Bedside Swallow Evaluation Template
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Bedside Swallow Evaluation
The Bedside Swallow Evaluation (BSE) is a clinical assessment used to evaluate a patient's swallowing function at the bedside. This evaluation is crucial for identifying dysphagia, assessing aspiration risk, and guiding appropriate interventions to ensure safe oral intake. The BSE involves a systematic assessment of various components of swallowing, including oral motor function, sensory awareness, and coordination of swallowing reflexes.
Patient Information
Name | |
Age | |
Gender | |
Medical Record Number | |
Date of Evaluation |
Clinical Presentation:
Chief Complaint | |
Relevant Medical History |
Observation
1. Oral Mechanism Examination | Yes | No |
|---|---|---|
Lip Closure | ||
Tongue Mobility | ||
Palatal Elevation | ||
Laryngeal Elevation | ||
Presence of Oral Residue |
2. Cough Reflex | Yes | No |
|---|---|---|
Spontaneous Cough | ||
ough After Swallowing | ||
Ability to Clear Secretions |
3. Voice Quality | Yes | No |
|---|---|---|
Wet/Gurgly Voice | ||
Hoarseness | ||
Vocal Effort |
4. Oral Sensation | Yes | No |
|---|---|---|
Sensory Awareness | ||
Gag Reflex | ||
Ability to Detect Food in Mouth |
Swallowing Trials
1. Liquid Consistency | Yes | No |
|---|---|---|
Volume | ||
Ability to Initiate Swallow | ||
Presence of Coughing | ||
Signs of Aspiration |
2. Pureed Consistency | Yes | No |
|---|---|---|
Texture Tolerance | ||
Mastication Ability | ||
Bolus Formation | ||
Swallowing Coordination |
3. Solid Consistency | Yes | No |
|---|---|---|
Texture Tolerance | ||
Mastication Ability | ||
Bolus Formation | ||
Swallowing Coordination |
Overall Assessment
Overall Swallowing Safety | |
Recommendations/Interventions |
Comment/Feedback |
|---|
Provide any additional comments or feedback regarding the evaluation process or the patient's swallowing function. |
[Evaluator's Signature Over Printed Name]
Templates
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