JCPSLP Vol 16 no 3 2014_FINAL_WEB

Figure 1. Process map of texture modified diet and fluid provision at Austin Health – Austin Tower and ONJ Wards

Discipline

Prescribing

Ordering

Identify special dietary needs

Initiate SP and/or DT Cerner referral if indicated

Nurse (ANUM/RN)

Instruct ward clerk to order specified diet

Ward clerk (WC)

Is the change a downgraded TMD/F code and is it outside cut-off time for next meal?

Notify MM of TMD/F code order or change

Enter required TMD/F code on TrakCare

No

Send DT referral with detailed comments incl. diet code, prognosis, d/ch plan if known

Yes

Document TMD/F recommendation

Recommend texture

Place bed-sign outlining TMD/F required

Is it a complex diet/ fluid code entry on TrakCare?

Notify ANUM/RN of TMD/F required

Speech pathologist (SP)

Request via Lanpage that DT make TMD/F code entry on TrakCare

modified diet/fluid (TMD/F)

No

in patient’s medical file

Yes

Dietitian (DT)

Verbally notify FP of TMD/F order or change if applicable

Conduct interview with pt. Enter diet code data into Chefmax according to dietary requirements

Crosscheck diet/fluid code changes via TrakCare prior to cut-off time

Print TrakCare report &

Menu monitor (MM)

Authorise & finalise diet codes in Chefmax

give to FP. Print meal tray slip & give to FSA

Complete new meal tray slip and give to FSA

Food service assistant (FSA)

Fluid prep staff (FP) Personal service assistant (PSA)

TrakCare reports received from MM

Processes in the kitchen Meetings were held with food services department staff to discuss the initial audit results and their perceived “high- risk” areas within the kitchen, plating line, and meal delivery process. Three key areas were identified as requiring attention: (1) the lack of cross-checking processes, (2) the level of level of supervision on the plating line, and (3) the absence of supervision in the re-therm trolley room. Changes implemented as a result of these meetings include an additional food services supervisor was directed to work on the plating line, enabling further cross-checking of plated meals and diet/fluid code changes. New allocation of a food services supervisor who was directed to work in the re-therm trolley room enabling cross-checking and system controls to streamline diet/fluid code changes prior to plated meals being transferred to the ward. A whiteboard was introduced for all new diet slips to be affixed to.

Individual meetings were also held with nurse unit managers (n = 4) to discuss the first audit results. The discussion included the presence of safe swallowing bed-signage and the importance of bed-signs moving with patients who are transferred to other beds or wards. Education was provided regarding the role of the safe swallowing bed-sign in the TMD/F provision system. Actions and implemented changes as a result of this meeting included: • Speech pathologists 1. Adequate copies of bed-signs made available in each department/ward 2. Verbal and email reminders provided to speech pathologists quarterly regarding placement of safe swallowing bed-sign when clinically indicated • Nurse unit managers 1. Review bed-transfer processes with staff with reminders to move bed-sign when patient transferring to another bed or ward.

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JCPSLP Volume 16, Number 3 2014

Journal of Clinical Practice in Speech-Language Pathology