Rita Hunsucker, DNP, Nicole Cornell, MS, Gerald Hobbs, PhD, Jorge Con, MD & Alison Wilson, MD WVU Medicine, J.W. Ruby Memorial Hospital

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1 Rita Hunsucker, DNP, Nicole Cornell, MS, Gerald Hobbs, PhD, Jorge Con, MD & Alison Wilson, MD WVU Medicine, J.W. Ruby Memorial Hospital

2 The authors have nothing to disclose.

3 Post extubation dysphagia (PED) is difficulty swallowing which occurs following intubation.1 PED is a significant complication experienced by 3% to 62% of patients.1 Risk factors are inconsistent.1 37% of trauma patients are silent aspirators.2 The length of time from extubation to evaluation by speech therapy is 36 hours on average.3

5 Decreased patient satisfaction Delay in nutritional interventions Decreased caloric intake Increased length of stay Increased mortality Increased cost

6 We hypothesize that the Standardized Swallow Assessment, a bedside nursing screen, results in earlier nutritional intake and no changes in adverse outcomes in the post extubated adult trauma patient.

7 A quasi experimental post test only design Pre implementation group, speech therapy evaluated at trauma surgeon s discretion Post implementation group, every patient was screened by bedside RN using Standardized Swallow Assessment Inclusion criteria: intubated trauma patients over 18 years of age. Exclusion criteria mandible fractures head and neck cancer hx NPO for medical or surgical reasons.

8 Already in use within the institution for stroke Pre swallow Screening Checklist must be completed Water swallow test: With the patient alert and sitting upright, give first a teaspoonful of water. If there are no problems, repeat the process with a second and third teaspoonful. If there is still no problem evident, give half a glass of water. If there is no problem, the patient has passed the SSA.4

9 Time from extubation to diet order and adequate oral intake were studied using Wilcoxon/Kruskal Wallis Tests. Hospital and ICU length of stay (LOS) were analyzed with T test. Fisher s exact was utilized to evaluate unplanned and emergent reintubation, return to higher level of care, pneumonia, and mortality.

10 Differences in aspiration related complications of rates of pneumonia, unplanned intubation, emergent reintubation, unplanned return to ICU, and mortality were not statistically significant

11 Significant differences between groups ventilator days history of alcohol/drug use. SSA group earlier diet order (13 hours, p = 0.03) earlier adequate oral intake (16 hours, p = 0.006) shorter ICU LOS (2 days, p = 0.03) shorter hospital LOS (5 days, p= 0.02) Cost savings of $41,797 to the patient and $8,988 to the institution.

12 Table 1. Patient Characteristics Characteristic Control (n=64) Experimental (n=28) Difference P value Age (mean in years) Gender (M, F) 75%, 25% 82.14%, 17.86% Ventilator Days Face AIS Head/Neck AIS ISS GCS Hx Respiratory Disease % % Hx Alcohol/Drug 14.75% 35.71%

13 Table 2. Outcomes Outcome Control (n=64) Experimental Difference (n=28) P value Hours from Extubation to Diet Order Hours from extubation to adequate diet Mortality Rate 7.8% Pneumonia Rate 10.94% 10.71% Unplanned Intubation Rate 21.88% 7.14% Unplanned Return to ICU Rate Hospital Days 7.81% 3.57% ICU Days Emergent Re intubation Rate 15.63% Pre hospital Intubation 39.34% 7.14% % Multi Intubation Rate 10.71% %

14 Utilizing a post extubation dysphagia screen provides the opportunity for earlier oral intake. Implementation of the nursing dysphagia screening at our institution resulted in no increase in aspiration related events. Although our numbers are small, it appears that the nursing bedside dysphagia screen is a safe, cost effective alternative to the formal swallow evaluation performed by speech therapists.

15 1. Skoretz, S. A., Flowers, H. L., & Martino, R. (2010). The incidence of dysphagia following endotracheal intubation. Chest, 137(3), Retrieved from 2. Kwok, A. M., Davis, J. W., Cagle, K. M., Sue, L. P., & Kaups, K. L. (2013). Post extubation dysphagia in trauma patients: It s hard to swallow. The American Journal of Surgery, 206, de Medeiros, G. C., Sassi, F. C., Mangilli, L. D., Zilberstein, B., & de Andrade, C. R. (2014). Clinical dysphagia risk predictors after prolonged orotracheal intubation. Clinics, 69(1), DOI: /clinics/2014(01)02 4. Perry, L. (2001). Screening swallowing function of patients with acute stroke. Part one: Identification, implementation, and initial evaluation of a screening tool for use by nurses. Journal of Clinical Nursing, 10, Retrieved from

Use of water swallowing test as a screening tool in acute stroke unit

Use of water swallowing test as a screening tool in acute stroke unit Amy Wong 1, Fanny Ip 2 & Ripley Wong 1 Queen Mary Hospital Presentation quote 1: Speech Therapists, Speech Therapy Department 2: Ward