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Learning Objective 1: Identify the elements of performing a swallow screen to identify any “at risk” patients
Learning Objective 2: Discuss the benefits of an Aspiration Prevention Program.
The Aspiration Prevention Team recently implemented an EBP a house wide program to assist nursing in the prevention aspiration in all patient populations. The policy incorporates three parts:
- Perform an RN Swallow Screening by using an evidence based tool on admission and change of condition on all adult patients (except obstetrics).
- Identify “at risk” patients at meals with the use of a gold meal tray and use. “STOP”-- campaign which includes 4 key EBP recommendations with feeding.
- S- Sit the patient up
- T- Take time to assist and observe
- O- Oral Care after each meal
- P- Position them up for 30 minutes after meal
- Perform oral care regime to decrease oral bacterial load and why it helps to decrease risk.
Additional supportive measures implemented as part of the house wide program:
- Mandatory education for all nursing staff
- Physician education
- Multidisciplinary care plan designed to incorporate a joint plan of care for nursing, speech therapy and the dietitian all on one care plan
- Patient/Family brochure educating them on Aspiration prevention.
Outcomes/Results:
Patients are being identified at risk that do not fall into the “expected” at risk population profile. Speech therapy evaluations are now completed within 24 hours to evaluate a “high risk” patient. Monthly reviews are completed on all patients discharged with secondary diagnoses of aspiration and nursing peer review is performed on all those cases where might have been preventable. The goal of this program is for each unit to prevent one aspiration per month.
Lessons learned:
Data on aspiration prevention and incidence is difficult to obtain based on coding requirements. This is our baseline year of collecting frequency of preventable aspiration and nurse performance of accurate screening and implementation of the care plan elements.