Background: Swallowing difficulties can affect 85% of acute stroke patients. A bedside swallow screen is standard of practice to establish whether potential acute stroke patients can safely swallow before receiving oral intake including medications. An inter-professional performance improvement team consisting of a Clinical Nurse Specialist, Speech Language Pathologist, Registered Dietitian, Stroke Coordinator, Unit Educator and Clinical Manager was formed. The purpose of the team was twofold; to standardize the process of performing a swallow screen in stroke patients in response to a recent decline in the screening compliance, coupled with the directive to implement an evidenced-based tool.
Methods: A review of practice and policy identified insufficient evidence for our three sip swallow test. A literature review indicated a need for a defined volume. The volume dependent screen detects the more specific harm event, aspiration versus dysphagia. Throughout the literature 3 ounces was demonstrated to be the most frequently referenced volume. The Plan-Do-Study-Act model was then used to implement a new process for swallow screening. Re-educating the staff was paramount to the success of implementing a new process. Nursing staff along the continuum of care were educated with 91% currently trained on the new process. Essential to the process was updating the electronic medical record system to ensure accurate and consistent practice.
Results: The team approach utilizing collaboration, open communication and problem solving resulted in the timely implementation of an evidence based tool. In addition, there was an increase in the average swallow screen compliance from 78% for 2014 to 84% for first quarter 2015. Currently, intensive weekly reporting of swallow screen compliance reviewed by the inter-professional team allows timely, individualized education as part of our ongoing monitoring.
Conclusion: The inter-professional team proved to be an effective method to identify gaps in our practice and policy which led to a change in the defined volume for the swallow screen. The team approach resulted in the successful implementation of a new process utilizing an evidence-based tool and increased swallow screen compliance.