Literature that amongst patients suffering from dysphagia

Literature
Review

(Armstrong & Mosher, 2011) stated that amongst
patients suffering from dysphagia one third will aspirate and of those up to a
third go on to develop pneumonia.

(Bray et al., 2016), carried out a study to see if a delay in bedside dysphagia
screening and comprehensive dysphagia assessments by a SLT were associated with
the risk of stroke associated pneumonia. The aim of this investigation was the
length of time taken to be screened for dysphagia and to establish if there was
a correlation of patients which ended up with stoke related pneumonia. It was
found that delays in screening for and assessing dysphagia after stroke, were
associated with a higher risk of stroke associated pneumonia. Due to stoke
associated pneumonia being one of the main causes of death after acute stroke,
carrying out an early dysphagia assessment could reduce deaths. (Bray et al., 2016), used assessments that could be implemented even in settings
without access to high-technology specialist stroke care and by other members
of multidisciplinary team (MDT) if adequate training has been given.

 

Among patients that do aspirate one third
will develop pneumonia. It is concerning
that due to nursing staff being unaware of the risk of chest infections caused
by aspiration, patients can go on to develop aspiration pneumonia. Which can be
fatal and is preventable if all nursing staff are trained and following
protocol.

A  study to support the idea of training other
healthcare professionals was carried out by (Palli et al., 2017) in which they trained nursing
staff to perform formal dysphagia screening in every acute stroke patient by
using the Gugging Swallow Screen (GUSS) (Trapl et al., 2007). The dysphagia screen carried
out by the nursing staff was compared to the swallowing assessment carried out by
the SLT over a 5-month period. The researchers compared time taken to screen
for dysphagia; pneumonia rate and length of time in hospital. Two groups were
used, a control and intervention group which were comparable regarding sex, age
and severity of stroke. In the intervention group time to screen for dysphagia
was reduced compared to the control group. Patients in the intervention group
had a 3.8% pneumonia rate whereas the control group was 11.6% and the median
length of stay in hospital for the intervention group was decreased by 11.1%(Palli et al., 2017).

These two studies demonstrate that 24 hours a
day, seven days a week access to dysphagia trained nursing staff, would be
beneficial in terms of patient treatment and reduced hospital stay.

(Gandolfi et al., 2014), carried out a study investigating the impact of a
standardised multidisciplinary protocol approach to the management of
post-stroke dysphagia. They observed patients with post-stroke dysphagia and
compared the outcomes of the usual treatment given for dysphagia to those of
treatment using the standardised diagnostic and rehabilitation
multidisciplinary protocol. The MDT consisted of neurologists, nursing staff,
rehabilitation physicians, physiotherapist, nutritionist, SLT, radiologist and ear,
nose and throat (ENT) specialist. The
outcome measures were death; pneumonia evident on x-ray; a need for respiratory
support and the number of patients who were tube feeding on discharge. A
subgroup of the team reviewed the available literature on post-stroke dysphagia
management to include the most appropriate elements and procedures to include
in the protocol. The final protocol consisted of two consecutive phases. A diagnostic
phase (defining the swallowing problem), which involved a screening assessment
carried out by trained nursing staff in screening and neurologists. The
clinical assessment was carried out by rehabilitation physicians. Instrumental
examination using Fibre Optic Endoscopic Evaluation of Swallow (FEES) or Video
Fluoroscopy (VFSS). The dysphagia rehabilitation was carried out by the SLT.
The results of this study found that the treatment of post-stroke dysphagia
under a standardised protocol delivered by MDT can significantly reduce
aspiration pneumonia and deaths in hospitals and increase the rate of stroke
survivors who are free from Nasogastric Tube Feeding (NTF).

 

This
evidence again supports the idea of nursing staff being trained in dysphagia
assessment and how this benefits patients. However, this approach may be
difficult to administer on wards due to the commitments and availability of all
the healthcare professionals involved.

 

Lees, Sharpe, & Edwards, (2006), discussed the findings
of an audit to assess the improved outcomes of training nursing staff to carry
out dysphagia screening for patients who have had a stroke. The method used was
a standardised screening assessment based on the CODA guideline (CODA, 1998). This assessment requires
nursing staff to use clinical judgement to observe the patient for coughing, choking
and dribbling. The length of time taken from admission to the patient being
screened for dysphagia was recorded. The audit showed that by training nurses
to dysphagia screen an average screen waiting time of 35 hours was reduced to
less than 1 hour, thus reducing length of time stroke patients spent nil by
mouth.

This research supports the importance of nursing staff being
able to give dysphagia screens to patients who have been admitted to hospital
due to stroke. The time patients spent as nil by mouth was decreased.

 

(Magnus, 2001) found that training nursing staff in administering
swallow screening resulted in a decrease in inappropriate referrals to SLTs and
a reduction in requests to assess patients with decreased alertness. On wards
in which senior nursing staff have been dysphagia trained, there was increased
compliance with SLT recommendations (Magnus, 2001).

 

This
paper showed that dysphagia screen training of nurses, alleviated pressures on
the limited number of SLT’s available within hospitals.

 

Black, (2002) reported on a nurse from Gateshead who had
noticed a need for nursing staff to be more aware of the risks of dysphagia. He
expressed his concern regarding how few SLTs there were and how they did not
have the resources to provide immediate assessment for emergency admissions.
Based on this he developed a training programme to manage dysphagia, stating
that now patients wait no longer than a day for an initial swallowing screen. Before
he developed this programme, there were two SLTs who could assess swallowing,
following his training there are 148 nursing staff who are trained to carry out
the swallowing screen. Due to this, SLTs now have less pressure on carrying out
these assessments (Black, 2002).

This indicated that nursing
staff can successfully carry out the training of colleagues after they have
been trained by SLTs, as well as practising this on wards by carrying out
swallowing screens, without the support of SLT’s.