Qualitative Analysis of Therapist Documentation of Assessments of Orally Feeding Infants Who Require Noninvasive Respiratory Support.

Abstract

Purpose: This is a qualitative analysis of speech-language pathology and occupational therapy documentation of bedside assessments of infants orally feeding on noninvasive respiratory support (NRS).

Method: Data were extracted from speech-language pathology and occupational therapy electronic health record documentation of bedside feeding/swallowing assessment and treatment of infants on NRS. These data included the rate of documentation of objective metrics, as well as themes in feeding safety, quality, and therapeutic interventions.

Results: Notes from 37 speech-language pathologist and occupational therapist bedside visits were included. Data on the amount of NRS during oral feeding were inconsistently documented, but reported flow rate ranged from 0.2 to 5.0 l per minute. Approximately 57% of notes indicated some type of overt feeding problem. Objective data were inconsistently documented, but common metrics included signs of possible aspiration (cough in 16.2% and congestion in 13.5% of notes), liquid viscosity (43.2% of notes), feeding modality (94.6% of notes), volume offered (56.8% of notes) and consumed (81.1% of notes), and feeding time (56.8% of notes). Documentation themes include assessment of both safety and quality, implied stability and success rather than explicit documentation of such, infrequent instrumental assessment referral, differences between assessment versus follow-up treatment notes, differences in structured/templated notes versus unstructured narratives, and missing data.

Conclusions: Missing data limited our ability to draw conclusions regarding safety and quality of oral feeding during NRS use. We make recommendations for documentation, including prioritizing objective data, clarifying clinical interpretations, patient responses to interventions trialed, and use of structured narratives and flowcharting.