Swallow evaluation tool to reduce aspiration among acute stroke patients: A quality improvement project

Abstract

Problem & purpose: Dysphagia, a common yet often underdiagnosed neurological symptom after an acute stroke, can lead to life-threatening aspiration pneumonia. A three-month chart review at the project site revealed 42.5 % incidence of aspiration among acute stroke patients, necessitating additional intervention and cost for stabilization. Literature suggests that early dysphagia screening using a validated tool is associated with decreased aspiration and complications. However, the project site employed a screening tool that lacks validation, and completion within 24 h was <50 %. This quality improvement initiative aimed to reduce aspiration risk among acute stroke patients by implementing the Yale Swallow Protocol tool (YSP), within 24 h of admission.

Methods: Over a 15-week implementation period in the fall of 2023, the YSP tool was included in the nurses' admission bundle at a stroke-certified neurological intermediate care unit. All eligible patients screened using the YSP tool were referred to a speech-language pathologist (SLP) if they failed the test. Nurses received education prior to and during implementation. Weekly audits assessed the number of patients screened and the utilization of the YSP tool.

Result: Out of 63 eligible patients, 37 (59 %) were screened within 24 h of admission. Of those screened, 29 met exclusion criteria in step one and were referred for SLP evaluation. Four failed the water swallow test in step two and were referred to SLP, and 4 passed the screening and were cleared for regular diet. Three patients were identified with aspiration pneumonia of the 37 screened. Overall, there were 59 % compliance with using the tool.

Conclusion: YSP is a quick, easy-to-follow, and effective tool to screen acute stroke patients within 24 h of admission. Further studies should explore its implementation in other areas including the Emergency Department where acute stroke patients are initially encountered. Nurses can safely utilize the tool with ongoing education on aspiration prevention.

Keywords: Acute stroke; Aspiration; Aspiration pneumonia; Swallow evaluation tool.