11 Dysphagia Screening – State of the Art Conference Proceedings from the State of the Art Nursing Symposium International Stroke Conference 2012 Neila.
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Dysphagia Screening – State of the ArtConference Proceedings from the State of the Art
• National Quality Forum (NQF) was unable to endorse dysphagia screening because there were no clinical trials completed that identified an optimal swallow screening.
• 2010 - Joint Commission retired the dysphagia screening performance standard due to the lack of a standardized screening tool.
• There is concern that clinicians will omit dysphagia screening, leading to worse patient outcomes.
Background• Stroke is a leading cause of dysphagia
-- 42%
• Aspiration occurs in 50% of dysphagic patients– 1/3 develop pneumonia– Associated with three-fold higher mortality
• To avoid aspiration, new stroke patients are left NPO until dysphagia screen: “no ice chips, no oral medications, no water, no exceptions!” (several guidelines)
What is Needed: Reliable and Valid Screening Tools
• Dysphagia screening - pass/fail procedure to identify an individual who may or may not need a complete dysphagia assessment
– Can be performed by trained clinician
• Contrasted with Swallowing Assessment – a behavioral evaluation of swallowing function that consists of an extensive cranial nerve evaluation and direct examination of swallowing
– Performed by Speech-Language Pathologist (SLP) Instrumental dysphagia assessment aims to Identify swallowing impairment and the effects of compensatory strategies
Screening Tool Selection• No single screening tool is best for all contexts
• Contextual elements– Organization structure– Patient flow and composition of heath care– Size of hospital, volume of stroke patients– Personnel – nursing and speech language
• Conceptual Model: Each component is a sequential step in the process of organizing a clinical interdisciplinary team and CQI – Agree– Build – Commence– Document– Evaluate– Feedback
Conclusions from Symposium• Screening of swallowing in stroke patients is critical, to prevent
adverse outcomes related to aspiration and inadequate hydration/nutrition
• Absence of consensus on best screening instrument does not mean no screening should be done
• Use the American Speech Language Hearing Association (ASHA) definition: “Swallowing screening is a pass/fail procedure to identify individuals who require a comprehensive assessment of swallowing function or a referral for other professional and/or medical services.”