Background: Dysphagia occurs in up to 78% of stroke patients and is associated with poor patient outcomes. We have previously reported low concordance rates between dysphagia screens performed by neuroscience bedside nurses compared with Speech Language Pathologists (SLPs) using the 3oz water test.
Hypothesis: A multidisciplinary intervention can improve concordance rates of dysphagia screening between bedside nurses and SLPs and reduce aspiration pneumonia rates among stroke patients.
Methods: An interdisciplinary team including stroke quality nurses, clinical nurse specialists, SLPs, and nursing informatics developed a 3-step intervention including 1) modifications of the electronic dysphagia screen forms to simplify documentation and provide step-by-step instructions for nursing staff, 2) hospital-wide re-education to nurses on performing dysphagia screens and 3) adjustment of all stroke ordersets to include prechecked NPO orders to prevent diet orders prior to a dysphagia screen. Interventions were completed by August 31, 2016. All stroke patients admitted to a Comprehensive Stroke Center from March 1, 2016 to May 31, 2017 were included in this analysis to determine aspiration pneumonia rates pre- and post-intervention (N=988). To determine concordance rates in dysphagia screening, neuroscience nurses and SLPs performed the same screen on consecutive stroke patients within <24 hours of each other; concordance rates were compared before and after study intervention.
Results: Overall aspiration pneumonia rates significantly declined after the intervention from 11.8% to 7.3% (p=0.03). Significant declines in aspiration pneumonia rates after intervention were seen in ischemic stroke (10.4% vs 4.3%, p=0.02) patients but not seen in intracranial hemorrhage (14.8% vs 10.1%, p=0.41) or subarachnoid hemorrhage patients (11.5% vs 10.1%, p=0.85). Concordance rates between nurses and SLPs significantly increased from 52% pre-intervention up to 73% post-intervention (p=0.04).
Conclusion: Our 3-step multidisciplinary dysphagia screening intervention significantly reduced aspiration pneumonia rates among ischemic stroke patients and improved concordance rates in screening results among neuroscience nurses and SLPs.