Interprofessional case study

Summary

Russell, a 45-year-old ALS patient, experiences a decline in muscle function, difficulty swallowing, and increased risk of aspiration. Despite evaluations by various healthcare professionals documenting these issues, there's a lack of holistic care and effective interprofessional communication. This results in Russell developing severe pneumonia and ultimately passing away. The case highlights the importance of a coordinated approach to prevent aspiration and the need for clear communication among healthcare teams.

Takeaways

• 😷 Russell, a 45-year-old male, was diagnosed with amyotrophic lateral sclerosis (ALS) a year prior to the events described.
• 📉 Russell has experienced a decline in muscle function, with recent difficulties in chewing and swallowing.
• 👩‍⚕️ Russell's wife has become his primary caregiver, feeding him milkshakes due to his difficulty in eating solid food.
• 🏥 Upon entering the rehabilitation facility, Russell underwent evaluations by various healthcare professionals, each documenting their findings in an electronic medical record.
• 🤒 A nurse noted Russell's difficulty eating, with increased coughing and choking during meals, which are signs of potential aspiration.
• 🗣️ The speech-language pathologist observed signs of aspiration during vocalizations, indicating a risk of inhaling food or liquid into the lungs.
• 🏋️‍♂️ The physical therapist noted Russell's difficulty maintaining the stamina needed for self-feeding.
• 🔧 The occupational therapist recognized the need for adapted devices to assist with positioning and self-feeding.
• 🚨 On Friday, the speech-language pathologist observed signs of aspiration and labored breathing while Russell was eating, and updated the care protocol accordingly.
• 🏥 Over the weekend, Russell's condition deteriorated, with a nurse reporting fever, labored breathing, and unresponsiveness, leading to a diagnosis of severe pneumonia.
• 💔 Russell was transferred to the intensive care unit but later passed away, highlighting missed opportunities for a holistic approach to safe healthcare.
• 🤝 The case revealed that the healthcare team missed opportunities for interprofessional communication and collaboration to prevent aspiration.
• 🔍 The script suggests further exploration of case studies and strategies for improving interprofessional communication in healthcare settings.

Q & A

What is amyotrophic lateral sclerosis (ALS)?

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord, leading to muscle weakness and difficulty in performing daily activities.

What difficulties has Russell been experiencing since his ALS diagnosis?

Russell has been experiencing an overall decline in muscle function, difficulty in chewing and swallowing, and increased coughing and choking during meals.

Why did Russell's wife begin feeding him milkshakes?

Russell's wife began feeding him milkshakes because eating solid food had become too difficult for him due to his ALS symptoms.

What is the role of the rehabilitation facility in Russell's care?

The rehabilitation facility evaluates Russell's condition and documents findings from various professionals, which are accessible to all providers involved in his care.

What observations did the speech-language pathologist make about Russell?

The speech-language pathologist observed signs of aspiration during vocalizations and labored breathing, indicating potential swallowing difficulties.

How did the physical therapist's observations differ from the speech-language pathologist's?

The physical therapist noted that Russell was experiencing difficulty with the stamina necessary for feeding himself, focusing on the physical endurance aspect rather than the swallowing mechanism.

What did the occupational therapist document about Russell's need?

The occupational therapist documented the need for adapted devices to assist with positioning and self-feeding, highlighting the importance of environmental modifications for Russell's comfort and independence.

What happened on Friday after a week of therapy?

On Friday, the speech-language pathology staff member observed Russell displaying signs of aspiration and labored breathing while eating, leading to concerns about his swallowing safety.

What emergency situation did Russell experience on Sunday evening?

Russell became febrile, his breathing was labored, and he was generally unresponsive, leading to a diagnosis of severe pneumonia.

What were the missed opportunities for Russell's treatment according to the interviews and quality assurance reviews?

The missed opportunities included a lack of a holistic approach to safe healthcare, insufficient interprofessional communication, and not addressing the risk of aspiration as a team.

What terms are used to describe contributors to aspiration in the script?

The terms used to describe contributors to aspiration include fatigue, positioning, choking, and coughing.

Where can one find more case studies and strategies for interprofessional communication and collaboration?

More case studies and strategies for interprofessional communication and collaboration can be found at U.S. Documen Kinetics' website.