Patient Safety and the SLP

SLPs play a vital role in promoting clear and effective communication across health care settings. In addition to directly supporting individuals with communication disorders or differences, SLPs can also offer guidance to the health care team on evidence-based communication strategies and tools—such as

• using plain language, supported conversation techniques, and augmentative and alternative communication (AAC) systems or
• documenting and obtaining necessary communication accommodations.

By supporting effective communication and proactively planning for communication access, SLPs help reduce misunderstandings, strengthen patient engagement and autonomy, and improve safety outcomes. Ensuring communication access also supports patients’ mental health, promotes psychological recovery, and helps mitigate delirium in health care settings.

Communication breakdowns can occur between health care practitioners and patients or their care partners, as well as among practitioners themselves. Reduced communication contributes to about one in four patient safety incidents in health care and is the sole cause of safety incidents in roughly one in 10 cases (Keshtkar et al., 2025).

See the Communication Access resource for additional information.

SLPs ensure that documentation is clear, complete, and clinically relevant. This includes avoiding certain abbreviations—such as those on the Joint Commission’s “Do Not Use” [PDF] list—to reduce the risk of miscommunication.

Effective documentation may include the following elements:

• session details, such as SOAP notes (Subjective, Objective, Assessment, Plan) or other structured formats
• key communications with the interdisciplinary care team
• clear rationale for services, including medical necessity and functional relevance
• evidence that the services require the skills of an SLP
• patient safety concerns, including risk factors and mitigation strategies
• progress toward individualized goals and updates to the plan of care

See the Documentation in Health Care resource for additional information.

SLPs demonstrate competence in all practice areas to provide safe, high-quality care. From the standpoint of ASHA’s Code of Ethics, clinicians are expected to be trained and competent in each area of service that they provide, and competence is self-assessed by the clinician. Some clinicians may need more practice than others before feeling confident in a practice area.

Formal competency assessments—including documentation of competency—can vary depending on facility and state guidelines. Written competency plans can protect clinicians and can help clinicians meet documentation standards for facility reviews or surveys.

Clinicians can consult resources such as the Dysphagia Competency Verification Tool (DCVT) [PDF] to help develop facility-specific competencies.

Staying current with research-based interventions supports safer, more effective patient care. Consider these strategies for maintaining and expanding your clinical knowledge:

• consulting the Evidence Maps to assist with making evidence-based decisions
• using the Practice Portal to facilitate decision-making on clinical and professional topics
• referring to peer-reviewed practice guidelines (examples follow)
• Best Practices in Modified Barium Swallow Studies
• Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1
• Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Pediatric Populations: Part 2
• American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury
• participating in continuing education to remain current with evolving evidence across diverse patient populations
• engaging in quality improvement (QI) initiatives to enhance clinical care and patient safety

Safe, effective care relies on a multidisciplinary, team-based approach with the patient and their care partners at the center of the care team. SLPs collaborate with physicians, nurses, physical therapists (PTs), occupational therapists (OTs), and dietitians—among many others—to address swallowing, communication, and cognitive needs. Strong interprofessional practice improves outcomes, reduces errors and adverse events, and ensures that clinicians tailor care to each patient. By actively participating in team discussions and advocating for patient-specific needs, SLPs play a key role in creating a safer, more coordinated care experience.

The Joint Commission, a health care accreditation organization, establishes national patient safety goals to improve patient care. These goals are updated annually and may differ depending on the health care setting. The Joint Commission identifies several areas that are essential to providing safe, high-quality health care—including effective communication [PDF].

To view the most recent safety goals by setting, see the Joint Commission’s National Patient Safety Goals webpage.

SLPs may be asked to perform tasks that are not explicitly listed in ASHA’s Scope of Practice in Speech-Language Pathology. Some tasks—such as repositioning a patient or suctioning a patient’s tracheostomy—may be part of clinical service delivery. Others, such as taking vital signs, may be assigned by the employer to support overall patient care.

Before performing any clinical support activities, SLPs are advised to consult their state licensing board to ensure that such tasks are permitted under their state practice act. Employers are responsible for providing appropriate training, necessary equipment, written policies, and documentation of the SLP’s competency to perform clinical support activities. Patient safety depends on clinicians being fully trained and competent in any task that they perform.

See ASHA’s position statement on multiskilled personnel for additional information.

Telehealth service delivery requires proactive safety planning. SLPs can collect emergency contact information at the beginning of the treatment interval and confirm the patient’s physical location at the start of each session in case urgent medical assistance is needed. Additionally, ensuring that the patient has the cognitive, sensory, and technological supports in place can maximize safe, effective participation.

SLPs can also evaluate whether telehealth is clinically appropriate or whether in-person care is necessary (e.g., if safety concerns arise as a result of the patient not seeing a provider in person). Establishing clear communication protocols and implementing an emergency response plan can reduce risk during virtual sessions.

See ASHA’s Telepractice Practice Portal for more information.

SLPs who work in facilities with limited access to instrumental swallowing assessments, insufficient staffing, or reduced resources navigate unique challenges while ensuring patient safety. In these settings, innovative approaches can help maintain high-quality, safe care despite constraints.

Strategies for Managing Resource Limitations

• Improve access to instrumental swallowing assessments—When videofluoroscopic swallowing studies (VFSS) are unavailable, building in-house flexible endoscopic evaluation of swallowing (FEES) competency can help ensure timely, appropriate instrumental swallowing assessment. Alternatively, consider partnering with mobile VFSS or FEES providers to bring services on-site.
• Leverage mentorship and networking—Establishing formal or informal mentorship programs with experienced SLPs in nearby facilities can strengthen clinical decision making, promote information sharing, and support continuity of care. See ASHA’s Mentoring Programs for more information.
• Advocate for flexible staffing and telepractice—Expanding staffing access through PRN/per diem coverage or regional SLP partnerships can help meet patient needs. In some cases, teletherapy may be appropriate for individuals in remote areas or for those with limited access to in-person care.
• Standardize clinical protocols—Develop and implement evidence-based, structured pathways for common clinical scenarios to promote consistency, reduce variability in care, and support clinical decision making. Protocols may include standardized screening tools, documentation templates, care checklists, and referral criteria.
• Utilize online resources—When evaluation and treatment tools are limited, take advantage of online resources to access evidence-based assessment and treatment materials. Here are some examples:
  • Shirley Ryan AbilityLab Rehabilitation Measures Database
  • National Institutes of Health (NIH) Toolbox
  • National Foundation of Swallowing Disorders—Swallowing Exercises

Health care professionals may experience moral distress during times when

• systemic or institutional policies or practices limit their ability to provide the care that they believe is needed or
• they are asked to participate in practices that do not align with standards of care, the Scope of Practice in Speech-Language Pathology, ethical standards, and/or billing standards.

For example, a patient may wish to eat and drink despite aspiration risk, but administrative policies or facility rules may prevent the SLP from honoring that choice. This disconnect can lead to compromised patient autonomy, increased safety risks for patients, and staff burnout and turnover. Addressing moral distress through open communication, team-based discussions, and consultation with ethics professionals is essential to creating a safer, more supportive care environment.