East Tennessee State University Digital Commons @ East Tennessee State University Electronic eses and Dissertations Student Works 5-2015 Training Clinical Judgment Skills for Interpreting Feeding Behavior in Preterm Infants: A Comparison of Video and In Vivo Simulation Jamesa R. Ewing East Tennessee State University Follow this and additional works at: hps://dc.etsu.edu/etd Part of the Maternal, Child Health and Neonatal Nursing Commons , and the Speech Pathology and Audiology Commons is esis - Open Access is brought to you for free and open access by the Student Works at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in Electronic eses and Dissertations by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact [email protected]. Recommended Citation Ewing, Jamesa R., "Training Clinical Judgment Skills for Interpreting Feeding Behavior in Preterm Infants: A Comparison of Video and In Vivo Simulation" (2015). Electronic eses and Dissertations. Paper 2522. hps://dc.etsu.edu/etd/2522 brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by East Tennessee State University
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East Tennessee State UniversityDigital Commons @ East
Tennessee State University
Electronic Theses and Dissertations Student Works
5-2015
Training Clinical Judgment Skills for InterpretingFeeding Behavior in Preterm Infants: AComparison of Video and In Vivo SimulationJamesa R. EwingEast Tennessee State University
Follow this and additional works at: https://dc.etsu.edu/etd
Part of the Maternal, Child Health and Neonatal Nursing Commons, and the Speech Pathologyand Audiology Commons
This Thesis - Open Access is brought to you for free and open access by the Student Works at Digital Commons @ East Tennessee State University. Ithas been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Digital Commons @ East Tennessee StateUniversity. For more information, please contact [email protected].
Recommended CitationEwing, Jamesa R., "Training Clinical Judgment Skills for Interpreting Feeding Behavior in Preterm Infants: A Comparison of Videoand In Vivo Simulation" (2015). Electronic Theses and Dissertations. Paper 2522. https://dc.etsu.edu/etd/2522
brought to you by COREView metadata, citation and similar papers at core.ac.uk
Documentation should include rationales for critical decisions and interventions, while
also stating a patient’s progress or decline associated with the clinical course for each
1.5
ml/m
in —
En
du
ran
ce
OFS level 2 Low actual feeding skills
High endurance
OFS level 4 High actual feeding skills
High performance
OFS level 1 Low actual feeding skills
Low endurance
OFS level 3 High actual feeding skills
Low endurance
30% PRO — Feeding Skill
31
client (Blair & Smith, 2012). Effective documentation has both practical and legal
implications, because accurate documentation significantly lessens the risks of
miscommunications and negative patient outcomes. Accurate documentation can be
utilized to effectively plan, intervene, and evaluate various treatment methodologies
(Paans, Nieweg, van der Schans, & Sermeus, 2011). When medical documentation lacks
quality, suboptimal care is provided to patients in a hospital setting (Paans et al., 2011).
Although clear guidelines are provided for healthcare providers in general, existing
literature related to the quality of documentation by SLPs is limited. No evidence exists
for SLPs’ quality of documentation in the electronic medical record for preterm infants.
Practice and documentation of oral feeding in the NICU closely follows the
medical model. Appropriate documentation is an integral part of advancing preterm
infants to full oral feedings (Ludwig & Waitzman, 2007). Medical documentation
regarding preterm infant feeding performance often lacks descriptive or objective
information regarding the following information: infant’s readiness to feed, level of
development associated with their oral feeding skills, and level facilitation provided by
the caregiver. Rather, oral feeding documentation often focuses on general classifications
such as: poor, fair, or good. Other health professionals may misinterpret such subjective
impressions in medical documentation because perceptions across healthcare professional
vary.
The quality of documentation is frequently decreased due to common barriers that
are shared amongst professionals. Barriers include time constraints, an excessive
caseload, lack of concise expectations and guidelines, and disrupted work conditions
(Blair & Smith, 2012; Paans et al., 2011). Professionals often state that documentation
32
takes time away from client care (Blair & Smith, 2012). Blair and Smith noted that
professionals working in acute care settings could spend 25% to 50% of their time on
documentation, which could result in less time with patients or longer work hours. Less
time with patients, threatens optimal medical management because care providers may
not observe key symptoms exhibited at bedside. Correct clinical judgments across
medical professionals depend on understanding disease course and symptomatology.
