Run Modified Barium Swallow Study Preparation Checklist — Free

Patient and Order Verification

Patient identity verified using two identifiers critical (required)

Confirm patient identity using two approved identifiers before preparation begins.

Yes No N/A

MBSS order and indication confirmed critical (required)

Verify the modified barium swallow study order, clinical indication, and any special instructions.

Yes No N/A

Relevant allergies or prior contrast reactions reviewed critical (required)

Confirm whether the patient has a history of barium intolerance, aspiration concerns, or other relevant reactions requiring escalation.

Yes No N/A

Note (optional)

Contraindication or safety concern identified

Document any active contraindication, precaution, or reason the study should be delayed or escalated.

Patient Positioning and Mobility Readiness

Patient positioned upright or per ordered protocol critical (required)

Confirm the patient is positioned as required for the study, typically upright in the fluoroscopy suite unless otherwise ordered.

Yes No N/A

Head, trunk, and seating support adequate for safe imaging critical (required)

Verify the patient can maintain the required posture with appropriate support and without unsafe slumping or instability.

Yes No N/A

Assistive devices or transfer support available as needed

Confirm any required gait belt, wheelchair, transfer aid, or staff assistance is available before moving the patient.

Yes No N/A

Patient able to participate in study instructions critical (required)

Assess whether the patient can follow simple directions needed for the videofluoroscopic exam.

Yes No N/A

Barium Consistencies and Supplies

Required barium consistencies prepared critical (required)

Verify all ordered consistencies are available and prepared for the exam, such as thin liquid, nectar-thick, honey-thick, puree, or solid as applicable.

Barium preparations labeled and within usable condition critical (required)

Confirm prepared materials are clearly labeled and suitable for use per local policy and manufacturer instructions.

Yes No N/A

Appropriate utensils and feeding materials available

Verify cups, spoons, straws, and any other required feeding tools are present and clean.

Yes No N/A

Study materials match the ordered protocol critical (required)

Confirm the prepared consistencies and sequence align with the ordered MBSS protocol and any speech pathology requests.

Yes No N/A

Radiology Coordination and Imaging Readiness

Radiology staff notified and available for the exam critical (required)

Verify the radiology team has been informed and is ready to proceed with the videofluoroscopic study.

Yes No N/A

Fluoroscopy room and equipment ready for use critical (required)

Confirm the fluoroscopy suite, imaging equipment, and required accessories are ready and functional before patient entry.

Yes No N/A

Communication completed between ordering team and radiology

Document that any special instructions, precautions, or study modifications were communicated to the imaging team.

Yes No N/A

Any delays or coordination issues documented

Record any scheduling, staffing, or workflow issues that could affect study timing or completion.

Final Readiness and Escalation

All required preparation steps completed critical (required)

Confirm the patient, supplies, positioning, and coordination steps are complete and the study is ready to begin.

Yes No N/A

Outstanding concerns escalated to appropriate clinician critical (required)

Document whether any unresolved safety concern, contraindication, or missing preparation item was escalated to the ordering clinician or radiology lead.

Yes No N/A

Inspector notes

Add any additional observations relevant to the MBSS preparation process.

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Run: Modified Barium Swallow Study Preparation Checklist

Patient and Order Verification

Patient Positioning and Mobility Readiness

Barium Consistencies and Supplies

Radiology Coordination and Imaging Readiness

Final Readiness and Escalation

Get your results