Implementation of stroke Dysphagia screening in the emergency department.
Implementation of stroke Dysphagia screening in the emergency department.
复制标题
在急诊科实施中风吞咽困难筛查。
DOI：
10.1155/2013/304190
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发表时间：
2013
影响因子：
1.9
通讯作者：
Petersen,NancyJ
中科院分区：
文献类型：
--
作者：
Daniels,StephanieK;Anderson,JaneA;Petersen,NancyJ
吞咽困难的早期检测在卒中中至关重要，因为它可以改善医疗保健结果。在急诊科（艾德）使用吞咽筛查工具（SST）似乎是最合乎逻辑的，因为它是患者接触的第一点。然而，艾德护士给药SST的可行性，特别是涉及试验用水吞咽给药的可行性尚不清楚。本试点研究的目的是（1）在艾德实施SST，并跟踪护士的依从性，（2）通过访谈确定SST管理的障碍和促进因素，（3）制定并实施流程改进计划以解决障碍。2009年10月至2010年6月，对278名有卒中症状的患者进行了筛查。接受筛查的患者比例从2009年10月的22.6%上升到2010年3月的80.8%，随后在6月下降到61.9%（Cochran-Armitage检验z =-5.1042，P <0.0001）。与实施前两个月相比，实施后接受筛查的几率高出4.0倍。结果表明，这是可行的艾德护士管理SST与水吞咽组件。研究结果应有助于提高疑似卒中患者的护理质量，并改善吞咽筛查的多学科合作。
Early detection of dysphagia is critical in stroke as it improves health care outcomes. Administering a swallowing screening tool (SST) in the emergency department (ED) appears most logical as it is the first point of patient contact. However, feasibility of an ED nurse‐administered SST, particularly one involving trial water swallow administration, is unknown. The aims of this pilot study were to (1) implement an SST with a water swallow component in the ED and track nurses’ adherence, (2) identify barriers and facilitators to administering the SST through interviews, and (3) develop and implement a process improvement plan to address barriers. Two hundred seventy‐eight individuals with stroke symptoms were screened from October 2009 to June 2010. The percentage of patients screened increased from 22.6 in October 2009 to a high of 80.8 in March 2010, followed by a decrease to 61.9% in June (Cochran‐Armitage testz= −5.1042,P< 0.0001). The odds of being screened were 4.0 times higher after implementation compared to two months before implementation. Results suggest that it is feasible for ED nurses to administer an SST with a water swallow component. Findings should facilitate improved quality of care for patients with suspected stroke and improve multidisciplinary collaboration in swallowing screening.