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Hard to Swallow:
A Multidisciplinary Approach to Increase Dysphagia Compliance in Stroke Patients
In the fall of 2020, the project leaders initiated a multidisciplinary approach that would illuminate opportunities to increase dysphagia compliance in stroke patients while promoting a collaborative environment.
The project aims were to:
1) qualitatively examine the nature of dysphagia fallouts,
2) determine multidisciplinary workflows and barriers to success, and
3) develop strategies to enhance dysphagia compliance.
The Neuroscience Clinical Nurse Specialist (CNS) for L5/L6, accompanied by a CNS student, interviewed multiple stakeholders regarding dysphagia compliance including Providers (including Physicians and Advanced Practice Providers [APPs] comprised of Nurse Practitioners and Physician Assistants), Pharmacists, Speech & Language Pathologist (SLP), EHR Optimization Coordinator (EOC), and frontline Nurses for perspectives on workflows and barriers to success. Additionally, the CNS helped to improve several micro- and macrosystem processes including policy unification and electronic health record (EHR) enhancements. The Unit Educator (UE) for the Neurosurgery Acuity-Adaptable Unit (AAU) unified the efforts of all three Neuroscience UEs, who then formed a workgroup (including APPs, Pharmacists, SLP, CNS, Neurosurgery/Neurology Improvement Consultant, and EOC) to improve frontline Nursing performance. The SLP helped drive change on several process aspects, including EHR enhancements and SLP workflow improvements. The EOC led a multidisciplinary EHR workgroup and developed the new Swallow Safety Storyboard to increase multidisciplinary access to key patient information.
Over a two-year period, beginning with the initiation of project elements in November 2020 through November 2022, the dysphagia measure compliance average increased 12% from 75.8% (range 60-90%) to 85.16% (range 75-93%, p=0.011) and stabilized.
The collective process improvements, led by the CNS, UE, SLP, and EOC, served to enhance patient safety and helped secure re-designation as a Comprehensive Stroke Center. This improvement work has been impactful enough to garner five podium presentations and has allowed the project leaders to amplify SHCs exemplary patient care at both regional and national conferences.
The collective process improvements served to enhance patient safety and helped Stanford Health Care achieve re-designation as a Comprehensive Stroke Center.
Acknowledgments:
Monika B. Lu, MSN, RN, CNS, CNML, Neurologic ICU Patient Care Manager
Victor Tamayo, MSN, RN, CNRN, Neurology/Stroke/Epilepsy AAU Patient Care Manager
Jacob Drown, BSN, RN, CNML, Neurosurgery AAU Patient Care Manager
Michael Engen, BSN, RN, CCRN, CNRN, TCRN, L4 Unit Educator
Kara Sutton, BSN, RN, L4 Unit Educator
Leticia Cortez, MSN, RN, NPD-BC, PCCN, SCRN, Neurology/Stroke/Epilepsy AAU Unit Educator
Nicole Burnham, MSN, RN, CCRN, CNRN, SCRN, Stroke Program Manager
Luci Parker, MS, BSN, RN, Stroke Quality Specialist
Richard Reagin, MSN, RN, SCRN, Stroke program Coordinator
The multiple frontline Nurses, Speech & Language Pathologists, Pharmacists, and Providers that helped with interviews, input, improvements, and implementation
Submitted by: Stacy L. Serber, PhD, RN, CNS, SCRN
Clinical Nurse Specialist III, Neuroscience L5/L6