Date of Graduation

5-2015

Document Type

Thesis

Degree Name

Bachelor of Science in Nursing

Degree Level

Undergraduate

Department

Nursing

Advisor/Mentor

Holloway, Ginger

Committee Member/Reader

Smith-Blair, Nan

Committee Member/Second Reader

Lofton, Annelle

Abstract

Dysphagia is a prevalent manifestation of stroke. An evidence-based dysphagia assessment is needed to provide quality care to stroke patients. Aims: To provide a descriptive analysis of the patient’s admitted to the hospital with the primary diagnosis of stroke; to evaluate three dysphagia screening tools; and to develop an education program to address training and implementation of the chosen dysphagia assessment tool on pilot units. Design: Descriptive analysis, and an educational program. Setting: Local hospital in Northwest Arkansas. Patients: Pre-data included patients with the primary diagnosis of stroke, over the age of 18, excluding those identified with cognitive impairment, admitted to the local hospital between August 2013 and August 2014. Methodology: Phase I was conducted during May to July 2014 and consisted of comparing three dysphagia screening tools; Barnes Jewish Hospital Stroke Dysphagia Screen, the Toronto, and the Gugging Swallow Screen. Next a retroactive medical record review of patients over the age of 18 admitted to the hospital between August 2013 and August 2014, with the primary diagnosis of stroke was conducted. Patients identified with cognitive impairment were excluded from the study. The charts were evaluated to determine: if a dysphagia assessment was administered and how soon following admission to the hospital, the rate of documented pneumonia (information from nurses notes, physician notes, and chest x-ray), medications, occurrence of diagnostic tests, and bed positioning. Phase II consisted of development and implementation of an education program based on the hospital adopted dysphagia assessment tool. Analysis: A descriptive analysis and summary statistics were performed to summarize the information obtained through a review of medical records from patients admitted with the primary diagnosis of stroke. Results: Of the charts analyzed, 94 met the study’s inclusion criteria. Of the 94 charts analyzed, 23 charts did not include a dysphagia assessment. Of the 94 charts analyzed, 44 charts revealed administration of PO medications before the documentation of a dysphagia assessment. Of the 44 patients who received PO medications before a dysphagia assessment, 12 charts revealed no documentation of one of the diagnostic tests included in the study, in other words, no documentation of a chest x-ray. Of the 12 charts that revealed no chest x-ray, as well as PO medications before a dysphagia assessment, 4 were declared an aspiration risk. Of the 94 charts analyzed, 2 charts had documented pneumonia at discharge. Conclusion: The data in this study shows the need for dysphagia assessment and the literature shows the evidence of this need. While the national organizations have not chosen a superior dysphagia screen, the hospital in this study has. The Barnes Jewish Hospital Stroke Dysphagia Screen/ASDS is the dysphagia screen of choice for the hospital in this study, which was implemented in September 2014. The goal of a bedside dysphagia assessment is to detect those suffering from dysphagia with an easy-to-use tool that can be performed by many professions, including nursing. Therefore, nurses must be aware of this need and solution to care. The organization may implement the assessment, but it is up to the nurses to carry out the implementation. Further assessment should be completed to assess the compliance with the newly implemented dysphagia assessment tool in relation to the education program created and presented to the hospital during this study.

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