Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.
-
Upload
elfrieda-simon -
Category
Documents
-
view
216 -
download
0
Transcript of Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.
![Page 1: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/1.jpg)
Meeting PSC Stroke 7 Standard
Tool creation
Policy development
Process to improving care
![Page 2: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/2.jpg)
Purpose of performing swallow screen (SS) by nursing (Perry, 2001):
• Quickly identify overt dysphagia• Performed before ANYTHING PO• No withholding PO if pt passes screening• Failures ensure rapid SLP referral • Decrease unneeded Dysphagia Eval (DE) by SLP• Comprehensive nursing assessment
![Page 3: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/3.jpg)
Purpose of performing SS…(cont.)
• NOT DE (i.e., water only)• Screening for possibility of dysphagia • H2O less irritating if aspirated (DePippo, et al.,1992)• Less time consuming tool
– 5cc, 10cc, & 90cc of water
• Improves communication between nursing and SLP
![Page 4: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/4.jpg)
SS and Nursing Scope of Practice
• MI Public Health Code are generic guidelines– MI does not have Nurse Practice Act
• SS not specifically addressed• Must consider:
– Basic formal nursing training– Professional experience– Continuing Ed programs with formal instruction– Infringement on trained SLP dedication, time &
education
![Page 5: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/5.jpg)
Process for Designing Protocol
• Developed SS in 2004 before PSC certification• Collaboration between SLP and Stroke CNS• Combined several screening tools• Evidence based:
– BSS study (‘98), – BDST (’92)– Kidd Water Test (“93)– SSA (’01)– Massey Bedside (’02)
![Page 6: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/6.jpg)
Bedside Swallow Screen Performed by Nursing
• Individual & small group education • Education performed ED & adult units by SLP & CNS • Staff concerns:
– time issues– clinical expertise– SS confused with DE – confusion in documentation affects billing – RN/SLP scope of practice
![Page 7: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/7.jpg)
Bedside Swallow Screen Performed by Nursing
• HOB elevated 90 degrees to slow bolus entrance into pharynx and allows for maximum airway
protection (Cherney, 1994)• No straws by nursing during screen • Straws increase risk of aspiration due to difficulty
coordinating suck using oral pressure vs. inhalation (Logemann, 1998)
![Page 8: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/8.jpg)
Bedside Swallow Screen Performed by Nursing
• initially designed for stroke pts• where to document results?
– different nursing forms each unit– stickers vs standardized location on forms
• physician education– ordering appropriately– holding all PO (include meds) for failure
• continuing ed & education of new employees
![Page 9: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/9.jpg)
Process:
• Developed swallow screen • Developed teaching tools (hand outs)
– algorithm instruction card, sheets, short lecture• Addressed staff concerns during education• Maintain f/u with DM/ADM• Reward &/or recognition for performance
![Page 10: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/10.jpg)
Process:
• Stroke CNS presence in ED• Add order & nursing policy # to TIA/Stroke Orders• Continued chart review & data sharing in
meetings/postings• Update forms • SS added to standardized nursing notes & Stroke Care
Plan (highlighted)
![Page 11: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/11.jpg)
Process:
• Article in nursing newsletter• Added swallow screen pass/fail to neuro t sheet in ED• Educate admit/ED physicians • Reeducate during nursing competency programs• Continue feedback on performance to DM/ADMs• SLP & CNS developed research study to validate SS
![Page 12: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/12.jpg)
Expanded Policy
• PI Physician champion (Pneumonia Team) approved core team to review & redesign policy
• Expanded to all patients at risk• Redesigned algorithm• Mandatory ed for adult med/surg unit nursing staff• Transparent data
![Page 13: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/13.jpg)
Expanded Policy• Computerized teaching module objectives:
» Define & add complications of dysphagia» Specify high risk patient populations» Identify patients for whom SS is
contraindicated» Describe proper SS procedure» Determine what constitutes failure of SS» Describe documentation of findings
• Added scenarios & test questions
![Page 14: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/14.jpg)
Performance Improvement
• Continue to provide motivators:
– frequent education– recognition– transparent data – ongoing prospective chart review– multidisciplinary rounds
![Page 15: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/15.jpg)
Nursing Research Study:“Concordance Between Patient Bedside Swallow
Screen and Dysphagia Evaluation Results Obtained from Neurological Nurses and Speech Pathologists”
• Purpose:
1. compare staff nurse assessment with SLP &
2. look at influence of certain patient characteristics.• Validation of SHS SS• Endpoint:100 stroke patients consented• IRB approval
![Page 16: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/16.jpg)
Nursing Research Study
• Neuro nurses education 1 on 1 for reliability• Improved nursing and physician staff by in• Orders for SS from many physician services• Data collection by CNS and SLP• Patient collection from Neuro/Stroke ICU and Neuro
Stepdown• Study abstract submitted to AHA ISC 2010
![Page 17: Meeting PSC Stroke 7 Standard Tool creation Policy development Process to improving care.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d165503460f949eb7df/html5/thumbnails/17.jpg)