Implementing a systematic care pathway for management of dysphagia after cardiothoracic surgery.
This longitudinal quality improvement study explored the impact of a new multidisciplinary dysphagia care pathway on swallow screening referrals, patient journeys and swallow outcomes in patients after cardiac surgery. The new dysphagia care pathway consisted of i) nurse chart review triaging using...
| Publicado en: | Intensive & Critical Care Nursing Vol. 70 |
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| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Jun2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=156673720&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 156673720 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09643397 DOI jtl: Intensive & Critical Care Nursing issn: 09643397 maglogo: N pubinfo: dt: Jun2022 vid: 70 pid: 82545 pub: Elsevier B.V. place: Philadelphia, Pennsylvania artinfo: ui: 156673720 156673720 156673720 10.1016/j.iccn.2022.103224 156673720 ppct: 1 formats: tig: atl: Implementing a systematic care pathway for management of dysphagia after cardiothoracic surgery. aug: au: Miles, A. Lee, Y.Y. McLellan, N. Gillham, M. affil: Speech Science, The University of Auckland, Grafton Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand sug: subj: Quality Improvement Multidisciplinary Care Team Swallowing Therapy Critical Path Deglutition Health Screening Nursing Referral and Consultation Cardiac Surgery Thoracic Surgery Implementation Science Human Deglutition Disorders Prevention and Control Treatment Outcomes Prospective Studies Disease Management Record Review Triage Risk Assessment Deglutition Disorders Risk Factors Speech-Language Pathology Intensive Care Units Descriptive Statistics Diet Enteral Nutrition Patient Discharge Aspiration Surgical Patients ab: This longitudinal quality improvement study explored the impact of a new multidisciplinary dysphagia care pathway on swallow screening referrals, patient journeys and swallow outcomes in patients after cardiac surgery. The new dysphagia care pathway consisted of i) nurse chart review triaging using established risk factors, ii) nurse swallow screening (including a cough reflex test and water swallow test) and iii) rapid referral routes to speech pathology. All patients referred for swallow screening in 2020 after the commencement of the new dysphagia care pathway were included (n = 114). Data was compared to two historical, published data sets at the research site (n-41 in 2012–2013 and n = 121 in 2013–2016). Cardiovascular intensive care unit. 52% failed chart review and 29% failed cough reflex test. All patients who passed chart review and cough reflex test returned to a normal diet without need for speech pathology referral. Silent aspiration rates were high in those who failed chart review and the cough reflex test (42%, 43% respectively). For those who received a swallow screen, enteral feeding rates were 70% on first assessment and 27% by discharge from the unit in historical data (2013–2016). In comparison, in 2020, enteral feeding rates were 44% and 8% respectively. Referrals for nurse swallow screening and speech pathology increased following the introduction of the care pathway. There has been a reduction in enteral feeding rates and length of enteral feeding at discharge. High rates of silent aspiration in those who fail screening suggests stepwise nurse dysphagia screening successfully picks up at-risk patients. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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