Speech Language Pathologists’ Clinical Judgment Skills
Correct judgment, clinical skills, and overall knowledge are used to optimize
health outcomes for patients. SLPs develop correct critical judgment skills through
constant practice, experiences, knowledge, and continuous critical analysis (Kienle &
Kiene, 2011). Judgment is used in various aspects of treatment including: diagnosis,
therapy, decision-making, and communication.
Making correct clinical judgments is challenging, especially when access to
objective data is limited as is the case with feeding skills in premature babies. Further,
judgments made without the use of objective measures may result in errors due to
limitations in human decision-making and biases (Bryant, Finnegan, & Berbaum, 2011).
The use of clinical judgment in the practice of speech-language pathology is a
sparsely researched topic (Records & Weiss, 1990), but feeding intervention for preterm
infants can be related to skills within other medical professions. Speech-Language
Pathologists use scores from objective measures as well as informal and formal
evaluations to derive clinical decisions (Records & Tomblin, 1994).
Clinical judgment skills progress over time and become more reliable with
effective training (Bryant et al., 2011; Records & Weiss, 1990). Golderg (1968) stated
33
that experience alone was not enough to positively impact judgment skills. Training
correct clinical judgment and decision making needs to be studied in SLPs expected to
determine the nature of swallow competence and airway protection in preterm infants.
Deciding the appropriate time to transition preterm infants from tube to full oral feeding
is challenging given the lack of evidence for symptomology of aspiration in this
population. Yet, the consequences are grave as mistakes or ill informed decisions may
result in significant and severe illness. As we seek to understand the nature of swallowing
development and airway protection in preterm infants, effective training must follow to
maximize the benefit to preterm infants.
Training of Healthcare Professionals
Training of future and experienced healthcare professionals is critical for the safe
care of patients. The use of patient simulators has recently increased opportunities for
training students. Two methods of simulation training are of particular interest. In vivo
simulation and video training have been supported and opposed in research.
In Vivo Simulation Training for Healthcare Professionals
In vivo simulation is used as a way to reduplicate aspects of real life situations,
but they are not intended to replace the need for hands-on learning in the clinical
environment (Maran & Glavin, 2003). In vivo simulation allows students and
professionals to advance clinical judgment skills in a risk-free environment. Fidelity is a
term used to distinguish the degree to which the simulator replicates the real
environment. High fidelity patient simulators (HFPS) have been available for
approximately 20 years and provide the maximum interaction between the student and a
recreation of a real life experience (Nehring, Wexler, Hughes, & Greenwell, 2013). Most
34
research surrounding HFPS examines learning outcomes, student satisfaction, and
judgment skills (Nehring & Lashley, 2009).
MacBean, Theodoros, Davidson, and Hill (2013) state that simulated learning
environments can be effective in increasing clinical and observational skills before
professional placement, providing additional exposure to specialized areas of speech–
language pathology, and increasing interprofessional learning skills. Literature
concerning the use of simulators in the training of speech-language pathology students is
extremely limited (MacBean et al., 2013). Literature that focuses on the use of in vivo
human patient simulation mannequins (HPSM) to train SLPs to assess OFS is non-
existent as far as could be determined. However, there is literature that supports the use
of HPSM in teaching nursing students and other medical professionals.
For example, Alinier et al. (2006) completed a pre-test/post-test study to examine
the effectiveness of the use of a HPSM in undergraduate nursing instruction on
acquisition of knowledge, decision-making skills, communication, and clinical skills
performance during the Objective Structured Clinical Examination. Although Alinier and
colleagues (2006) does not involve SLP students assessing preterm infants, the study’s
design and outcome measures are similar to the proposed design and measures of the
current investigation. Participants were randomly assigned to the experimental or the
control group. Both groups were tested before receiving instruction. The experimental
group was exposed to the regular curriculum and simulation training, while the control
group only received training via the regular curriculum. Following training, both groups
displayed noticeable gains in knowledge, but the experimental group had a significantly
higher increases. The authors concluded that simulation was a safe and effective way of
35
training students (Alinier et al., 2006). While research is clear on the benefits of using
HPSM in medical training, more research is needed to determine the benefits of HPSM in
the field of speech-language pathology.
