A screening tool developed by PhD student Dr Kathryn Head, a Clinical Lead Speech and Language Therapist, can immediately determine whether newly diagnosed stroke patients show signs of impaired swallowing and need referral for a full swallow assessment when admitted to hospital.
First study in UK to establish a reliable and valid dysphagia screening tool for use with acute stroke patients by nurses
Currently there is no consistent method for screening an acute stroke patient’s capacity to swallow and, without a robust screening method, patients might face delays in assessment on whether they can safely eat or drink.
Kathryn explained, “The world literature and an audit of screening practices in England and Wales highlighted a need for a universal way of screening for signs of swallowing impairment in patients admitted to hospital after having a stroke. Different hospitals across Wales were using different methods of screening and at the time of the audit, patients could wait several days for a swallow assessment. Due to the associated risks surrounding impaired swallowing, some patients were placed nil by mouth as a matter of course.”
The overall aim of the toolkit is to prevent acute stroke patients with normal swallows being placed nil by mouth and to prevent patients who have difficulty swallowing from being fed inappropriately.
The dangers of not identifying difficulty in swallowing in patients who have had a stroke can include the entry of materials into the lungs which can cause pneumonia and even death.
Kathryn’s toolkit includes a series of short tests such as checking that the patient is fully conscious to accept oral feeding and timing the patient drinking a quantified volume of water.
The swallow screening can be carried out by nurses on patients as soon as they arrive at the hospital to ensure minimum discomfort for the patient. This meets the Welsh Governments targets for screening all new stroke patients for signs of impaired swallowing within the first 24 hours of hospitalisation
Kathryn added, “It was reported in 2010 that around 20%* of all patients admitted to hospital are malnourished. Evidently, steps taken to address the prevention of malnutrition and complications of having a difficulty in swallowing, which include aspiration pneumonia, dehydration, morbidity, mortality and implied costs are critical.”
Kathryn’s toolkit is now entering the final stages of its assessment and could soon be in use in health care throughout the UK and further afield.
*Figure of 20% published by Lean and Wiseman in 2010 via Age concern UK