Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

Abstract

Background and Purpose: In patients with acute stroke, undernutrition and aspiration pneumonia are associated with increased mortality and length of hospital stay. Formal screening for nutritional risk and dysphagia helps to ensure optimal nutritional management in all patients with stroke and to reduce the risk of aspiration in patients with dysphagia. We developed a national guideline for nutritional and dysphagia screening in acute stroke, which was introduced in our stroke unit on June 1, 2012. The primary objective was to audit adherence to the guideline and to achieve full implementation. Second, we assessed the prevalence of nutritional risk and dysphagia. Methods: We performed a chart review to assess performance of screening for nutritional risk and dysphagia in all patients with stroke hospitalized for ≥ 48 hours between June 1, 2012, and May 31, 2013. Next we applied a ''clinical microsystems approach'' with rapid improvement cycles and audits over a 6-month period to achieve full implementation. Results: The chart review showed that nutritional risk screening was performed in 65% and swallow testing in 91% of eligible patients (n ¼ 185). Proactive implementation resulted in >95% patients screened (n ¼ 79). The overall prevalence of nutritional risk was 29%, and 23% of the patients failed the initial swallow test. Conclusions: Proactive implementation is required to obtain high screening rates for nutritional risk and swallowing difficulties using validated screening tools. The proportion of patients at nutritional risk and the prevalence of dysphagia at initial swallow test were in the lower range of previous reports.

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

“…This may have contributed to the low dysphagia rate. Similar to our study, Kampman et al [19] reported 23% of patients to fail an initial swallowing screening test in an unselected stroke patient sample. Arnold and colleagues diagnosed dysphagia in 20.7% of 570 consecutive patients treated in a tertiary stroke center [1].…”

Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses

“…Two studies did not report ages, but specified the population as adult or geriatrics. The majority of studies included participants with stroke ( n = 19) [ 34 – 36 , 38 , 39 , 42 , 48 , 51 – 54 , 56 – 60 , 62 , 66 , 68 ]. Fifteen studies included patients with diverse diagnoses: e.g., post-surgery, internal medicine, geriatrics, pneumonia, trauma, gastrointestinal tract disease, cardiovascular disease, respiratory tract disorders, fractures, musculoskeletal, neurologic and neurodegenerative diseases, and head and neck cancer [ 25 , 27 , 28 , 33 , 40 , 43 , 45 , 47 , 50 , 55 , 61 , 63 , 69 – 71 ].…”

“…Over half (26/44) of studies reported OD prevalence data using screening and clinical non-instrumental assessments methods or tools that were either designed by the authors for the purpose of the study or modified versions of published tools, thus lacking information on diagnostic performance and psychometric properties [ 26 – 28 , 34 , 36 , 38 – 42 , 44 – 46 , 48 , 52 – 54 , 58 – 60 , 62 , 64 – 66 , 70 , 72 ]. Of the screening and clinical non-instrumental assessment tools used to determine OD with known diagnostic performance and psychometric properties, the Volume-Viscosity Swallow Test (V-VST) [ 74 ] was the most commonly used screen [ 47 , 55 , 61 , 63 , 64 , 68 ] and the Eating Assessment Tool-10 (EAT-10) [ 75 ] was the most frequently used PROM [ 33 , 37 , 43 , 47 , 49 , 50 , 69 , 71 ].…”

Deglutição Comprometida: Uma Abordagem De Enfermagem De Reabilitação

“…O estudo destes casos permitiu ajuizar sobre a importância da avaliação sistemática da deglutição e o acompanhamento do risco nutricional dos doentes com AVC que exigem um esforço contínuo (25) .…”