Nursing management of post-stroke dysphagia in a tertiary hospital: a best practice implementation project

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Abstract

Background:

Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological conditions such as stroke. Nurses, who are available to patients 24 hours a day in hospital are in an ideal position to identify individuals with swallowing difficulties and initiate interventions that may prevent further complications until a formal assessment can be undertaken.

Objectives:

The aim of this evidence implementation project was to improve nursing management of dysphagia in acute stroke patients and prevent the occurrence of aspiration in patients admitted to the neurology ward of Huashan Hospital, Fudan University, Shanghai.

Methods:

This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools. The same six audit criteria were used for the baseline and the follow-up clinical audits. The baseline audit was followed by the implementation of strategies targeted to address the identified barriers and the follow-up audit evaluated changes in practice. The same sample size (20 nurses and 30 patients) was used for both audits.

Results:

Improvements in practice were observed for all six audit criteria. The result of the post-implementation audit showed 100% compliance for the following recommendations: use of a validated tool, nurse-initiated dysphagia screening, appropriate referral to Speech and Language Therapy and education for nurses on dysphagia screening. The lowest compliance rate was for criterion 4 (patient education before discharge), which was 80%. The compliance rate for criterion 3 (screening within 24 hours from admission) was 93%.

Conclusion:

This project has demonstrated significant improvements in nursing practice related to dysphagia screening and management. The project was successful not only in increasing the knowledge and skills of nurses but also in implementing a formalized process for dysphagia screening and referral. Strategies to sustain practice change should be developed, and regular audit cycles need to be carried out to monitor the process and evaluate outcomes.

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