Sample Narrative QI Report
Important aspect of care andservice:
High-risk, problem-prone area.
quality of life standards for residents receiving enteral
nutrition via gastrostomy tubes.
2. Prevention of aspiration pneumonia in residents on
1. Presence or absence of dysphagia diagnosis by
2. Presence or absence of diet-specific recommendations by
3. Quantification of residents receiving PO intake in
conjunction with enteral tube feedings.
Means to trigger evaluation: 100% compliance expected.
Collection and organization of data:
1. Data source: clinical record
2. Data collection method: retrospective
3. Sampling method: stratified probability; all
residents on tube feedings
Evaluation: Conducted in _________ (month/year).
Summary of results:
1. Sample size: 29/34 residents on tube
(4 residents discharged; 1
2. Presence of dysphagia
4. Resident receiving PO and tube
1. Of note, as listed above, is the lack of pertinent
diagnoses and specific recommendations made by previous
2. Previous clinician initiated PO intake for 13% of
tube-fed residents, whereas current clinicians have initiated
PO intake for 44% of residents. This impacts on quality of
life, prevention of aspiration pneumonia in tube fed patients
(i.e., patients that are NPO and on tube feedings are at a
higher risk for aspiration pneumonia), as well as cost factors.
3. Incomplete documentation supporting NPO status.
4. Overall, most cases presented poor or inconsistent
documentation supporting tube feeding placement.
5. For 2/29 cases, the dysphagia evaluations were
6. For 1/29 cases, the dysphagia evaluation was missing
from the medical record.
7. Previous clinician recommendations for PO intake were
vague in Â¾ cases.
8. Access to information regarding PO diet restrictions by
consistency was difficult upon chart review.
Proposed actions to improve care and service:
1. SLP to inservice nursing staff on overall dysphagia
2. SLP to continue monitoring new admissions on tube
feedings, so as to conduct a dysphagia evaluation upon arrival
at the facility. Formal policy to be developed with
Director of Nursing.
3. Formal dysphagia management policies to be
4. To discuss the development of a feeding/dysphagia team
with key clinical personnel.
5. Filing issues to be discussed with and addressed by
Director of Nursing.
These results present a baseline from which to build upon as
the scope of speech-language pathology/dysphagia services at ABC
nursing home are developed.
The above to be re-assessed in six months for all residents on
tube feedings at that time.
Adapted from: Lynn, D. & Riquelme, L.F. (1997).
Q.I. - The Easy Way: A Practical Guide for Developing
Quality Improvement Programs. Glenmont, NY: New York State Speech-Language-Hearing