Video Recorded Simulation Training for Healthcare Providers
Direct observation has been the primary means for learning new material.
Advances in technology create platforms for video creation and viewing to advance
learning opportunities across medical professionals. Video modeling allows instructors
to maximize aspects of students’ learning environment by editing content and advanced
preparation of course objectives. Video training can be used to provide educational
experiences for an infinite number of people at one time, while direct observation is
limited by factors such as room accommodations, scheduling conflicts, and price. While
video modeling has its advantages, it does not permit hand-on practice in a risk free
environment.
Dempsey, Iwata, Fritz, and Rolider (2012) studied the effect of in vivo training
versus video training in 59 undergraduate psychology students to determine which
training method resulted in correct identification of target behaviors, definitions, and
procedures. The control group was provided a written description of a videotaped session
before viewing the tape and was aware of target behaviors and procedures. The
experimental training group received written descriptions of target behaviors, definitions,
and procedures before observing a 10-minute, in vivo session. After the video, students
were instructed to document actions observed. Documentation reports were compared
with those of a trained professional. For the control group, training was complete when
students attained a minimum of 90% agreement across six video segments. For the
36
experimental group, training was complete once students attained a minimum of 90%
agreement with the professional across three consecutive sessions. After the completion
of training, all students participated in a post-test. The post-test included three ten-minute
videotaped sessions. Students in the experimental group scored higher than the control
group with an average of 98.9% agreement with the trained professional. Authors
concluded that combining video and in vivo training allowed for the best results.
In a study directly related to the current study, Ferguson (2013) examined the
effects of traditional lecture training versus lecture plus video simulation training on 66
nurses’ and 43 SLPs’ ability to accurately interpret feeding and swallowing in preterm
infants using a pre-test/post-test design. Participants were separated into two training
groups. Clinical markers were defined in both training methods. The simulation group
viewed a video recording of a simulation mannequin demonstrating each clinical marker,
while the lecture only group only viewed the lecture.. Results showed that the video
simulation group (M=18.93, SD = 2.88) documented significantly more clinical markers
(p=.001) during the post-test when compared to the lecture only group (M=13.09, SD=
4.32). Knowledge test scores improved for both groups but did not show significant
difference between groups. Results indicated that the video simulation training group
documented more signs of distress and disorganization when compared to the lecture
only group. The experimental group had higher post-test scores for correct clinical
judgment. Ferguson (2013) concluded that both groups displayed significant progress in
the previously mentioned areas, but the lecture plus simulation video training resulted in
significantly greater gains in clinical judgment skills. Further study in needed to
37
determine to optimal method of training health care providers to recognize signs of
distress during bottle feeding in preterm infants.
Purpose of Present Investigation
The purpose of this study was to compare the effectiveness of lecture plus in vivo
simulation training (LIST) and lecture plus video simulation training (LVT) on graduate
level speech-language pathology students’ knowledge of feeding and swallowing in
preterm infants, documentation of behavioral and physiological clinical markers, and
clinical judgment decisions.
Research Questions and Hypotheses
The following research questions were posed:
1. Do students who receive in vivo simulation training document distress signs more
accurately than students who receive video simulation training?
2. Do students document behavioral cues or physiological distress more accurately
and does accuracy depend on training method.
3. Do students’ test scores that reflect knowledge gained increase after training and
differ based on training method?
4. Do students’ clinical judgment scores increase with training and differ based on
training method?
The following research hypotheses were proposed:
1. Documentation accuracy of distress signs will increase with training for both
groups, but that the LIST group will document more accurately.
38
2. Physiological clinical markers would be documented more accurately. It was also
hypothesized that the LIST group would have a better documentation accuracy
when compared to LVT group.
3. Both training groups would increase their knowledge test scores after training
with no significant difference between groups.
4. Clinical judgment scores would increase for both groups with the LIST having
more significant growth when compared with the LVT group.
