Improving Bedside Swallow Screening in Acute Stroke Patients: An Evaluation Plan

Improving Bedside Swallow Screening in Acute Stroke Patients: An Evaluation Plan by Juliette A. Segree MSN, University of South Florida, 2002 BSN, University of South Florida, 2002 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2016 Abstract A stroke is a life-changing event for a patient and his or her family. The acute stroke patient is at risk for developing aspiration pneumonia, whether silent or overt. Prevention of pneumonia in this population requires timely completion and documentation of the bedside swallow screen to identify those patients at risk for aspiration pneumonia; however, anecdotal data from the emergency department at the site of this project suggested that completion and documentation of the screening were inconsistent. Guided by the quality caring model adopted by the project site as well as the logic model, the aim of this project was to evaluate emergency room nurses’ compliance with documentation after completing a modified bedside swallow screening. To facilitate documentation compliance, the current bedside screening tool was modified to make it user friendly. Electronic records of stroke patients (n = 104) admitted to the emergency room were monitored for a period of 6 months after implementing the modified bedside swallow screening tool. The findings indicate that implementing the modified bedside swallow screening tool achieved 93% documentation compliance in the electronic records and 100% documentation in patient charts over this 6-month period and clearly identified patients at risk for developing aspiration pneumonia. Further study is recommended to determine the relationship between the results of the modified bedside swallow screening and the development of hospital-acquired pneumonia. Implementation of this modified bedside swallow screening tool can initiate therapeutic measures to reduce the incidence of aspiration pneumonia in the acute stroke patient, resulting in shorter length of hospitalization and reduced health care costs.A stroke is a life-changing event for a patient and his or her family. The acute stroke patient is at risk for developing aspiration pneumonia, whether silent or overt. Prevention of pneumonia in this population requires timely completion and documentation of the bedside swallow screen to identify those patients at risk for aspiration pneumonia; however, anecdotal data from the emergency department at the site of this project suggested that completion and documentation of the screening were inconsistent. Guided by the quality caring model adopted by the project site as well as the logic model, the aim of this project was to evaluate emergency room nurses’ compliance with documentation after completing a modified bedside swallow screening. To facilitate documentation compliance, the current bedside screening tool was modified to make it user friendly. Electronic records of stroke patients (n = 104) admitted to the emergency room were monitored for a period of 6 months after implementing the modified bedside swallow screening tool. The findings indicate that implementing the modified bedside swallow screening tool achieved 93% documentation compliance in the electronic records and 100% documentation in patient charts over this 6-month period and clearly identified patients at risk for developing aspiration pneumonia. Further study is recommended to determine the relationship between the results of the modified bedside swallow screening and the development of hospital-acquired pneumonia. Implementation of this modified bedside swallow screening tool can initiate therapeutic measures to reduce the incidence of aspiration pneumonia in the acute stroke patient, resulting in shorter length of hospitalization and reduced health care costs. Improving Bedside Swallow Screening in Acute Stroke Patients: An Evaluation Plan by Juliette A. Segree MSN, University of South Florida, 2002 BSN, University of South Florida, 2002 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2016 Dedication I dedicate this work to my children, Donald, Danielle, and Gabrielle, whose support and sacrifice were invaluable to me. Especially Gabrielle, who literally would check to see if I had any assignment due. Acknowledgments The Doctor of Nursing Practice journey was made possible with support from my family, friends, and program instructors. Instrumental in this journey were my children; Donald, Jr., Danielle, and Gabrielle. Thank you for enduring countless hours of my studying and writing, and for keeping me focused. Dr. Eileen Fowles, whose relentless interest in my success is evident in my completion of this program, thank you. And finally, my friend and preceptor Carrie Risher, DNP, MSN, for sacrificing your time and sharing your knowledge.