We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byJack Alvarez
Modified over 3 years ago
Dysphagia Screening – State of the Art Conference Proceedings from the State of the Art Nursing Symposium International Stroke Conference 2012 Neila J. Donovan, PhD, CCC-SLP Stephanie K Daniels, PhD, CCC-SLP, BRS-S Jeff Edmiaston, MS, CCC-SLP Jan Weinhardt, MSN, RN, GCNS-BC Debbie Summers, RN, MSN, FAHA, ARNP Pamela Mitchell, PhD, RN, FAAN, FAHA 1 1 ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
The Clinical Dilemma National Quality Forum (NQF) was unable to endorse dysphagia screening because there were no clinical trials completed that identified an optimal swallow screening. 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. ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Conference Purpose Review characteristics of valid and reliable screening and assessment tools Identify strengths and limitations of most commonly used current tools Describe how to make decisions about dysphagia screening selection Provide an example of institutional quality improvement in establishing swallow screening for stroke ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
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) ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
What is Needed: Reliable and Valid Screening ToolsDysphagia 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 ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Background Research has shown that swallow screening by trained nurses and physicians is feasible and reliable. Important predictors of dysphagia and risk of aspiration may include: Abnormal volitional cough Dysphonia Dysarthria Cough after swallow Voice change after swallow ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Effective Screening ToolQuick and minimally invasive with high sensitivity and specificity to identify dysphagia and aspiration risk Defined scoring system Pass – patient can be fed Fail – patient kept NPO and speech language pathology consulted Specifies level of training required for staff performing screening ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Several Dysphagia Screenings are Available for Nurses to Administer in Acute Care3-ounce water test (DePippo et al., 1992; Suiter & Leder, 2008) Burke Dysphagia Screening Test (DePippo et al., 1994) Toronto Bedside Swallowing Screening Test (Martino et al., 2009) Bedside Swallowing Assessment (Smithard, 1997) The Timed Test (Hinds, 1998) Standardized Swallowing Assessment (Perry, 2001) Gugging Swallow Screening (Trapl et al., 2007) Acute Stroke Dysphagia Screening (Edmiaston et al., 2010 ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Screening Tool SelectionNo 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 pathology Availability of radiology ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Screening Tool SelectionKepner Tregoe Decision Matrix (K-T Matrix) can be utilized to best determine a multidisciplinary teams’ needs when choosing a screening tool Easily identifies important factors deemed most important In context of personnel and training needs ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Screening Tool Selection and ImplementationConceptual Model: Each component is a sequential step in the process of organizing a clinical interdisciplinary team and CQI Agree Build Commence Document Evaluate Feedback ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
CQI and Tool selection What? Select Screening toolConsider evidence for reliability and validity Consider ease of administration, time, safety for patient at risk- input from the staff nurse or designated nurse(s) Consider resources available and tailor it to the specific institution Remember, nurses do screens, SLPs do evaluations 12 ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Evaluate for your contextWas the tool valid? Was it easy, efficient, safe? Modifications? Was there congruence between nurse and SLP? Was there compliance in keeping patient NPO until screen completed? Long term: Aspiration pneumonia rate Patient satisfaction Physician satisfaction Readmission, LOS, cost effectiveness ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Conclusions from SymposiumScreening 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.” ©2013 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
Approaches to Swallow Screening: Part 1 Susan Wehner, PhDc, RN, APRN, BC Michigan State University Vascular Neurology.
Dysphagia: Management Approach in Stroke
Development of an Evidence- Based Acute Care Screen Anna Alt-White, PhD, RN Connie Case, BSN, RN Jackie Hind, MS Karin Kirchhoff, PhD, RN Beverly Priefer,
Speech-Language Pathology and Dysphagia Nursing QUERI Paula A. Sullivan, MS, CCC-SLP, BRS-S North Florida/South Georgia Veterans Health System Gainesville,
Impetus for Dysphagia Nursing QUERI RRP Anna C. Alt-White, PhD, RN Office of Nursing Services.
BEDSIDE ASSESSMENT OF SWALLOWING
Meeting PSC Stroke 7 Standard
Comprehensive Geriatric Assessment and the Patient- Centered Clinical Method.
Telefluoroscopy in Dysphagia Management James L. Coyle Communication Science and Disorders University of Pittsburgh.
Shannan K. Hamlin, PhD, RN, ACNP-BC, AGACNP-BC, CCRN
Ashley Deal University of Central Florida
Multidisciplinary Approach to Sedation Goals and Treatment Algorithms to Treat Pain & Sedation Needs of PCTU Patients Connie Myres RN, MSN, CCRN & Sandra.
Best Practices for Dysphagia Management Post Stroke
Sounding “Wet” As a Diagnostic Indicator of Aspiration By: Lena Ellison Wayne State University.
