Abstract WP436: Sensory Distraction to Help Decrease Agitation in Stroke Patients

Abstract

Background: Dysphagia is a common complication after stroke. To ensure adequate nutritional intake, nasogastric (NG) or other feeding tubes may be inserted. Post-stroke agitation and aggression can occur in 15 to 35% of stroke survivors as early as 4 days after stroke. At Rush University Medical Center (RUMC), it is common for the Stroke Unit patients to have feeding tubes and any other tubes necessary for treatment. It is a growing concern that agitated stroke patients self-remove feeding and other tubes requiring reinsertion and/or limb restraints. Although historically sensory modulation has not been heavily utilized in stroke patients, sensory based treatment objects in psychiatric inpatient units have been reported to reduce the use of restraints. Purpose: The purpose of this quality improvement project was to decrease agitation in stroke patients using sensory distraction objects (SDO). The goal of this project was to decrease the use of limb restraints and prevent patient self-removal and staff reinsertions of feeding and other tubes during this study period. Method: This project targeted stroke patients in the RUMC 12 West Tower Unit who were agitated, restless, impulsive, or anxious. Each patient was given a SDO, such as a plastic ring toy, glitter ball, activity belt, or a silk handkerchief attached to their gown. A decision tree was used to assign a SDO based on the patient’s cognitive and motor function. The Agitation Behavior Scale (ABS) was used to measure agitation in stroke patients; the scale was used pre- and post-implementation. Post-implementation assessment was done within one hour after the SDO is given. The use of limb restraints and patient self-removal of feeding and other tubes was observed. Conclusion: The project included 15 participants. Eleven out of 15 patients showed a decrease in agitation with a distraction object using the ABS. Only 20% of participants pulled out their feeding or other tube and two patients required restraints during the study period. In conclusion, this project did showcase a decrease in agitation for stroke patients using a SDO and decreased the use of limb restraints. The SDO prevented patient self-removal and staff reinsertion of feeding and other tubes.