ACQ Vol 10 No 2 2008

Work– l i f e balance : preserv i ng your soul

Appendix A.Weekend speech pathology service referral continued

Outcome of most recent speech pathology contact: Request weekend service intervention:

Initial assessment – swallowing Initial assessment – communication Review current diet Educate patient/family re swallowing management Direct swallowing therapy (please specify)

Communication therapy (please specify)

Check patient’s medical chart/check with nursing staff Other (please specify)

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Frequency of service requested:

Saturday Sunday

Estimated priority ranking (by patient’s usual SP):

COMPLETED BY SUPERVISING SPEECH PATHOLOGIST:

Patient prioritisation (before new referrals are received): _ ___________________________________________

SUNDAY Weekend service provided:

SATURDAY Weekend service provided:

Initial dysphagia assessment Initial communication assessment

Initial dysphagia assessment Initial communication assessment

Swallowing review Swallowing therapy Communication therapy Education regarding swallowing management Discussion with nursing or medical team/checking of patients notes Other (please specify) ____________________________________________________ ____________________________________________________ Diet continued: no change to patient’s current management plan Patient commenced oral feeding: Diet: Enteral feeding was commenced Patient was not admitted to hospital over the weekend due to intervention Diet downgraded: Diet upgraded: Patient unable to be seen due to: ____________________________________________________ The outcome of this service was:

Swallowing review Swallowing therapy Communication therapy Education regarding swallowing management Discussion with nursing or medical team/checking of patient’s notes Other (please specify) _ ___________________________________________________ _ ___________________________________________________ Diet continued: no change to patient’s current management plan Patient commenced oral feeding: Enteral feeding was commenced Patient was not admitted to hospital over the weekend due to intervention Diet downgraded: Diet: ________________________________________________ Diet upgraded: Diet: ________________________________________________ The outcome of this service was:

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S peech P athology A ustralia