Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Leung KWC(1), Chan KW(2), Wong R(2), Wan HY(1), Fung SS(1), Wong LY(1)
Affiliation :
(1) Department of Cardiothoracic Surgery, Queen Mary Hospital (2) Department of Speech Therapy, Queen Mary Hospital
Introduction :
Dysphagia is common after cardiac surgery, affecting approximately 20% of patients, and has detrimental effects, including delayed food intake, compromised nutrition, increased risk of aspiration pneumonia and prolonged hospital length of stay. Screening patients with high-risk of post-extubation dysphagia and establishing a structured multi-disciplinary workflow are crucial for ensuring positive outcomes. However, there is currently no standardized workflow or guideline in the literature for nursing care.
Objectives :
1. Develop a streamline and standardized workflow of Nurse Swallowing Screening. 2. Improve nurses’ ability to identify patients at risk of dysphagia and refer them to Speech Therapists for timely swallowing management. 3. Formulate a multi-disciplinary workflow for managing patients with dysphagia. 4. Reduce the incidence of aspiration-related complications and decrease the delay in resuming oral intake after cardiothoracic surgery.
Methodology :
A Nurse Swallowing Screening Protocol for QMH CTSD ICU was developed in collaboration with doctors and speech therapists. The screening protocol consists of two parts: the first part involves patient chart review and general observations, and the second part includes stepwise oral feeding trials of thickened and thin liquid. Before implementation of swallowing screening, ten ICU nurses received training sessions and underwent a competency assessment conducted by QMH speech therapists. The pilot Swallowing Screening Protocol was implemented from November to December 2023.
Result & Outcome :
Seventy-one patients underwent the screening during the pilot phase. Eleven patients failed Part 1 of the screening and ten of them were diagnosed with dysphagia by speech therapists. The positive predictive value of Part 1 screening was 91% compared to the bedside assessment conducted by speech therapists. Seven patients failed Part 2 swallowing trials and all of them were diagnosed with dysphagia with 100% positive predictive value. The prevalence of post-operative dysphagia among the study population was 25%. There was no case of pneumonia reported after resuming oral feeding. The Nurse Swallowing Screening Protocol provided a standard, safe, and user-friendly method for CTSD ICU nurses to perform post-extubation dysphagia screening. The protocol demonstrated the importance of multi-disciplinary approach to manage patients at risk of dysphagia. The screening will be implemented for every patient undergoing cardiac surgery in QMH.