39
CHAPTER 3
METHODS
Overview of Study Design
A pre-test/post-test design was used to measure and compare the effects of lecture
with in vivo simulation training and lecture with video training on the students’ ability to:
(1) accurately document behavioral cues and physiologic distress, (2) form clinical
judgments, and (3) gain knowledge regarding feeding and swallowing in preterm infants.
Pre-test/post-test designs are generally used in behavioral research to determine the effect
of a training method on participants’ performance or knowledge. This design allows the
researcher to examine the difference between groups as well as training effects (Dimitrov
& Rumrill, 2003). Students viewed a prerecorded PowerPoint® lecture, participated in
either video simulation training or in vivo simulation training, and completed knowledge
testing by following web-links to SurveyMonkey®
. The PowerPoint® lecture training was
designed to increase students’ awareness of the development of preterm infants’
biological systems as they develop in an extrauterine environment and students’
knowledge of the oral feeding skills (OFS) assessment.
The purpose of both video and in vivo simulation training was to increase
participants’ knowledge and understanding of preterm infants’ development and non-
verbal communication that signals increased likelihood of airway compromise. Indicators
for increased risk were the same for both groups and included subjective behavioral cues
and objective physiologic distress. Behavioral cues of disorganization and objective
measures of physiological decline were identified and reviewed in the video training
module and in vivo simulation training. For the purpose of this study, behavioral cues
40
that indicated an infant was disorganized included drooling and gulping. Objective
physiologic distress measures included apnea, desaturation, bradycardia, cyanosis,
tachypnea, and coughing.
While training content was the same for both groups the training method required
participants to either participate in vivo simulation (LIST) or watch video simulations
(LVT). Participants in both groups completed a self-paced, on-line, pre-recorded
PowerPoint® lecture. Participants trained using LIST received additional training, live
holding a high-fidelity patient simulator infant. While participants held the infant patient
simulator, the infant experienced behavioral and physiologic signs. See Figure 2 of a
participant holding the patient simulator. Participants in the LVT group received
additional training, on-line watching video recorded patient simulator infants experience
behavioral and physiologic signs. Figure 3 depicts an example of the material that was
presented to the students in the LVT group. Notice the infant is experiencing cyanosis
(blue), desaturation (low oxygen), and apnea.
Participants
Fifty-two second semester graduate level speech-language pathology students
enrolled at East Tennessee State University and Old Dominion University were recruited
to participate in this investigation. Approval was obtained from the Institutional Review
Boards at East Tennessee State University and Old Dominion University. All tasks
required for this study were prerequisites of a graded laboratory experience included in
the Dysphagia class curriculum at each university. Participants signed an informed
consent permitting lab data to be used for research purposes; consent was concealed until
grades were posted to decrease students’ perceptions of coercion.
41
Figure 2. Example of In Vivo Simulation Training
Figure 3. Example of Video Simulation Training
Ferguson, N. F. (2013). Interpretation of feeding and swallowing in preterm infants:
Influence of video simulation training, (Unpublished doctoral dissertation).
University of South Alabama, Alabama.
42
A convenience sample of twenty-seven students enrolled at East Tennessee State
University and registered in a dysphagia courses were assigned to the lecture plus in vivo
simulation training (LIST) group. A convenience sample of twenty-five students enrolled
as graduate students at Old Dominion University and registered in a dysphagia course
were assigned to the lecture plus video training (LVT) group. All participants were
women currently enrolled in a graduate program for Speech Language Pathology. One
participant in the LIST group had children prior to the study. Both groups’ GRE verbal
scores, GRE quantitative scores, and undergraduate GPA were compared using a one-
way ANOVA statistic to ensure no differences between groups. While the LIST yielded a
higher undergraduate grade point average, F(1,50) = 19.234, p = .000, partial η2 = .278,
the LVT group yielded a higher GRE verbal score, F(1,50) = 4.824, p = .033, partial η2 =
.088. Students were assigned to each group based upon the university they attended.
ETSU owned an HPSM; ODU did not. See Figure 4 for details.
Figure 4. Depiction of Group Assignments.
