Abstract 2128: Development and Impementation of a Nursing Swallow Screen

Abstract

Development and Implementation of a Nursing Swallow Screen Timely and safe administration of medications and PO intake for patients is essential. The goal of Capital Health (CH) was to develop and implement a standard swallowing screen completed by nursing for all patients admitted to a comprehensive stroke center with the confirmed or potential diagnosis of CVA or TIA. A review of literature and communication with other hospitals and the American Speech Language and Hearing Association uncovered a limited amount of information about swallowing screens. The CH Swallowing Screen was designed by the Stroke Team using information from other hospitals and input from the Nursing and Speech Pathology Departments at CH. The Swallowing Screen, comprised of 3 distinct sections, was designed to be sensitive to aspiration and determine the safety of gross swallowing skills or the need for a complete swallowing assessment by a certified Speech Language Pathologist (SLP). An added benefit of this screen was more rapid access to oral medications and PO intake. After screen development and nursing staff education, the form became a standard part of the admission process for all patients admitted to CH with a confirmed or potential diagnosis of CVA/Stroke or TIA. The following variables were selected as key components of the program: - If the patient passed the Swallowing Screen but was referred for a full evaluation, were the findings of the full assessment in agreement with those of the screening? - If a patient failed the Swallowing Screen, was s/he referred for a full evaluation by the SLP? - If the patient passed the Swallowing Screen, was s/he then placed on a diet? Data was collected from January 2008 to December 2010. Results indicate that the CH Swallowing Screen is being used both accurately and effectively. Agreement between the initial screening and full assessment (variable #1) improved from 91% in 2008 to 100% in 2010. During the same time period, effectiveness of the process (variable #2 and #3) improved from 83-98% and 87% to 92% respectively. Patients who pass the screen are now receiving oral medications and an oral diet in a more timely fashion. Patients who do not pass the screen are being referred to the SLP for a full assessment, while maintaining NPO status until that assessment is completed. Finally, the nursing staff has demonstrated proficiency to assess gross swallowing skills, as evidenced by agreement when patients who passed the screen were also evaluated by the SLP and no diet modifications were necessary. The development and implementation of the swallowing screen at CH has enhanced the timeliness and quality of treatment provided to CVA/stroke patients. Finally, use of this screen has fostered increased awareness and facilitated collaboration between Nursing and the Speech Pathology Department, thus improving the effectiveness of patient care and becoming part of the culture at CH.