Aspiration Risk Screening: Implementation of Bedside Swallow Screening Protocol

Abstract

Problem: Approximately 80% of patients admitted to a 14-bed inpatient hospice unit have aspiration risk factors such as dysphagia, impaired mobility, decreasing level of consciousness, and terminal disease conditions. About 60% of patients are admitted with a physician's order of regular diet and Per Os (PO) medication regimen, which is changed after the patient shows overt signs of aspiration such as coughing or choking. Purpose: The quality improvement initiative aims to implement the Yale Swallow Protocol (YSP), a bedside swallow screening tool to identify patients at risk for aspiration during length of stay at an inpatient hospice unit. Methods: Inpatient facility nurses were trained on how to administer the YSP with video visuals and paper handouts. A post-training survey was administered to ensure understanding of the tool. All patients admitted to the unit were screened using the YSP, incorporated into the admission assessment. The three-step YSP screening include an exclusion criterion to evaluate patient’s eligibility, the protocol administration instructions, and a pass or fail criteria with results and recommendations. Data was collected weekly over 15 weeks via a quick response code (QR Code) onto REDCap, a secure database for analysis. Chart audits are conducted weekly on each eligible patient to ascertain screening outcomes. Results: Total of 15 inpatient nurses completed the YSP training, 87% were trained onsite and 13% trained remotely. All nurses agreed on ease of use of the protocol. A total of 63 patients were screened using the YSP with 100% screening rates achieved in weeks 6,13 and 15, 67% screen positive for aspiration risk, with 33% passing the protocol. A diet of thickened liquid and pleasure feed was recommended for 54% of patients. Conclusion: The YSP is a validated tool, effective in identifying aspiration risk in patients. Screening results indicate high risk of aspiration among hospice patients admitted to the unit, thus the need to standardize aspiration risk screening at the inpatient hospice unit.