All up in my Pockets!
“Pockets so swole just like Popeye on his spinach”—Roscoe Dash
Everyone has an “after-work ritual” as soon as they step foot in the house. Maybe it’s immediately stripping out of your germ-covered scrubs? Maybe it’s calling a loved one? Maybe it’s crashing on the couch and scrolling your social media timeline? My “after-work ritual” is emptying my pockets of all the miscellaneous items I forgot to leave at work (which is honestly a practice I adopted only after ruining one too many pen lights in the washing machine…RIP). Consequently, if you hang around me long enough, you are guaranteed to run into my mini junk piles of work-related items scattered around my kitchen counter, dresser, coffee table, car console…you name it!
You see, my pockets are my primary method of transporting my necessities around the hospital. I am notorious for packing my pockets like a game of Tetris (THERE ARE LEVELS TO THIS!) All the other SLPs in my office have figured out innovative ways to carry their items—fanny packs, plastic caddies, tote bags—but for some reason, I rely simply on my pockets. Ok, in reality, I’m just way too vain to wear a fanny pack. There. I said it.
Working in one of the largest and busiest acute care hospitals in my city, I am constantly on-the-go serving patients across service lines. While we do have a centrally-located Speech Therapy office for me to place my personal belongings, I realistically may only make it back to the office a couple times a day and I spend the rest of my day as a nomad roaming from floor to floor. So not having your essentials handy could quickly turn your day into an unproductive frenzy.
My perfectly packed pockets are often a topic of conversation among my patients, as well. Many are intrigued with all the things I carry in my pockets and I’ve become accustomed to hearing comments such as, “what else you got in there?”
You know those magic tricks where the magician pulls a never-ending scarf out of his hat? That is the equivalent to my pockets. So, I figured I would let the world in on the mystique of what I am toting around all day. Whether you are like me and rely on your pockets or have some other creative carrying device, these are the most important items I think every medical SLP should consider adding to his or her clinical toolkit.
THE ESSENTIALS..don’t leave home without ‘em!
SPOONS: Much of my day is spent completing bedside swallow evaluations, instrumental swallow evaluations, and dysphagia treatment. I usually start all of my evaluations with ice chip via spoon or thin liquids via spoon. A spoon is an especially great starting point for my critically ill patients for ice chip trials, small sips of water, or simply trying to elicit a swallow with a dry bolus. I feel like the spoon is the building block.
STRAWS: Another swallowing staple. Straws provide an opportunity to assess patients’ swallowing under various conditions. I always have to roll my eyes at this blind fear some people have of straws (“ThEy CaUsE AsPiRaTiOn”). Straws can be a great clinical tool for some patients or just simply a personal preference. When in doubt, do an instrumental swallowing evaluation to be sure a straw is right for your patient.
APPLESAUCE: Pudding, applesauce, yogurt…whatever floats your boat! A puree consistency is usually always a part of my swallow evaluation.
CRACKERS: Some facilities use graham crackers, saltines, or if you are one of the luck ones out there, Lorna Doone cookies. Again, a regular solid consistency is usually always a part of my swallow evaluation.
THICKENER PACKETS: Repeat after me: I.WILL.NOT.THICKEN.LIQUIDS.AT.THE.BEDSIDE. I.DO.NOT.HAVE.X-RAY.VISION. It is so important that we are getting instrumental swallow assessments on our patients before we start haphazardly thickening liquids. I think thickener has previously been a primary tool in many SLP toolkits, but times are changing and our profession is evolving (I hope.) So let me be very clear—I carry thickener packets only so that I can asses patients‘ swallowing with different viscosities during my FEES. I also carry thickener packets in the event I need to do some patient/family education on thickening liquids prior to discharge (and I like to leave a few samples too.)
GAUZE/ALCOHOL WIPES: I always find myself searching for one of these for some reason or another. These are perfect for wiping the tip of the FEES scope if it gets gunked. You know that saying “it’s better to have it and not need it, than to need it and not have it”?…yeah that.
LONG-HANDLED Q-TIPS: This is one of my quick-and-easy FEES candidacy tests. The absolute worst is when you get everything set up for your FEES only for your patient to start trashing, swatting, and cursing the minute the scope touches their nostril (talk about unproductive time!!) So, whenever I am questioning a pt’s tolerance of the endoscope, I insert just the tip of a long-handled q-tip in the nostril and within seconds I get a pretty good idea if they will be able to tolerate the endoscope. If I am immediately met with restlessness and agitation, I save myself the time, save our precious endoscopes, and order an MBSS. This method has proven to be fairly reliable time and time again.
LUBRICANT: I will occasionally add a small amount of lubricant to the end of my endoscope during a FEES, particularly for patients with very dry nasal cavities (think patients on high flow nasal cannula, patients with thick dried secretions, etc.), to help make placing the endoscope a little easier.
PEN LIGHT: When I was a graduate student, one of my favorite professors gifted me a pen light and I have been hooked ever since. Every time I supervise a student, the first thing I recommend he/she does is to purchase a quality penlight. I promise you won’t do another oral mech without one. I mean, if you don’t have a pen light, what are you even looking at?
