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Published on: December 29, 2023
The Codesign, Development and Implementation of an Indian Poststroke Swallow and Hydration Care Bundle: A Feasibility
Elizabeth Boaden1, C Elizabeth Lightbody1, Stephanie P Jones1
1School of Nursing and Midwifery, University of Lancashire, Preston, UK, deakin.edu.au.
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.
Results:
Fifty-three healthcare staff completed the care bundle training. We recruited 183 participants, preimplementation group (n = 92). 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.
