Qualitative Analysis of Therapist Documentation of Assessments of Orally Feeding Infants Who Require Noninvasive Respiratory Support.

IF 2.3 3区 医学 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY
Carolyn Barnes, Kit N Simpson, Janina Wilmskoetter, Heather McGhee, Keeley Nichols, Heather S Bonilha
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Abstract

Purpose: This is a qualitative analysis of speech-language pathology and occupational therapy documentation of bedside assessments of infants orally feeding on noninvasive respiratory support (NRS).

Method: Data were extracted from speech-language pathology and occupational therapy electronic health record documentation of bedside feeding/swallowing assessment and treatment of infants on NRS. These data included the rate of documentation of objective metrics, as well as themes in feeding safety, quality, and therapeutic interventions.

Results: Notes from 37 speech-language pathologist and occupational therapist bedside visits were included. Data on the amount of NRS during oral feeding were inconsistently documented, but reported flow rate ranged from 0.2 to 5.0 l per minute. Approximately 57% of notes indicated some type of overt feeding problem. Objective data were inconsistently documented, but common metrics included signs of possible aspiration (cough in 16.2% and congestion in 13.5% of notes), liquid viscosity (43.2% of notes), feeding modality (94.6% of notes), volume offered (56.8% of notes) and consumed (81.1% of notes), and feeding time (56.8% of notes). Documentation themes include assessment of both safety and quality, implied stability and success rather than explicit documentation of such, infrequent instrumental assessment referral, differences between assessment versus follow-up treatment notes, differences in structured/templated notes versus unstructured narratives, and missing data.

Conclusions: Missing data limited our ability to draw conclusions regarding safety and quality of oral feeding during NRS use. We make recommendations for documentation, including prioritizing objective data, clarifying clinical interpretations, patient responses to interventions trialed, and use of structured narratives and flowcharting.

需要无创呼吸支持的口服喂养婴儿临床医师评估文件的定性分析。
目的:对无创呼吸支持(NRS)下口服喂养婴儿的床边评估的语言病理学和职业治疗文献进行定性分析。方法:提取NRS婴儿床边喂养/吞咽评估和治疗的语言病理学和职业治疗电子健康记录资料。这些数据包括客观指标的记录率,以及喂养安全、质量和治疗干预方面的主题。结果:纳入37名语言病理学家和职业治疗师的床边就诊记录。关于口服喂养期间NRS量的数据记录不一致,但报告的流量范围为每分钟0.2至5.0 l。大约57%的笔记显示出某种明显的喂养问题。客观数据的记录不一致,但常见的指标包括可能的吸痰迹象(16.2%的音符咳嗽和13.5%的音符充血)、液体粘度(43.2%的音符)、喂养方式(94.6%的音符)、提供的体积(56.8%的音符)和消耗的体积(81.1%的音符)和喂养时间(56.8%的音符)。文档主题包括安全性和质量的评估,隐含的稳定性和成功,而不是明确的此类文档,不频繁的工具评估转诊,评估与随访治疗笔记之间的差异,结构化/模板化笔记与非结构化叙述的差异,以及缺失的数据。结论:数据缺失限制了我们得出关于NRS使用期间口服喂养安全性和质量的结论的能力。我们对记录提出了建议,包括优先考虑客观数据,澄清临床解释,患者对试验干预措施的反应,以及使用结构化叙述和流程图。
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来源期刊
American Journal of Speech-Language Pathology
American Journal of Speech-Language Pathology AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION
CiteScore
4.30
自引率
11.50%
发文量
353
审稿时长
>12 weeks
期刊介绍: Mission: AJSLP publishes peer-reviewed research and other scholarly articles on all aspects of clinical practice in speech-language pathology. The journal is an international outlet for clinical research pertaining to screening, detection, diagnosis, management, and outcomes of communication and swallowing disorders across the lifespan as well as the etiologies and characteristics of these disorders. Because of its clinical orientation, the journal disseminates research findings applicable to diverse aspects of clinical practice in speech-language pathology. AJSLP seeks to advance evidence-based practice by disseminating the results of new studies as well as providing a forum for critical reviews and meta-analyses of previously published work. Scope: The broad field of speech-language pathology, including aphasia; apraxia of speech and childhood apraxia of speech; aural rehabilitation; augmentative and alternative communication; cognitive impairment; craniofacial disorders; dysarthria; fluency disorders; language disorders in children; speech sound disorders; swallowing, dysphagia, and feeding disorders; and voice disorders.
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