52 Graduate Level SLP Students
Lecture plus in vivo simulation training
group
N = 27
Lecture plus video simulation training
group
N = 25
43
Materials
The LIST group used a high fidelity, HPSM, Premie HAL S3009 to complete an
in vivo training simulated clinical experience (SCE). Two trained controllers operated
the high-fidelity mannequin during SCE. Physiological clinical markers (tachypnea,
desaturation, bradycardia, apnea, coughing, and cyanosis) were preprogrammed and
presented to each participant individually. In addition, behavioral cues, gulping, changes
in muscle tone, and drooling were modeled for participants individually.
For the LVT group, this study used previously created video scenarios described
by Ferguson (2013). A high fidelity, human patient simulation mannequin, HAL model
S3010 was used to record eight two-minute bottle feeding scenarios. Each video depicted
a previously programmed scenario on half of the screen with a vital sign monitor
occupying the other half. Refer back to figure 3. The vital sign monitor in each video
displayed heart rate, oxygen saturation, and respiratory rate. Signs of distress included
cyanosis, bradycardia, tachypnea, apnea, coughing, drooling, gulping, and desaturation
presented across simulation videos.
Scenario creations, video creations, and testing materials were created by
Ferguson (2013). The high fidelity, HPSM, Premie HAL S3009 was created by Gaumard
and purchased by East Tennessee State University for use in the speech-neurology
laboratory. Videos for this study included an orientation video that explained study task
to participants and to ensure participants understood the process and time requirements of
completing the study. A video that explained documentation format was used to help
students professionally organize documentation. A self-paced video lecture was used to
educate participants about preterm infant birth and feeding development. The eight
44
feeding scenarios were created to depict feeding situations frequently experienced by
preterm infants. The scenarios included medical history, feeding history, and a two-
minute video of the patient simulator bottle feeding experiencing combinations of distress
signs. These scenarios were used measure participants’ ability to document accurately
and to form correct clinical judgments. These exact scenarios were programmed into the
patient simulator Preemie Hal S3009 for the purpose of this investigation.
Measurement Instruments
A knowledge test was used to measure pre and post course understanding of
preterm infant birth and feeding development. A clinical judgment assessment tool used
by Ferguson (2013) was used to measure pre and post course judgment skills. The
knowledge tests measured cognitive learning by using recognition and recall tasks for
both groups (Bloom & Krathwohl, 1989). The ten-question test included four multiple
choice, three fill in the blank, and three list questions. See Table 1 for detailed questions
and answers. The clinical judgment task required participants to analyze and integrate
information, which is a higher-level cognitive learning task than the knowledge test.
Clinical judgment scores were calculated by percent of correct responses across six
categories for each of the eight simulation scenarios. The clinical judgment section
required each participant to recognize the clinical problem, accurately document
significant clinical markers, state/decide the correct intervention recommendations,
document rationales to support their decision, and accurately calculate an OFS level
across eight two-minute prerecorded video simulation scenarios. Participants gain one
point for each of the six required criteria across the eight scenarios for a total of forty-
eight points. See Appendix A for the scoring rubric for correct clinical judgment
45
Table 1
Note: Answers are bolded
Knowledge Test Questions 1. Airway protection in premature infants is primarily a function of the _________.
A. Laryngeal chemoreflex (LCR) B. Cough Reflex C. Irritant Reflex D. Laryngeal-Cough Reflex
2. Premature infants experience discrepancies in the integration of sensory and motor activities secondary to _____________________.
A. deficits in myelination of the prefrontal lobes B. differences in the timing of myelination between the CNS and PNS C. differences in in the development of the digestive system D. delays in neuronal proliferation
3. Premature infants experience disequilibrium between the sympathetic and parasympathetic branches of the autonomic nervous system. The parasympathetic branch does not return balance to the system once the fight or flight response activates in premature infants. Subsequently, bottle feeding after hands-on care may result in
A. dysrhythmic sucking patterns B. increased episodes of reflux C. increased gastric motility D. decreased gastric motility
4. In infants, the cough reflex develops at _______ weeks gestation. A. 32 B. 36 C. 40 D. 44
5. Premature infants may have extreme responses to airway protection reflexes, which can be observed in non-verbal behavior. List three extreme responses that may occur when airway protection reflexes are triggered in premature infants. Prolonged apnea, bradycardia, desaturation, color change, cyanosis, tachypnea, coughing
6. Disorganization may precede aspiration during bottle feeding. List three behavioral clinical markers
that indicate an infant is disorganized. Shut-down, drooling, gulping, change in muscle tone, grunting, finger splay, arching, hyper-alert, gaze aversion, slack jaw, sighing, regurgitation, worried face, tongue protrusion, yawn, flaccidity, startle, eyes closed, facial grimace, limb extension, mottled or cyanotic, apnea, bradycardia, rapid heart or respiratory rate.
