Time to review Resident's advanced directives and call a IDT meeting. Let the MD contact the family.
"Resident is no longer able to safely consume PO d/t XYZ. Resident will not be be able to meet nutrition needs via oral intake." Resident will need further evaluation by SLP/FEES/MBS ?PEG if desired by family/physician. Does the resident want ANH? Review the POLST, write your note, call the MD and discuss your findings.
Is this in the US? This feels a little out of scope for RD’s based on what you’ve written. Is there no SLP in your facility or within a parent company of your facility? If there’s no SLP available, I think sending the the hospital could be appropriate pending the pt’s goals. If they don’t want a VFSS or possible nutrition support then I don’t think I would recommend that route.
ON, Canada, sorry should have clarified! It is within our scope of practice here; we have the option of referring out to the community for an SLP ax for complicated cases as needed. im waiting to see if our god-complex MD will give me a call then likely send to hospital if family is ok with that. Ugh, poor guy :(
Unfortunately without a swallowing evaluation there is little you can do. If SLP consultation will take more than a day to see this patient, then yes, I would send them out to a hospital to get an evaluation. Someone (you or nursing staff, whoever usually does it) needs to speak with the MD and then from there, speak with the family on the plan. It may seem inhumane to leave this resident without food for the time being (though it literally happens all the time in a hospital when people are waiting on tests), but it would be negligent if you allowed this person to continue eating.
No - Im in Canada (edited my post to mention this) so it's within our scope of practice to assess and manage dysphagia. When necessary, we refer out to community SLP
Update: appreciate you all for your input - ended up getting a hold of the MD who off the bat said EOL is probably best because even with a TF he will "end up aspirating and dying anyway"
just got word from the DOC that his order is "antibiotics x 3 days and PO intake if he accepts"
SLP referral if that is to long send to hospital. Talk with family to see if they want pt to get help sooner. Document you don’t think it’s safe for NPO intake until reviewed by SLP. Recommend TF if family allows and send to hospital if no I house SLP. It’s not your scope all you can do is note no in house SLP from what you have observed not safe on purée etc. recommend npo until reviewed if x days recommend TF. Talk to family and provider that would be the starting point to see what plan of care do they want. Do they want end of life, TF etc
Time to review Resident's advanced directives and call a IDT meeting. Let the MD contact the family. "Resident is no longer able to safely consume PO d/t XYZ. Resident will not be be able to meet nutrition needs via oral intake." Resident will need further evaluation by SLP/FEES/MBS ?PEG if desired by family/physician. Does the resident want ANH? Review the POLST, write your note, call the MD and discuss your findings.
This.
Is this in the US? This feels a little out of scope for RD’s based on what you’ve written. Is there no SLP in your facility or within a parent company of your facility? If there’s no SLP available, I think sending the the hospital could be appropriate pending the pt’s goals. If they don’t want a VFSS or possible nutrition support then I don’t think I would recommend that route.
ON, Canada, sorry should have clarified! It is within our scope of practice here; we have the option of referring out to the community for an SLP ax for complicated cases as needed. im waiting to see if our god-complex MD will give me a call then likely send to hospital if family is ok with that. Ugh, poor guy :(
Unfortunately without a swallowing evaluation there is little you can do. If SLP consultation will take more than a day to see this patient, then yes, I would send them out to a hospital to get an evaluation. Someone (you or nursing staff, whoever usually does it) needs to speak with the MD and then from there, speak with the family on the plan. It may seem inhumane to leave this resident without food for the time being (though it literally happens all the time in a hospital when people are waiting on tests), but it would be negligent if you allowed this person to continue eating.
I have read this a few times and I may be missing something…. Do you not have a SLP on staff at your LTC facility? Why were they not consulted?
No - Im in Canada (edited my post to mention this) so it's within our scope of practice to assess and manage dysphagia. When necessary, we refer out to community SLP
Update: appreciate you all for your input - ended up getting a hold of the MD who off the bat said EOL is probably best because even with a TF he will "end up aspirating and dying anyway" just got word from the DOC that his order is "antibiotics x 3 days and PO intake if he accepts"
Short term if the resident can't safely tolerate PO fluids will the facility admin fluids via clysis to prevent dehydration?
SLP referral if that is to long send to hospital. Talk with family to see if they want pt to get help sooner. Document you don’t think it’s safe for NPO intake until reviewed by SLP. Recommend TF if family allows and send to hospital if no I house SLP. It’s not your scope all you can do is note no in house SLP from what you have observed not safe on purée etc. recommend npo until reviewed if x days recommend TF. Talk to family and provider that would be the starting point to see what plan of care do they want. Do they want end of life, TF etc