PAGER: Yes, you read that correctly. I have a pager. Call me, beep me, if you wanna reach me.
RADIATION BADGE: My facility requires that we wear radiation badges when we are in the flouro suite, despite our radiation exposure being minimal. You never know when you may get called to “come on down” to radiology, so I stay ready so I don’t have to get ready.
PEN—I swear pens just grow legs and walk away. They are truly a hot commodity in hospitals. I always jot down detailed notes in between seeing patients, keep data during my sessions, and you never know when you will have to scribble down a name or number quickly. Sounds like a basic items, but don’t get caught without one.
N-95 mask: These are the masks that are required when entering patient rooms with airborne precautions. Every year I have to go to my facility’s Occupational Health and get fitted for a mask that fits my face. Not sure if everyone has my face, but every time I have an airborne precautions patient, I can never find my mask size. I inevitably spend way too long tracking one down (again, those dreadful words: unproductive time), so now I always carry a spare because I literally can’t even.
CELLPHONE: Of course I always have my phone in my pocket…who doesn’t? But I must admit, I struggle with this. I never want to be the person who walks around with her head down on her phone, as I believe it appears unprofessional and disconnected from our patients/visitors. However, I also underestimate how much I use my phone for clinical tasks and patient care. I use my phone to keep important numbers/codes, I use a HIPAA-compliant encrypted texting app to communicate with physicians, and I am constantly in communication my SLP team members to keep everyone updated on our work flow. Believe it or not, my cellphone is just as important at work as it is outside of work.
BONUS ITEMS…for the overachievers!
WATCH/TIMER: I wear a watch everyday. It’s so handy for timing patients on cognitive tasks (e.g., verbal fluency, delayed recall, spaced retrieval, attention). We also know that minutes rule the therapy reimbursement world, so having a watch helps me accurately manage and keep track of my time throughout the day.
DECK OF CARDS: The cognitive-linguistic therapy possibilities are endless with a deck of cards! Think sorting tasks, math tasks, attention tasks, naming tasks, sequencing/organization tasks, even receptive/expressive language tasks for all complexity levels. Just be very cautious about infection control when taking these to and from patient rooms.
COINS: Again, the cognitive-linguistic therapy possibilities are endless! Money management is one of the most functional tasks we can do with patients. We all have bills, right? I KNOW I DO! With just a few coins in your pocket, you can have a full out therapy session. I mean, who doesn’t love money?
MARKERS: I at least like to keep a standard black marker on me at all times, but having a few colorful markers is even better! Markers are perfect for making bold dark lines for patients who may have visual deficits. Colorful markers can help with visual organization or visual cues (like a page anchor for visual inattention/neglect).
BLANK PAPER: I keep a piece or two folded in my pocket. Blank paper can make the perfect impromptu basic communication board (in conjunction with the aforementioned markers). Or it can be used to quickly and informally asses reading/writing. And for those patients who use writing as their primary form of communication, they are always appreciative of the extra paper.
DRY ERASE MARKER: The number one reason I like to have a dry erase marker is to update the temporal orientation information on the white boards in the room. It is nearly impossible to reorient your patient when it’s Friday and their white board still has Tuesday written on it. The white boards in the rooms are also often used as a centralized location for communication among disciplines (PT, OT, ST, case management, RN, MD, etc.) or between family/staff. There is just no guarantee you will be able to find a [working] dry erase marker when you need one.
WISHFUL THINKING…a girl can dream!
ORAL SUCTION—Usually these are set up on the wall of each pt’s room, but every once in a while, I need one quickly and, much to my dismay, a suction is no where to be found. How amazing would it be if I could just reach in my pocket for one???
SUCTION TOOTHBRUSHES: Speaking of suction, let’s talk about those equally important toothbrushes that attach to it! I wish I could throw these out like candy. YOU GET A TOOTHBRUSH! YOU GET A TOOTHBRUSH! *Oprah Winfrey voice* Oral care, y’all…it’s important.
EMESIS BAG: You know how they say you can never find a pen when you need one? The same applies for emesis bags. I routinely find myself frantically running around the unit trying to find one before my pt starts projectile vomiting. Yikes. CUPS: These manage to go flying off the shelves of every nourishment room right when I need one. Go figure. If your luck is anything like mine, you will find yourself preparing for a bedside swallow evaluation or a FEES without a cup in sight. Sometimes I wish I could just carry around a sleeve of cups with my name on it. Or maybe an emergency stash of disposable collapsable cups that would fit right in my pocket? (Hey! Don’t steal that idea…I might use it.)
NOTEBOOK: While I can’t fit this in my pocket, I like to carry a multi-pocket binder with a variety of printed materials organized by topic (e.g., speech, language, cognition, dysphagia, etc.) This allows me to always have printed education materials to give to patients/families, a stash of formal and informal evaluations, printed communication boards of varying complexities, and my favorite functional treatment tasks.
Phew..that was a really long list! Did I miss anything? Comment below and let me know all about your medical SLP must-haves!