7. List three disengagement cues an infant displays when they are not ready to feed orally.
Posttest 2B_ Answer Key P Category Description Met Expectation: #8 Pg 7
1 Problem o Difficulty feeding (any suggestion of problem accepted) 2 Reports essential data
Physiologic ONE Behavioral ALL Drooling included: # 2 is ___ Drooling excluded : # 2 is ______
Documented ALL the following: o Muscle tone changes o Drooling o Tachypnea o Gulping (large/loud swallows – they define it)
3 Initiates intervention and recommendations
Documented Both of the following: o Stop oral feeding: hold oral feeding,
tube feed remaining volume o Recommends feeding and swallowing
evaluation consult, OT, SLP, MBS 4 Provides rationale to
support action in #3 Documented rationales for hold feeding and recommendations due to: Any One
o Muscle tone changes, drooling, gulping, or tachypnea
o Disorganized infant o Therapeutic intervention to compensate o OFS Level is correct
5 Aspiration possible o Yes pulmonary health, diff breathing; working to ventilate; respiratory compromise 6 OFS Level 3 o Correct Y N:___ Total number met out 6 # _____ drooling included # _____ drooling excluded
____Yes / ___ No - Met expectation for scenario L (3/6)
O Category Description Met Expectation: #7 Pg 8
1 Problem o Difficulty feeding(any suggestion of problem accepted) 2 Reports essential data
Physiologic ALL Behavioral NONE
Documented ALL the following: o Desaturation o Apnea o Color change *may doc tachypnea chg muscle tone
not coded 3 Initiates intervention and
recommendations Documented Both of the following:
o Stop oral feeding: hold oral feeding, tube feed remaining volume
o Recommends feeding and swallowing evaluation consult, OT, SLP, MBS
4 Provides rationale to support action in #3
Documented rationales for hold feeding and recommendations due to: Any One
o Desaturation, apnea, color changes o Global statement of physiologic decline o OFS Level is correct
72
5 Aspiration possible o Yes pulmonary health, diff breathing; working to ventilate; respiratory compromise 6 OFS Level 1 o Correct Y N:_____ Total number met out 6 # ___________
____Yes / ___ No - Met expectation for scenario L (3/6)
Video Scenarios
J Category Description Met Expectation: #2 Pg 9
1 Problem o Difficulty feeding (Mild) (normal states desaturation) 2 Reports essential data
Physiologic ALL Behavioral NONE
Documented ALL the following: o Desaturation
3 Initiates intervention and
recommendations Documented ONE of the following:
o Continue oral feeding with caution o Recommends some technique to
compensate for mild desaturation 4 Provides rationale to
support action in #3 Documented rationales recommendations due to: Any One
o Desaturation OR treatment suggested: pacing, change position to compensate for mild desaturation etc
o OFS Level is correct 5 Aspiration possible o No (no distress ; ok to say yes if relate to desaturation) 6 OFS Level 4 o Correct Y N:____ Total number met out of
6 = #_____________________
____Yes / ___ No - Met expectation for scenario L (3/6)
I Category Description Met Expectation: #1 Pg 10
1 Problem o No problem; Tolerated feeding well 2 Reports essential data
Physiologic NONE Behavioral NONE
Documented ALL the following: o None required
3 Initiates intervention and
recommendations Documented ONE of the following:
o Continue oral feeding o Recommends advancing feeding
4 Provides rationale to support action in #3
Documented rationales for recommendations due to: Any One
o Tolerated without physiologic decline o OFS Level 4: correct
5 Aspiration possible o No safe feeding; not distress; breathing normal) 6 OFS Level 4 o Correct Y N:___ Total number met out of
6 = #__________________
____Yes / ___ No - Met expectation for scenario L (3/6)
73
M Category Description Met Expectation: #5 pg 11
1 Problem o Difficulty feeding(any suggestion of problem accepted 2 Reports essential data
Physiologic ONE Behavioral ALL Drooling included: # 2 is ___ Drooling excluded : # 2 is ______
