Level 4. only) Date Completed

Transcription

1 Therapist: Supervisor: Knowledge and Skills Framework Dimension: 2 Personal and people Development level 4 Demonstrates core knowledge of complex dysphagia from non-routine / complex aetiologies such as : Head and Neck Cancer Post Radiotherapy. Respiratory conditions. Spinal Cord Injury. Burns. Tracheostomy / Ventilator dependency Demonstrates core knowledge of pharyngo-oesophageal dysphagia. Oesophageal dysmotility. Cricopharyngeal bars/strictures. Oesophageal narrowing. Oesophageal strictures/webs. Zenker s or other type diverticulum. Gastroesophageal reflux, or laryngopharyngeal reflux. Hiatus hernia. Pharyngeal / Oesophageal Pouches. Achalasia. Based on patient reports, medical history, and clinical examination, the SLT should recognize the need for an extended VFS with an oesophageal screening, and /or a separate upper gastrointestinal series scheduled either in conjunction with the VFS, or performed at a later time. An oesophageal screening can be incorporated into most VFSs if the patient can tolerate even a small amount of contrast by mouth. The decision to perform these additional assessments is made with the radiologist, and/or after consultation with the referring physician (Mendell and Logemann, 2002). Based on the findings of the VFS, the SLT should confer and collaborate with the radiologist to make appropriate referrals. An upper GI series, oesophageal manometry, endoscopy, and/or ph studies, may be required to evaluate gastro-oesophageal function. Reading / Discussion with MDT Reading / Discussion with Supervisor Discussion with MDT Reflective practice / Presentation to peers of critical appraisal of relevant research at journal club / inservice. Presentation to peers of critical appraisal of relevant research at SIG / Study day / network meeting / MDT meeting. IPR / KSF appraisal Page 1 of 5

2 Knowledge and Skills Framework Dimension: 2 Personal and people Development level 4 Demonstrates awareness of own professional boundaries and maintains competency on an ongoing basis Participation in local radiology reflective clinical practice sessions including presenting at monthly clinical review meetings. Conducts X number of assessments per annum Participates in reflective clinical practice sessions during annual competency check / review Demonstrates ability to contribute to the development of Evidence base for the profession. Contributes to research in inter-rater reliability studies as a part of extended scope practitioner community activity. Demonstrates awareness of own professional boundaries and maintains competency on an ongoing basis Demonstrates awareness of own professional boundaries and maintains competency on an ongoing basis Demonstrates awareness of own professional boundaries and maintains competency on an ongoing basis Demonstrates knowledge of fluoroscopic assessment equipment and recording systems: Utilisation of a fluoroscopic system that provides a video signal at a minimum resolution of 400 lines. The type of fluoroscopy equipment (i.e., digital vs. analog) should be considered when purchasing recording equipment. Utilisation of a character generator is useful for documenting patient name, date, medical record. Utilisation of a time code generator is useful for measuring temporal events, structural movement, and bolus flow during the swallow. Utilisation of a Monitor. Utilisation of a Microphone. Page 2 of 5

3 Knowledge and Skills Framework Dimension: Health and Wellbeing 6 Assessment and Treatment planning level 4 Demonstrates ability to interpret and document during the study (on-line) / throughout review of the recorded study. Incorporate pertinent history. Identify and document anatomic and physiologic swallowing disorder(s) of oral preparatory, oral, pharyngeal, and cervical oesophageal phases. Determine and document impact of anatomic and physiologic swallow disorder(s) (i.e., location and approximate severity of residue, laryngeal penetration, presence, timing, and approximate severity of aspiration). Observe and document sensory awareness of residue, penetration, and/or aspiration (i.e. cough, throat clear, second swallow). Observe and document effectiveness of clearing of residue, penetration, and/or aspirated material. Document effectiveness of compensatory techniques, postures, manoeuvres, sensory enhancements and bolus modifications. Specific oral intake modifications (e.g., volume, viscosity, texture etc.). Therapeutic interventions required during meals (e.g. postures, manoeuvres, sensory enhancements, assistance, etc.). Safe feeding/aspiration precautions (e.g., sit upright, no straws, alternate liquids and solids, Positioning. Diet consistent with ethnocultural preferences and practices. Need for thorough and consistent oral hygiene. Dysphagia rehabilitation treatment plan consistent with exam findings. Need for and timing of re-evaluation Reflective practice / IPR / KSF appraisal Page 3 of 5

4 Knowledge and Skills Framework Dimension: Health and Wellbeing 6 Assessment and Treatment planning level 4 Demonstrates ability to monitor caseload, pathways, referrers, waiting times for service monitoring / contractual obligations Monitors / extrapolates own and others (radiologist and radiographer) time for models of service delivery building a case for change of model of service delivery to SLT extended scope role. Develops patient journeys to establish ways to improve efficiency/ cost effective nature of service. Liaises with Hospital contracts manager to establish new consultant episode code Establishes appropriate referral pathways into and out of the service based on patient need (knowledge of role of instrumental assessment in contributing to the determination of a differential medical diagnosis). The SLT develops clear referral pathways into the service by developing awareness of referrers such as GPs or SLTs on referral criterion The SLT should confer and collaborate with the radiologist prior to making appropriate referrals. Liaises with Gastro-Enterology to develop appropriate referral pathways for patients requiring further investigations such as an upper GI series, esophageal manometry, endoscopy, and/or ph studies, may be required to evaluate gastro-oesophageal function. Liaises with ENT to develop appropriate referral pathways for patients requiring further investigations such as Endoscopy Liaises with Neurology to develop appropriate referral pathways for patients requiring further investigations such as CT scan Demonstrates ability to establish and maintain the ongoing development of service Lead responsibilities in VFS project development, liaises with service manager (as required) Co-ordinates care protocols for VFS with support from HOS (as required) Has understanding of government agendas which could impact on the VFS service Has documented evidence in initiating and co-ordinating audit projects related to VFS Training and experience in medico legal issues Page 4 of 5

5 Knowledge and Skills Framework Dimension: Health and Wellbeing 7 Interventions and treatments level 4 Demonstrates ability to make recommendations and prognostic statement. Document that results were discussed with appropriate medical personnel, individual with dysphagia, and caregiver. Ensure that documentation is interpretive, clear, thorough, and legible. Follow-up Educate individual with dysphagia and family/ caregiver as to findings and recommendations (may include review of recorded study when possible). Educate staff (e.g., nursing, health care assistants, careplanning team, teachers, aides) as to findings and recommendations. Provide results of examination to referring source. Assure recommendations are tolerated and followed, when possible. Make recommendations for repeat follow-up as needed. Demonstrates ability to apply theoretical knowledge to practice for dysphagia clinical area via planning and reflective clinical practice. However is able to reflect and perform rapidly on-line particularly for dealing constructively with unexpected / complex issues. Works as part of team Advanced dysphagia skills Discussion with supervisor Direct observation with supervisor when shadowing. Advanced dysphagia skills Reflective practice / IPR / KSF appraisal Page 5 of 5