Nurse-led dysphagia screening in the intensive care unit - An implementation study.

Area of Science:

• Critical Care Nursing
• Swallowing Disorders
• Healthcare Implementation Science

Background:

• Postextubation dysphagia is common in intensive care units (ICUs).
• Bedside screening by nurses is crucial for early detection and preventing aspiration.
• Systematic dysphagia screening protocols are vital for patient safety.

Purpose of the Study:

• To evaluate the implementation of nurse-led, systematic dysphagia screening in the ICU.
• To identify barriers and facilitators influencing the adoption of dysphagia screening.
• To enhance patient safety and oral intake postextubation.

Main Methods:

• Pragmatic implementation study utilizing the Behaviour Change Wheel framework.
• Implementation strategies included education, e-learning, peer support, feedback, and environmental cues.
• Data collected via chart reviews, participant logs, implementation logs, and focus-group interviews.

Main Results:

• High nurse participation in education (94%), lower in e-learning (67%).
• Low adherence to screening protocols (19% of extubated patients).
• Nurses found the Yale Swallow Protocol valid; barriers included NPO status, lack of interprofessional support, and documentation issues. Social support from colleagues was a facilitator.

Conclusions:

• Nurse-led dysphagia screening in ICUs is achievable but hindered by external factors.
• Protocol modifications for easier documentation and avoiding instrument alteration are needed.
• Successful implementation empowers nurses, aids decision-making, and promotes safe oral intake, requiring contextualization without compromising the screening tool's integrity.