Documented ALL the following: o Muscle tone changes o Drooling o Coughing o Gulping (large/loud swallows – they define it)
3 Initiates intervention and recommendations
Documented Both of the following: o Stop oral feeding: hold oral feeding,
tube feed remaining volume o Recommends feeding and swallowing
evaluation consult, OT, SLP, MBS 4 Provides rationale to
support action in #3 Documented rationales for hold feeding and recommendations due to: Any One
o Muscle tone changes, drooling, gulping, or coughing
o Disorganized infant o OFS Level is correct
5 Aspiration possible o Yes pulmonary health, diff breathing; working to ventilate; respiratory compromise 6 OFS Level 2 o Correct Y N:____ Total number met out 6 # _____ drooling included # _____ drooling excluded
____Yes / ___ No - Met expectation for scenario L (3/6)
K Category Description Met Expectation: #3 pg 12
1 Problem o Difficulty feeding (any suggestion of problem accepted) 2 Reports essential data
Physiologic ALL Behavioral NONE
Documented ALL the following: o Desaturation o Bradycardia (may doc chg muscle activity but not code)
3 Initiates intervention and recommendations
Documented Both of the following: o Stop oral feeding: hold oral feeding,
tube feed remaining volume o Recommends feeding and swallowing
evaluation consult, OT, SLP, MBS 4 Provides rationale to
support action in #3 Documented rationales for hold feeding and recommendations due to: Any One
o desaturation, bradycardia or global statement of physiologic decline, infant experienced unstable vital signs,
o OFS Level is correct 5 Aspiration possible o Yes pulmonary health, diff breathing; working to ventilate; respiratory compromise 6 OFS Level 1 o Correct Y N:__ Total number met out of
6 = # ____________
____Yes / ___ No - Met expectation for scenario L (3/6)
74
L Category Description Met Expectation: #4 Pg 13
1 Problem o Difficulty feeding (any suggestion of problem accepted) 2 Reports essential data
Physiologic ALL Behavioral NONE
Documented ALL the following: o Coughing o Apnea o Color change/cyanosis o Desaturation o Bradycardia *may doc chg in muscle tone not coded*
3 Initiates intervention and recommendations
Documented Both of the following: o Stop oral feeding: hold oral feeding,
tube feed remaining volume o Recommends feeding and swallowing
evaluation consult, OT, SLP, MBS 4 Provides rationale to
support action in #3 Documented rationales for hold feeding and recommendations due to: Any One
o Coughing, color change/cyanosis, desaturation, bradycardia or global statement of physiologic decline, infant experienced unstable vital signs,
o OFS Level is correct 5 Aspiration possible o Yes pulmonary health, diff breathing; working to ventilate; respiratory compromise 6 OFS Level 1 o Correct Y N:___ Total number met out 6 #_________
____Yes / ___ No - Met expectation for scenario L (3/6) N Category Description Met Expectation: #6 Pg14
1 Problem o Difficulty feeding (any suggestion of problem accepted) 2 Reports essential data
Physiologic ALL Behavioral ALL Drooling included: # 2 is ___ Drooling excluded : # 2 is ___
Documented ALL the following: o Desaturation o Drooling o Coughing o Tachypnea
3 Initiates intervention and recommendations
Documented Both of the following: o Stop oral feeding: hold oral feeding, tube feed
remaining volume o Recommends feeding and swallowing
evaluation consult, OT, SLP, MBS 4 Provides rationale to support
action in #3
Documented rationales for hold feeding and recommendations due to: Any One
o Desaturation, drooling, coughing, tachypnea o Global statement of physiologic decline and/or
behavioral disorganization o OFS Level is correct
5 Aspiration possible o Yes pulmonary health, diff breathing; working to ventilate; respiratory compromise 6 OFS Level 3 o Correct Y N:___ Total number met out of 6 = # _____ drooling included # _____ drooling excluded
____Yes / ___ No - Met expectation for scenario L (3/6)