Our 237-bed skilled nursing facility has recently engaged in continuous quality improvement (CQI) as part of the cite correction process when state surveyors found that nursing staff were not consistently following the feeding/swallowing and nutrition guidelines recommended after speech-language pathologists had completed the evaluation process for dysphagic residents. As part of the treatment plan, staff training had occurred. However, many reasons were given for not following the speech-language pathologists' treatment plan, e.g., “He eats/swallows fine,” “She never coughs,” “I don't have time to feed them that way,” and the overused, “We're short staffed.”

Our executive director formed an interdisciplinary team composed of the director and assistant director of Nursing Services, the nurse in charge of CQI, the director of Nutrition Services and her two assistants, the nurse-managers of all four units, the Facility Rehab director with team leaders of Occupational Therapy, Physical Therapy, and Speech-Language Pathology, the Social Services director, the director of Recreational Therapy, and the corporation rehabilitation coordinator. They were given the charge of creating policy, procedure and a measure of CQI which would eliminate inconsistencies in the implementation of feeding plans and breakdowns in communication of information from one department to another in order that our residents might eat in the safest and most dignified manner possible. The interdisciplinary team met on a weekly basis to review and make suggestions for changes in the policy and procedure developed by the various team leaders, nursing and nutrition services. Revisions were ongoing for approximately 6 weeks until each policy was accepted in its final form with supporting documentation created for data collection (CQI).