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AdvoCATing for Instrumentals: You Need to Squad Up!

As promised, the next few Fridays will be focused on how to advocate for instrumentals in your facility. The fact of the matter is, you can’t do it alone (unless you’re just incredibly persuasive, in which case you should quit now and go to law school). You need a squad, an ally, a co-conspirator. Finding that ally or allies in your building can be tricky, and time consuming… but well worth it the long run.

Your first choice is ideally someone that understands the possible consequences to inappropriate dysphagia treatment, like the Respiratory Therapist or the Registered Dietician. A little bit of collaboration goes a long way. Discussing patients with other professionals, asking their opinion, chatting about recent research or how great the IDDSI is… all of these things help build relationships that can have your back when you go the Admin about needing instrumentals. Even if it’s just a “Oh, Sharon the dietician and I were discussing Mr. Smith. We have both noticed that his PO intake has gone way down since he came back from the hospital on an altered diet. They didn’t actually do an instrumental at the hospital, we really need to do one here.” Orrrrr “Amanda the Respiratory Therapist and I are really concerned about Mr. Jones, lots of coughing with meals, his lungs don’t sound great, I am suspecting dysphagia, but really need to get an instrumental so that we can figure out what’s happening before it gets worse. I’d hate to see him go out with pneumonia.”

Another important characteristic of an ally is POWER. A DON, a physician, or a DOR are great examples here. Again, taking the time to develop that relationship and trust is critical for your patients, so it’s worth taking a couple minutes while writing notes or doing a chart review to chat up the DON that sat down for one second, just to let her/him know how a patient is doing, or even just compliment an RN that helped you out the other day. The following week, when you need help with the Admin, the DON can be more inclined to support you if you ask. Obviously, the physician is a fantastic ally… and some of them actually do get it, it just takes a little work. Giving them updates on patient outcomes, voicing concerns, all of these things can increase your street cred with physicians. And it’s a fantastic feeling going to an Admin with a “Dr. Lawrence would really like an MBS on this patient, he and I are very concerned, thanks (*smug look)”.

Productivity standards being what they are (that’s a whole other discussion…), it can be easier to just live on SLP island, get your job done as best you can, and get out… but providing adequate and appropriate patient care, including getting those instrumentals to direct you, makes it well worth the time it takes to get your squad together.

MBS Envision would love to be on your squad. If you are battling for instrumental assessments and would like some advice please reach out to me at

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