Follow the steps to effectively complete the Dysphagia Screening Tool.

1. Click ‘Get Form’ button to download and access the MR64B WACHS Dysphagia Screening Tool.
2. Begin by filling in the patient’s personal information at the top of the form, including surname, given name, unique medical record number (UMRN/MRN), date of birth (DOB), gender, postal code, address, ward, telephone number, and doctor’s name.
3. Move to Phase 1, where you will assess the patient’s history. Review the list of conditions and indicate ‘Yes’ or ‘No’ for each question. If any boxes are marked ‘Yes’, proceed to Phase 2. If all boxes are marked ‘No’, complete the Swallowing Management Plan as the patient will have a modified or general diet.
4. In Phase 2, conduct an interview with the patient, family, or carer. Record their responses to the questions regarding swallowing difficulties, cough episodes, and food modifications. Indicate ‘Yes’ or ‘No’ for each response.
5. If the responses indicate a potential issue, administer the Water Test only if all dysphagia indicators were marked ‘No’. Document the patient’s reaction to swallowing water.
6. Based on the results from both phases, determine the patient’s status regarding dysphagia. If there are indicators or failed Water Test, refer the patient to a speech pathologist and follow the necessary nutrition and hydration protocols. Document all findings in the medical record.
7. Complete the Swallowing Management Plan if dysphagia is identified, including recommendations for being nil by mouth (NBM), IV fluids, or NG feeds.
8. Finalize the form by entering your print name, designation, signature, date, and time in the designated fields. Ensure all sections are completed before saving the changes, downloading, printing, or sharing the form.

Complete your dysphagia screening online today to ensure the health and safety of your patients.