Abstract T P331: Collaborative Multidisciplanary Approach in the Development and Implementation of an Aspiration Risk Tool Within a Certified Comprehensive Stroke Program
Background and Issues: Dysphagia is the leading neurological cause of aspiration pneumonia in stroke patients. Swallowing abnormalities are associated with a 3-fold higher mortality rate. Accreditation agencies and the American Stroke Association recommend institutions establish a dysphagia screening tool for stroke patients. Early identification decreases adverse health consequences and increases patient family satisfaction.
Purpose: A multidisciplinary team of nurses and speech and language pathologists developed criteria to improve the identification of patients at risk for aspiration and created standardized tool.
Methods: A review of the literature provided the frame work to formalize a screening tool. The tool assists the nurse in identifying patients at risk. The screening tool is divided into four sections; cognition, cough assessment, control of oral secretions and oral motor strength. It is required for the patient to pass all four levels. Failure to pass any one of the sections results in a formal dysphagia assessment. Patients that pass the four sections graduate to a water challenge. A cup containing 90cc of water is placed in front of the patient, and the patient is instructed to pick up the cup and take a drink. Nurses observe the patient’s ability to successfully coordinate the task. Observation of choking, coughing, nasal aspiration or requiring frequent verbal cues to swallow results in failure of the water challenge. The failing patient is kept NPO and a formal dysphagia assessment is ordered. Patients’ not exhibiting any signs of aspiration passes the screen.
Results: The nursing staff recognized the importance of specific anatomical and mechanical components of dysphagia, which led to appropriate referrals to speech and language. Expedited referrals and reduced NPO time resulted in improved patient family satisfaction.
Conclusion: Through a collaborative multidisciplinary team approach it is possible to develop and implement an evidenced based, reliable aspiration screening tool. This tool should not only be used for stroke patients but any person at risk for aspiration.
Author Disclosures: S. Styron: None. J. Mazabob: None. G. Brown: None. M.W. Walton: None.
- © 2015 by American Heart Association, Inc.