Abstract WMP110: Catchy Acronym Improves Compliance in Hospital Struggling With Dysphagia Screening and NIHSS Assessment Upon Admission

Abstract

Background and Issues: A hospital in a Chicago suburb struggled with inconsistent dysphagia screening and National Institute of Health Stroke Scale (NIHSS) assessment upon admission for patients coding out as a confirmed stroke patient. Percentage of compliance for dysphagia and NIHSS were, in 2014, 79% and 84%, respectively. Purpose: The purpose of this Quality Improvement (QI) Project Abstract was to increase the number of stroke patients assessed for dysphagia and NIHSS upon admission. Methods: A sample size of approximately 90 patients over a three month period was used to identify admission diagnoses of patients that were not assessed for dysphagia and NIHSS upon arrival but did code out for stroke. D izziness, A ltered mental status, a trial fibrillation, W eakness and S yncope were the five diagnoses consistently utilized. It was recognized that patients admitted with these diagnoses needed to be routinely assessed. To help staff remember these five diagnoses, an acronym ( DAaWS ) was developed. Communication to staff of the new DAaWS acronym and practice began in 2015 and consisted of visual learning tools, staff meeting discussions, just-in-time learning, rounding to influence and 1:1 education. Results: Data from 2013 showed an average NIHSS at 90% / dysphagia at 76%. 2014 showed an average NIHSS at 84% / dysphagia at 79%. Implementation year of DAaWS practice, 2015 showed an average NIHSS at 91% / dysphagia at 94%. 2016 showed an average NIHSS at 97% / dysphagia at 90%. 2017 showed an average NIHSS at 96% / dysphagia at 84%. Of note is the 15% improvement of dysphagia from year 2014 to 2015 when the DAaWS practice began. Implementation of DAaWS had less impact on the NIHSS compliance in the initial year of 2015 with an increase of 7%. Subsequent years of 2016/2017 have seen an average increase in compliance of 12.5% from the 2014 data. Conclusion: In conclusion, the study showed that implementing a catchy acronym, DAaWS, to assist the nurse with early identification of potential stroke patients significantly improved the compliance of the dysphagia screening & NIHSS assessment upon admission.