Date of Publication
Faculty Mentor: Laura Lewis, Ph.D., RN | Clinical Mentor: Deb Hebert, MSN, RN, CNML
Purpose: Post-extubation dysphagia (PED) occurs in 3% to 62% of intensive care unit patients. Patients with moderate or severe PED are more likely to experience pneumonia, reintubation, or death. Early identification of post-extubation dysphagia is crucial so diet modifications, temporary feeding measures, and/or advanced swallow evaluations and therapies can be implemented. The purpose of this quality improvement project was to implement a nurse-administered dysphagia screening tool (NADST) for post-extubated patients in a 21-bed mixed medical intensive care unit (MICU) at a large academic medical center.
Methods: Utilizing quality improvement methods, a modified dysphagia screening tool was trialed in a MICU for two months. Eight Super Users (RNs) were recruited and attended one of three train the trainer sessions taught by a Speech Language Pathologist. The Super Users trained the remaining unit nurses (RNs). A 5-minute video for the unit nurses was created to supplement the trainings. Pre- and post-intervention surveys were administered to measure changes in knowledge, beliefs, and practices around PED screening. Patient electronic health records were reviewed to identify all patients eligible for PED screening and screening dispositions.
Results: Of the 59 eligible patients, 34 patients were screened utilizing the NADST. Nurses had a high level of knowledge but varying practices and comfort with dysphagia screening prior to the intervention. The intervention increased the comfort level and screening frequencies for PED. The NADST was found to be useful for improving nursing practice.
Conclusions: Through the utilization of a Super User training model, this quality improvement project demonstrated that implementing a standardized PED screening tool does improve PED screening frequencies.
Kehl, Andrew D., "Implementation and evaluation of a nurse-administered dysphagia screening tool to identify patient’s at high risk for post-extubation dysphagia" (2019). College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications. 59.