Abstract T P256: Effective Strategy for Implementation of Swallowing Assessment in the Acute Stage of Stroke
Background and Purpose: Dysphagia affects between one and two thirds of patients with acute stroke. According to the Danish national guideline, the standardized instrument “Gugging Swallowing Screen (GUSS)” including an indirect and a direct test of swallowing is the optimal method for swallowing assessment. The instrument has been translated to Danish form the original developed and validated. A strategy for implementation GUSS was started in January 2012. The aim of this report is to document the strategy and the results of this strategy.
Methods: Guided by the conceptual model for implementing improvements “Plan-Do-Study-Act” the strategy included following steps in the study period from January 2012- December 2012: 1. A steering committee representing nursing staff and occupational therapist was created. All nurses were educated in the use of GUSS theoretically and practical with bedside following up. A “screening package” including all instruments needed for the assessment and a registration form was made. 2. The implementations process was monitored.3. Monthly and early reports from the Danish Stroke Register on goal achievements in % of patients tested indirectly and directly on the admission day, respectively were studied. Depending on the results a plan for improvement e.g. a gatekeeper function was organized
Results: Data in The National Stroke register for the year 2012 showed that 599 patients were admitted with stroke within the study period. Indirect swallowing test: % patients assessed on the day of admission: 87% (95%CI 69-80%) (359 in 416 relevant patients) - an improvement from the year 2011 75% (69-80) 95 %CI (200 in 268 relevant patients).Direct swallowing test: % patients assessed on the day of admission: 86% (95%CI 83 - 89%) (359 patients in 416 patients) an improvement from the results in 2011: 71% (95%CI 66-75) (241 in 339 relevant patients); 525 patients were admitted with symptoms of stroke in 2011.
Conclusions: The instrument “Gugging Swallowing Screen GUSS” has effectively been implemented in the acute stroke unit in our institution, and had improved the goal achievement. The standard of 80% defined by the national steering group for both indicators has been achieved in 2012.
Author Disclosures: S.Z. Schaarup: None. H. Christensen: None.
- © 2014 by American Heart Association, Inc.