Abstract NS1: Sustained Reliability in Dysphagia Screening by Registered Nurses

Abstract

Background and Purpose: Registered nurses (RNs) are critical to the rapid completion of dysphagia screening as individuals presenting with stroke symptoms must have swallowing screened prior to oral intake including aspiration. With many swallowing screening tools, RNs are required to make judgments routinely performed by speech-language pathologists (SLP). We hypothesized that RNs could obtain and sustain high inter-rater reliability in completing dysphagia screening. Methods: RNs routinely working with stroke admissions at the Michael E. DeBakey VA Medical Center were recruited (N=15). They underwent a 20 minute didactic training concerning stroke and dysphagia which included observation of a video recording showing execution and interpretation of the screening items (lethargy, dysarthria, wet voice, abnormal volitional cough, and response to water swallow: cough, throat clear, wet voice). Following this, the RN was required to demonstrate correct administration and interpretation of the screening items using study staff and video clips of dysphagia screenings prior to screening patients. To establish RN inter-rater reliability, a randomly selected RN from the cohort of trained nurses and an SLP made simultaneous independent judgments of the same observations obtained from the screening of a stroke participant. Results: Between October 2012 and June 2014, 199 dysphagia screenings were completed. Overall, substantial reliability was identified between the RNs and the SLPs (k[SE] = .79[.02]) and was comparable to SLP inter-rater reliability (.83[.03]). Completion of <20 screenings (n = 10) resulted in substantial reliability (.74[.03]), while completion of >20 screenings (n = 5) yielded almost perfect reliability (.83[.02]). RNs with at least 20 screenings showed consistent improvement in reliability over time with an average increase of 19% (range 6.2% to 40.2%) when comparing earlier screenings to later screenings. Conclusions: RNs are reliable in obtaining and sustaining reliability in accurately completing dysphagia screening. Practice improves performance with high levels of sustained reliability achieved with completion of 20 screenings.