Title |
Dysphagia screening after acute stroke: a quality improvement project using criteria-based clinical audit
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Published in |
BMC Nursing, June 2017
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DOI | 10.1186/s12912-017-0222-6 |
Pubmed ID | |
Authors |
Jorun Sivertsen, Birgitte Graverholt, Birgitte Espehaug |
Abstract |
Dysphagia is common after stroke and represents a major risk factor for developing aspiration pneumonia. Early detection can reduce the risk of pulmonary complications and death. Despite the fact that evidence-based guidelines recommend screening for swallowing deficit using a standardized screening tool, national audits has identified a gap between practice and this recommendation. The aim was to determine the level of adherence to an evidence-based recommendation on swallow assessment and to take actions to improve practice if necessary. We carried out a criteria-based clinical audit (CBCA) in a small stroke unit at a Norwegian hospital. Patients with hemorrhagic stroke, ischemic stroke and transient ischemic attack were included. A power calculation informed the number of included patients at baseline (n = 80) and at re-audit (n = 35). We compared the baseline result with the evidence-based criteria and gave feedback to management and staff. A brainstorming session, a root-cause analysis and implementation science were used to inform the quality improvement actions which consisted of workshops, use of local opinion leaders, manual paper reminders and feedback. We completed a re-audit after implementation. Percentages and median are reported with 95% confidence intervals (CI). Among 88 cases at baseline, documentation of swallow screening was complete for 6% (95% CI 2-11). In the re-audit (n = 51) 61% (95% CI 45-74) had a complete screening. A CBCA involving management and staff, and using multiple tailored intervention targeting barriers, led to greater adherence with the recommendation for screening stroke patients for dysphagia. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 87 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 14 | 16% |
Student > Bachelor | 8 | 9% |
Researcher | 7 | 8% |
Lecturer | 5 | 6% |
Other | 5 | 6% |
Other | 16 | 18% |
Unknown | 32 | 37% |
Readers by discipline | Count | As % |
---|---|---|
Nursing and Health Professions | 26 | 30% |
Medicine and Dentistry | 9 | 10% |
Business, Management and Accounting | 4 | 5% |
Social Sciences | 3 | 3% |
Neuroscience | 2 | 2% |
Other | 7 | 8% |
Unknown | 36 | 41% |