Abstract WMP32: EMR Alert Improves Compliance With Dysphagia Assessment In Stroke Patients

Abstract

Introduction: Dysphagia in patients after a stroke is very common. There is a risk factor for aspiration pneumonia and is associated with worse patient outcomes. The American Heart Association guidelines recommend that a swallow screening be performed on all stroke patients prior to any oral intake. Stroke can present with a variety of symptoms and may not be identified at the time of the patient’s presentation. In analyzing patient data in which the dysphagia screening was not completed, it was identified to occur at the first oral intake of a medication. Our hypothesis is that if the nurse was alerted at the time of medication administration that a dysphagia screening needs to be completed, we could improve our compliance with this quality measure. Method: A new Electronic Medical Record (EMR) process was developed, that based on certain criteria, triggered an alert for the nurse when the first oral medication barcode was scanned. Within the alert there is a link to document the dysphagia screening. After documentation of the screening, the nurse is returned to the medication administration record to continue her administration. The criteria for triggering the alert is twofold. The first trigger is based on the presenting chief complaint on arrival to the emergency department. These would include chief complaints such as stroke symptoms, dizziness, weakness, etc. The second trigger occurs when the physician enters an order for dysphagia screening to be completed by nursing. With each of these triggers, the EMR logic looks to see if a dysphagia screen has already been documented and the alert only is generated if it has not. This process was initiated in the EMR in February 2021 for all 12 hospitals in the University Hospitals health system. Results: At University Hospitals Parma Medical Center dysphagia screening compliance improved from 82% in QTR 3 2020 to 90% in QTR 2 2021. Overall, in the University Hospital health system compliance improved from 85% in QTR 3 2020 to 89% in QTR 2 2021. Conclusion: An EMR alert has assisted the nurse to remember to complete this important dysphagia screening and improved compliance with this quality measure. In addition, nurses have reported an increase in satisfaction with the new workflow.