swallowing Study,” (Locricchio & Becker)

Does average fluoroscopy time at Genesis exceed average times reported in the studies cited by Bonilha et al. (2013)?

How much, on average, does fluoroscopy time (for the entire swallowing study) increase with the addition of each subsequent solid?

Reviewed 43 recorded MBSS studies (10 hours)

Are Genesis’ average MBSS fluoroscopy comparable to those reported other studies? Yes

Average exposure times reported in 3 studies by Bonilha (2013)=2.75-4.76 min; range: 30 sec.-18 min.

Genesis’ average exposure time= 3.39 min; range:1.17 - 7.82 min How much, on average, does fluoroscopy time (for the entire swallowing

study) increase with the addition of each subsequent solid? It didn’t! No solids, average time: 3.47 min (8 studies) One solid, average time: 4.58 min (3 studies) Two solids, average time: 3.31 min (11 studies) Three solids, average time: 3.23 min (21 studies)

Conclusions: Assessment of all three solids occurs most often at Genesis

One SLP performs the majority of MBSSs Other variables may impact radiation exposure time more than number of

items assessed, e.g. swallowing severity Future studies may explore the impact of these variables

Results

Questions?