From: To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development
Context considerations | Minimum standard care of practice | Additional standard care of practice |
---|---|---|
Diagnostic tools | Water swallow test Standardized clinical bedside assessment Pulse oximetry | Videofluroscopy-modified barium swallow test (VMBS) and/or fiberoptic endoscopic evaluation of swallowing (FEES) |
Equipment | Water, food of different consistencies (pudding and buscuits-deleted), spoon, cup, stethoscope (see Appendix 11) Pulse oximeter | Videofluroscopy machine Fiberoptic endoscopy machine |
Workforce | Physiatrist Occupational therapist Nurse | Radiologist Otorlaryngologist Speech pathologist |
Resources | Protocol for water swallow test (Appendices 8 and 9) Protocol for standardized clinical bedside assessment (Appendix 10) | Protocol for barium swallow and FEES when it is considered to be pathological |
Training | Training needed for water swallow and standardized clinical bedside assessment | Specialist training in tertiary hospital |
When is it done | As screening tool for aspiration Before nasogastric tube is removed or anything to be given by mouth | Done after a failed water swallow test, or presence of signs and symptoms of aspiration |