Nurse-driven Bedside Swallow Screen Facilitates Identification of Dysphagia in Stroke Patients and Reduces Aspiration Pneumonia

Introduction: Dysphagia occurs in over half of patients who have sustained acute stroke, and can lead to aspiration, subsequent pneumonia, increased length of hospital stay and death. Identification of dysphagia is vital to reduce these risks prior to oral intake or administration of oral medications. Swallow screening is an effective tool to identify at-risk patients. However, the swallow screen is often informal or omitted, resulting in premature oral intake. Nurses are highly skilled healthcare team members that are at the bedside with the patients and can be effectively trained as the first line of defense in identification of dysphagia. Methods: We implemented a nurse-driven swallow screen using the Iowa Model for Evidence-Based Practice. An interprofessional task force consisting of neurologists, nurse practitioners, speech pathologists, bedside nurses, nursing leadership, and nursing education selected a reliable swallow screening tool, which has been validated on the stroke population. Bedside nursing staff was trained and validated on the swallow screening tool. Subjects included all patients with ischemic or hemorrhagic stroke admitted to our institution in 2015 (n=220 spanning 12,607 patient days) pre-intervention, and in 2017 (n=263 spanning 12,691 patient days) post-intervention. We evaluated swallow screen completion rate and pneumonia rates on the neurology units. Results: The nurse-driven swallow screen initiative increased the percentage of patients with stroke screened from 73.3% in 2015 to 93.5% in 2017 (p<.001). Pneumonia rates on the neurology unit also decreased following this initiative, with aspiration pneumonia rates decreasing from 9.5 per 10,000 patient days to 4.7 per 10,000 patient days and all pneumonia rates decreasing from 28.6 per 10,000 patient days to 18.9 per 10,000 patient days. Conclusions: Empowering bedside nurses in the swallow screen process significantly improves dysphagia screening rates and decreases pneumonia rates in patients with stroke. In conclusion, implementation of nurse-driven swallow screen at bedside is an effective way to increase dysphagia identification in stroke patients and thereby improve patient care outcomes.