Implementing standardized, evidence-based nursing management to prevent aspiration risk in hospitalized older adults

Aspiration is a major safety concern among hospitalized older adults, yet clinical prevention practices remain inconsistent. Using the JBI Practical Application of Clinical Evidence System (JBI PACES) and guided by the Chinese Nursing Association group standard Prevention of Aspiration in Older Adults, this project aimed to implement a standardized evidence-based nursing program for aspiration risk prevention and to evaluate its impact on nurses' knowledge, adherence to audit criteria, and aspiration incidence.

This evidence-based audit-and-feedback project employed a pre-post design at a tertiary hospital in Shanxi Province, China, from July 2024 to December 2025. Reporting followed the SQUIRE 2.0 guidelines. A multidisciplinary team systematically retrieved and appraised evidence, yielding 22 audit criteria. Barriers and facilitators were analyzed using the Ottawa Model of Research Use. Guided by Proctor's Implementation Outcomes Taxonomy, effects were assessed at three levels: implementation outcomes (audit criteria adherence), service outcomes (nurses' knowledge, high-risk identification accuracy, feeding plan compliance), and clinical outcomes (aspiration incidence, patient satisfaction). Binary logistic regression adjusted for potential confounders.

Baseline characteristics were comparable between groups (P > 0.05). Aspiration incidence was lower in the post-implementation period (13.59%) compared with baseline (27.72%) (P = 0.015); after adjusting for age, sex, consciousness status, and nutritional route, aspiration risk remained significantly lower post-implementation (adjusted OR = 0.359, 95% CI: 0.157-0.820). Nurses' knowledge scores rose from 56.72 ± 8.29 to 85.03 ± 8.40 (P < 0.001), and high-risk identification accuracy increased from 34.65% to 81.55% (P < 0.001). Most audit criteria improved significantly: system-level criteria were fully adopted, positioning criteria reached 100%, and feeding behavior criteria showed the largest gains although absolute adherence remained lower. Feeding plan compliance improved from 41.58% to 77.67% (P < 0.001), and satisfaction scores from 80.35 ± 7.62 to 92.16 ± 4.85 (P < 0.001).

This JBI PACES-based multi-component intervention was associated with improved adherence to aspiration prevention measures and lower aspiration incidence among hospitalized older adults. Positive changes were observed across implementation, service, and clinical outcome levels within Proctor's taxonomy. Given the pre-post design, these improvements should be interpreted as observed changes rather than confirmed causal effects. Future studies employing stepped-wedge or multicenter controlled designs are needed to strengthen causal inference and assess long-term sustainability.

This evidencebased practice project was registered with the Fudan University Center for EvidenceBased Nursing, China (Registration No. ER20251074) on January 9, 2025.

Not applicable.