Document Detail


Practice on an acute stroke unit after implementation of a decision-making algorithm for dietary management of dysphagia.
MedLine Citation:
PMID:  15366545     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Dysphagia is a common disability seen in stroke survivors that has been associated with high morbidity and mortality. Research has indicated that implementing clinical guidelines and algorithms improves dysphagia management and patient outcomes. A decision-making algorithm designed to enhance the assessment and dietary treatment of swallowing difficulties in the acute stroke patient was implemented on a dedicated neuroscience unit in January 2002. Following implementation, the medical records of 30 acute stroke patients consecutively admitted to the unit between February and May 2002 were reviewed for stroke and dysphagia characteristics, dysphagia-related complications, discharge dispositions, interdisciplinary baseline assessments, and nursing evaluations throughout the hospitalization. Of those patients admitted with stroke, 56.7% were dysphagic. As compared with the nondysphagic patients, the dysphagic patients had three times' longer inpatient stay, an increased incidence of complications, higher morbidity, and increased need for inpatient rehabilitation services and institutionalized care following discharge. Twenty percent of patients did not receive aformal evaluation of swallowing function within the first 48 hours of admission. In 10% of the patients, diets were changed following the formal evaluation of swallowing to change an unsafe, prescribed diet. More than 70% of patients showed clinical improvement in swallowing function during their hospitalization. Nurses tended to document assessments of general neurological factors (e.g., level of consciousness) related to swallowing function more frequently than factors felt to be more specific to swallowing (e.g., choking) and nutrition (e.g., tolerates diet). The results support the important role of the neuroscience nurse in the early and ongoing assessment of swallowing function and in providing directions to further improve the quality of care delivered to stroke patients with various degrees of swallowing dysfunction.
Authors:
Sharron Runions; Nathalie Rodrigue; Carole White
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses     Volume:  36     ISSN:  0888-0395     ISO Abbreviation:  J Neurosci Nurs     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-09-15     Completed Date:  2004-10-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8603596     Medline TA:  J Neurosci Nurs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  200-7     Citation Subset:  IM; N    
Affiliation:
McGill University Health Centre-Montreal Neurological Institute and Hospital, Montreal, Quebec sharron.runions@muhc.mcgill.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Algorithms*
Deglutition Disorders / diet therapy*,  etiology,  nursing*
Female
Humans
Male
Middle Aged
Nursing Assessment / methods*
Prospective Studies
Statistics, Nonparametric
Stroke / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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