The Codesign, Development and Implementation of an Indian Poststroke Swallow and Hydration Care Bundle: A Feasibility Study

Background: Stroke is increasing in low- and middle-income countries. Stroke unit care, including evidence-based practice such as swallowing and hydration protocols, is associated with reduced disability and mortality. Objectives: The aim of this study is to codesign a swallowing and hydration care bundle for nurses to use with acute stroke patients, and to implement and evaluate the bundle on three acute stroke units across India. Methods: A multicentre, preimplementation and postimplementation feasibility study was conducted. We codesigned a care bundle (with stakeholders) which included the Global Evaluation of Swallowing and hydration screening and related actions/management. Implementation used clinical champions, education and training, barrier and enabler identification and site support. Participants included consecutively admitted patients, aged ≥ 18 years, with a clinical diagnosis of acute stroke and a persistent neurological deficit on presentation, who were admitted to a study site within 2 weeks of stroke onset. Swallowing evaluations using different consistencies increased from 22 (23.9%) to 51 (56%). Calculated osmolarity (cOsm) increased from 0 to 66 (73%) participants. Median cOsm was 288 mmol/L (IQR: 280-295 mmol/L); 15 (23%) participants were dehydrated. Conclusion: Care bundle implementation was feasible and improved swallowing and hydration management in three sites in India.