A case of practicing scoping & extending scope of practice – it is FEES-ible!

Ms Shabeena Miskin1

1Redcliffe Hospital, Queensland Health, Redcliffe, Australia

BACKGROUND: Speech Pathologists are recognised as specialists in the assessment and management of dysphagia.  Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is an instrumental assessment that involves transnasal endoscopic imaging of the surface anatomy of the critical structures of swallowing to evaluate secretion management, pharyngeal and laryngeal sensation, airway protection, bolus pathway, and bolus residue during swallowing. Historically, patients requiring FEES have been referred to a tertiary facility. However, as a greater need for FEES assessments emerged, this was not a sustainable practice from patient, staffing and resource-management standpoints. Therefore, we embarked on a journey to establish our own FEES service at Redcliffe Hospital

METHOD: The use of endoscopy to assess pharyngeal and laryngeal function as part of a swallowing assessment is a clinical practice that falls beyond the usual scope of a speech pathologist, and is considered extended scope of practice. We engaged support from our Intensive Care Unit for the purposes of training and support for our speech pathologists in developing procedural, interpretation and technical skills in FEES.  We persevered despite encountering several hurdles and challenges along the way in relation to staffing, time, and access to appropriate patients.

RESULTS: A Speech Pathology led FEES service has been successfully established and embedded into the speech pathology service profile at Redcliffe Hospital, a small metropolitan hospital outside of Brisbane.  Training is now underway to ensure succession planning and competency is maintained.

DISCUSSION OF OUTCOMES AND IMPLICATIONS: Our FEES service will allow for the provision of a gold-standard swallowing assessment to guide the treatment of swallowing disorders for our inpatients – a procedure that they would normally forgo or need to travel into a tertiary centre to access. This will improve the quality of care in dysphagia management – timeliness, accuracy, rehabilitation and quality of life, as well as patient flow.


Biography:

Shabeena is a Senior Speech Pathologist with over 15 years of clinical experience, working in the acute and subacute settings within Queensland Health.  She has a passion for dysphagia assessment and management in the acute setting, particularly in critical care.

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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