Abstract TP352: Dysphagia Screening: The Quest for a Validated Tool

Abstract

Background: Patients with stroke and other comorbidities are at risk for dysphagia and aspiration. Aspiration pneumonia is associated with high morbidity and mortality rates. Get with the Guidelines-Stroke recommends that stroke patients undergo dysphagia screening with a validated, evidence-based bedside testing protocol, approved by the hospital, prior to any oral intake. Dysphagia screening is also mandatory for any patient presenting with a stroke or transient ischemic attack per The Joint Commission guidelines, and may increase early identification in other populations. The dysphagia screen used within the health system’s acute care hospitals was not a validated tool. Purpose: The purpose of this evidence-based practice project was to determine which validated dysphagia screening tool best identifies hospitalized adult patients at risk for dysphagia and aspiration? Methods: The Johns Hopkins Nursing Evidence Based Practice Model was used for the evidence appraisal and synthesis. A thorough review of the evidence was conducted in multiple databases using keywords dysphagia, dysphagia screen*, and aspiration pneumonia. The evidence was reviewed by a system-wide interprofessional team. Articles were excluded if the screen was not validated in multiple populations or was not administered by nurses. Results: Sixteen articles were included in the evidence synthesis. Sources of evidence with consistently good quality were found. The 3-ounce water test was most frequently used in the published studies. The Yale Swallow protocol incorporating the 3-oz water study was widely researched for the stroke and general patient populations and is administered by multiple disciplines including nurses. The Yale swallow protocol is pass or fail with 96.5 sensitivity and 97.9 specificity if passed. Conclusions: Based on evidence synthesis, the Yale Swallow Protocol was determined to be a valid and reliable tool that met the test of applicability and feasibility for implementation throughout the health system. A recommendation for change was presented and fully endorsed by the health system’s stroke and pneumonia clinical effectiveness teams and nursing practice council. The tool was implemented after staff education and training was completed.