ACCF/AHA Clopidogrel Clinical Alert: Approaches to the FDA “Boxed Warning” A Report of the American College of Cardiology Foundation Task Force on Clinical.
SAFE STAFFING AS IT RELATES TO PATIENT SATISFACTION AND SAFETY Are We There Yet? Vicki Tarnow American Sentinel University.
Screening Strategies to Prevent Aspiration Pneumonia in Acute Stroke Jeri Lynn M. Braunlin MS CNRN, CNAA, BC, RN, BC Paula Lamb BSN RN.
MGH- Swallow Screening Tool (MGH-SST): Validation and Implementation in Acute Neuro Patients APSS Sept. 26, 2008 Audrey Kurash Cohen, MS, CCC-SLP Department.
Impact of the implementation of a validated swallow screening tool for acute stroke: Modified MASA Good afternoon, This afternoon I’m presenting a paper.
Coordinating Care Sierra Dulaney Lisa Fassett Morgan Little McKenzie McManus Summer Powell Jackie Richardson.
EVIDENCE BASED HEALTH CARE and BEST PRACTICES at Northwestern Health Sciences University Gert Bronfort DC, PhD; Michele Maiers, DC, MPH; Roni Evans DC,
Elaine Mormer, PhD, University of Pittsburgh Deborah Moncrieff, PhD University of Pittsburgh Deborah Dixon, MA, ASHA, Director, School Services
The Key to Writing Policies and Procedures Updated: February 2012 Public Health Nursing & Professional Development Unit Eunice Inman, RN Gay Welsh, RN.
Darci Becker, PhD, CCC-SLP, BCS-S Katherine Locricchio, MS, CFY-SLP Carli Schieferdecker, MS, CCC-SLP.
Quality Improvement Prepeared By Dr: Manal Moussa.
SIPS Project Strategy for an Integrated Preventative pathway for Swallowing difficulties in Care Homes Eleanor Stout Mary Heritage Derbyshire Community.
The Quality in Acute Stroke Care (QASC) Implementation Project Local Stroke Champion Presentation.
Diane Paul, PhD, CCC-SLP Director, Clinical Issues In Speech-Language Pathology American Speech-Language-Hearing Association
Using Outcomes and other Assessment Tools to Improve Quality Quality Improvement.
Speech and Language Therapy Early management of communication / swallowing difficulties after stroke 3rd June 2011.
KEY ITEMS IN DYSPHAGIA PROCESS
Enhanced Patient-Safety Intervention To Optimize Medication Education (EPITOME) Carl Sirio, MD Professor Critical Care Medicine, Medicine and Pharmacy.
It’s All About the Base: An Innovative Approach in Patient Education for Patients Living with Heart Failure Lauren Mueller, BSN, RN, PCCN, Laurie Freeman.
Implementing the Stroke Palliative Approach Pathway
Clinical Management Nutr 564: Management Summer 2003.
Risk Management / CQI Nutr 564: Management Summer 2002.
The Speech Language Pathologist’s Role in Schools
Stroke and Dysphagia Financial bid.
Ontario Stroke Network Forum Quality Based Procedures Update Stroke QBP Deborah Hammons Chief Executive Officer Central East LHIN January 9, 2015.
RENI PRIMA GUSTY, SK.p,M.Kes
Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy Tina Johnson,
Interprofessional Education and Practice: Creating Leaders and Opportunities for Clinical Learning MODULE 2 Setting the Scene Setting the Scene Funded.
NIHR CLAHRC for South Yorkshire National Institute for Health Research Enhancing the quality of oral nutrition support to hospitalised patients using the.
5/19/2009S. J. Pressler, University of Michigan School of Nursing 1 AHA Presenter Disclosure Information Susan J. Pressler How to Write a Strong Nursing-Based.
Nursing Diagnosis Chapter Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis The term nursing diagnosis.
Revised for 2013 Shannon Hein RN, CPN(C). published in the Canadian Medical Association Journal in May 2004 Found an overall incidence rate of adverse.
Value & Coverage Issue Brief Slides A Closer Look at Evidence-Based Performance Measurement.
How to Arrange and Rearrange so the Pieces Fit Barriers to Implementation of Evidenced Based Practice Vicki Good, RN MSN CCNS CENP Director of Nursing.
Amy Wilson-Stronks 1, Lance Patak 2, John Costello 3 1 The Joint Commission, Oakbrook Terrace, IL 2 University of Michigan Medical Center, 3 Children’s.
Potential Roles for Health Technology Assessment Agencies: Opportunities and Challenges for an Effective Health Technology Assessment Practice at the Meso.
© 2017 SlidePlayer.com Inc. All rights reserved.