Review of Evidenced-Based Nursing Protocols for Dysphagia Assessment

S troke is the leading cause of serious adult long-term disability in the United States with the estimated cost of $33 billion dollars annually. 1,2 Dysphagia, or impaired swallowing, is a common complication of acute stroke with an incidence that ranges from 37% to 78%. 3 Dysphagia is associated with aspiration, pneumonia, and malnutrition and remains challenging to identify at the bedside.It has been estimated that approximately half of all aspiration caused by dysphagia goes unrecognized.3 With the aging of adults in the United States, there is a critical need to focus on the early detection of dysphagia symptoms in hospitalized patients who experienced a stroke, accompanied by the initiation of a validated dysphagia screening protocol (DSP).4 This article will provide an update of the most commonly used DSPs and will provide guidance in the selection of a DSP for use in nursing. Clinical Practice Recommendations for NursingNurses, on the forefront of stroke care delivery, maintain a key role in early identification of patients with dysphagia.Although the Joint Commission no longer requires dysphagia screening rates be reported for stroke center certification, the Joint Commission encourages consistent monitoring for dysphagia and use of evidence-based DSPs. 5 Recommendations from the American Heart Association declare that a swallow evaluation should be performed in the first 24 hours after stroke.6 Physician order sets should include a swallow assessment with nutrition and swallow evaluation before oral intake.Patients who cannot swallow should have a nasogastric tube placed or endoscopic gastrostomy tube depending on severity.Patients should be kept NPO (nil per os or nothing by mouth) with intravenous normal saline running at a rate of 75 to 100 mL/h until a formalized evaluation by speech-language pathologist (SLP; Class I; Level of Evidence B).When a formal evaluation cannot be completed by SLP before oral intake is required, other members of the multidisciplinary team may perform a swallow screen.Nurses, who are typically at the patient bedside for extended periods of time and often first to provide oral medications or nutrition, should be familiar with DSPs.6